An interagency workgroup sponsored by the Department of Health and Human Services and the Department of Homeland Security was established in 2006 to revisit initial recommendations made in November 2005 and set forth new national guidance on vaccine use in the case of a pandemic.
Problems and Purpose
Background History and Context
In 2006, an interagency workgroup sponsored by the Department of Health and Human Services and the Department of Homeland Security was established to revisit initial recommendations made in November 2005 and set forth new national guidance. The workgroup sponsored public consultations of both nonpartisan citizens-at-large and stakeholders from organizations with recognized interests as one stream of input to identify the highest priority goals for a vaccination program when supplies are expected to be limited. The basic framework of the consultation assumed that the anticipated pandemic would be severe, akin to the 1918 influenza pandemic.
Organizing, Supporting, and Funding Entities
Lead sponsor: Department of Health and Human Services.
Altogether, the project involved the collaboration of 17 organizations. They included:
- Association of State and Territorial Health Officials
- Border Health Education Training Center at NM State University
- Centers for Disease Control and Prevention
- City of Milwaukee Health Department
- Henderson County Department of Public Health
- Nassau County Department of Public Health Emergency Preparedness
- National Association of County and City Health Officials
- New York State Senator Michael Balboni
- New York State Department of Health
- New Mexico State Health Department
- North Carolina Department of Health and Human Services
- Southern Area Health Education Center Environmental Health Comm
- The Keystone Center
- University of Nebraska
- US Department of Homeland Security
- Wisconsin Department of Public Health
Facilitation: The Keystone Center.
Participant Recruitment and Selection
Methods and Tools Used
What Went On: Process, Interaction, and Participation
The project was conducted in two phases of day-long dialogue and deliberation sessions—one before the guidance was drafted and another as part of the vetting process to obtain suggestions for revisions. In the first phase, there were two citizens-at-large meetings in Nassau County, New York and Las Cruces, New Mexico and one stakeholder meeting in Washington, DC with 100+ participants at each meeting. Attendees were asked to rate ten proposed goals on a 7 point Likert scale. The second phase meetings to solicit public response to the guidance were held in Milwaukee, Wisconsin, Hendersonville, North Carolina, and Washington DC. Altogether almost 500 citizens and 80 stakeholders participated.
In addition to face-to-face meetings, the project sponsored a web-based dialogue to obtain public input on the draft guidance from a larger segment of the public than might be engaged through in-person meetings.
Type of contributions by participants:
Learning about influenza, exchanging different viewpoints with other participants, weighing different values or goals, and rating each of ten proposed goals for a vaccination program.
Influence, Outcomes, and Effects
Outcome of the project:
In the first phase, the goals to vaccinate persons who are (1) essential to implementing a pandemic response program, (2) provide essential services in communities, (3) are at increased risk of pandemic influenza because of their jobs, and (4) children received the highest mean scores of 6.5, 6.0, 5.8, and 5.5 respectively. Vaccination of persons that are at highest risk of severe pandemic illness or death was ranked seventh with a mean score of 4.7. In the second vetting phase of the meetings, 69-93% of the citizens and stakeholders agreed or strongly agreed with the goals selected in the first phase, and 57-83% agreed or strongly agreed with the overall prioritization guidance. Several substantive suggestions for revisions to the guidance, such as including all persons in the vaccination program regardless of citizenship status were made.
The results from this project were used by the inter-agency work group (1) to help create and finalize an overall strategy for simultaneous (as opposed to sequential) vaccination of the highest-rated groups within four pre-selected categories of important groups and (2) for making revisions to the draft guidance. The highest-rated priority group (critical occupations) identified in this project were similar to those identified in an earlier public engagement project, but different from that recommended in the initial HHS guidance (high-risk persons) based on input from experts.
Analysis and Lessons Learned
In demonstrably helping to shape national policy on vaccine prioritization, this project provided further proof of the effectiveness of public engagement as a means of making better public policy decisions. This effectiveness was highlighted by HHS Secretary Mike Leavitt in a July 2008 press release announcing publication of the “Guidance on Allocating and Targeting Pandemic Influenza Vaccine.” He stated, “This guidance is the result of a deliberative democratic process…All interested parties took part in the dialogue; we are confident that this document represents the best of shared responsibility and decision making.”
Evaluation of the Public Engagement Project on Pandemic Influenza Vaccine Prioritization
Case Abstracts of a Multi-Year, Multi-Project Public Engagement Initiative to Better Inform Governmental Public Health Policy Decisions