Does having a seasonal influenza program facilitate pandemic preparedness? An analysis of vaccine deployment during the 2009 pandemic
Identifieur interne : 000078 ( Pmc/Checkpoint ); précédent : 000077; suivant : 000079Does having a seasonal influenza program facilitate pandemic preparedness? An analysis of vaccine deployment during the 2009 pandemic
Auteurs : Rachael M. Porter [États-Unis] ; Shoshanna Goldin [Suisse] ; Kathryn E. Lafond [États-Unis] ; Lisa Hedman [Suisse] ; Mellissa Ungkuldee [États-Unis] ; Jordan Kurzum [États-Unis] ; Eduardo Azziz-Baumgartner [États-Unis] ; Claudia Nannei [Suisse] ; Joseph S. Bresee [États-Unis] ; Ann Moen [Suisse]Source :
- Vaccine [ 0264-410X ] ; 2019.
Abstract
National seasonal influenza programs have been recommended as a foundation for pandemic preparedness. During the 2009 pandemic, WHO aimed to increase Member States’ equitable access to influenza vaccines through pandemic vaccine donation.
This analysis explores whether the presence of a seasonal influenza program contributed to more rapid national submission of requirements to receive vaccine during the 2009 influenza pandemic. Data from 2009 influenza vaccine donation, deployment, and surveillance initiatives were collected during May-September 2018 from WHO archival material. Data about the presence of seasonal influenza vaccine programs prior to 2009 were gathered from the WHO-UNICEF Joint Reporting Form. Cox proportional hazards models were used to assess the relationship between presence of a seasonal influenza program and time to submission of a national deployment and vaccination plan and to vaccine delivery.
Of 97 countries eligible to receive WHO-donated vaccine, 83 (86%) submitted national deployment and vaccination plans and 77 (79%) received vaccine. Countries with a seasonal influenza vaccine program were more likely to submit a national deployment and vaccination plan (hazards ratio [HR] 2.1; 95% confidence interval [CI]. Countries with regulatory delays were less likely to receive vaccine than those without these delays (HR 0.4, 95% CI: 0.2–0.6).
During the 2009 pandemic, eligible countries with a seasonal influenza vaccine program were more ready to receive and use donated vaccines than those without a program. Our findings suggest that robust seasonal influenza vaccine programs increase national familiarity with the management of influenza vaccines and therefore enhance pandemic preparedness.
Url:
DOI: 10.1016/j.vaccine.2019.11.025
PubMed: 31839465
PubMed Central: 6992512
Affiliations:
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PMC:6992512Le document en format XML
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<author><name sortKey="Azziz Baumgartner, Eduardo" sort="Azziz Baumgartner, Eduardo" uniqKey="Azziz Baumgartner E" first="Eduardo" last="Azziz-Baumgartner">Eduardo Azziz-Baumgartner</name>
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<author><name sortKey="Moen, Ann" sort="Moen, Ann" uniqKey="Moen A" first="Ann" last="Moen">Ann Moen</name>
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<series><title level="j">Vaccine</title>
<idno type="ISSN">0264-410X</idno>
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<imprint><date when="2019">2019</date>
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<front><div type="abstract" xml:lang="en"><sec id="S1"><title>Background:</title>
<p id="P3">National seasonal influenza programs have been recommended as a foundation for pandemic preparedness. During the 2009 pandemic, WHO aimed to increase Member States’ equitable access to influenza vaccines through pandemic vaccine donation.</p>
</sec>
<sec id="S2"><title>Methods:</title>
<p id="P4">This analysis explores whether the presence of a seasonal influenza program contributed to more rapid national submission of requirements to receive vaccine during the 2009 influenza pandemic. Data from 2009 influenza vaccine donation, deployment, and surveillance initiatives were collected during May-September 2018 from WHO archival material. Data about the presence of seasonal influenza vaccine programs prior to 2009 were gathered from the WHO-UNICEF Joint Reporting Form. Cox proportional hazards models were used to assess the relationship between presence of a seasonal influenza program and time to submission of a national deployment and vaccination plan and to vaccine delivery.</p>
</sec>
<sec id="S3"><title>Finding:</title>
<p id="P5">Of 97 countries eligible to receive WHO-donated vaccine, 83 (86%) submitted national deployment and vaccination plans and 77 (79%) received vaccine. Countries with a seasonal influenza vaccine program were more likely to submit a national deployment and vaccination plan (hazards ratio [HR] 2.1; 95% confidence interval [CI]. Countries with regulatory delays were less likely to receive vaccine than those without these delays (HR 0.4, 95% CI: 0.2–0.6).</p>
</sec>
<sec id="S4"><title>Interpretation:</title>
<p id="P6">During the 2009 pandemic, eligible countries with a seasonal influenza vaccine program were more ready to receive and use donated vaccines than those without a program. Our findings suggest that robust seasonal influenza vaccine programs increase national familiarity with the management of influenza vaccines and therefore enhance pandemic preparedness.</p>
</sec>
</div>
</front>
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<journal-id journal-id-type="pubmed-jr-id">7945</journal-id>
<journal-id journal-id-type="nlm-ta">Vaccine</journal-id>
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<article-categories><subj-group subj-group-type="heading"><subject>Article</subject>
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<title-group><article-title>Does having a seasonal influenza program facilitate pandemic preparedness? An analysis of vaccine deployment during the 2009 pandemic</article-title>
</title-group>
<contrib-group><contrib contrib-type="author"><name><surname>Porter</surname>
<given-names>Rachael M.</given-names>
</name>
<xref ref-type="aff" rid="A1">a</xref>
<xref rid="CR1" ref-type="corresp">*</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Goldin</surname>
<given-names>Shoshanna</given-names>
</name>
<xref ref-type="aff" rid="A2">b</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Lafond</surname>
<given-names>Kathryn E.</given-names>
</name>
<xref ref-type="aff" rid="A1">a</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Hedman</surname>
<given-names>Lisa</given-names>
</name>
<xref ref-type="aff" rid="A2">b</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Ungkuldee</surname>
<given-names>Mellissa</given-names>
</name>
<xref ref-type="aff" rid="A3">c</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Kurzum</surname>
<given-names>Jordan</given-names>
</name>
<xref ref-type="aff" rid="A4">d</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Azziz-Baumgartner</surname>
<given-names>Eduardo</given-names>
</name>
<xref ref-type="aff" rid="A1">a</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Nannei</surname>
<given-names>Claudia</given-names>
</name>
<xref ref-type="aff" rid="A2">b</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Bresee</surname>
<given-names>Joseph S.</given-names>
</name>
<xref ref-type="aff" rid="A1">a</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Moen</surname>
<given-names>Ann</given-names>
</name>
<xref ref-type="aff" rid="A2">b</xref>
</contrib>
</contrib-group>
<aff id="A1"><label>a</label>
Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA</aff>
<aff id="A2"><label>b</label>
World Health Organization, Geneva, Switzerland</aff>
<aff id="A3"><label>c</label>
Yale School of Public Health, New Haven, CT, USA</aff>
<aff id="A4"><label>d</label>
Sidney Kimmel Medical College, Philadelphia, PA, USA</aff>
<author-notes><fn fn-type="con" id="FN1"><p id="P1">Credit authorship contribution statement</p>
<p id="P2"><bold>Rachael M. Porter:</bold>
Conceptualization, Data curation, Formal analysis, Methodology, Writing-original draft, Writing-review & editing. <bold>Shoshanna Goldin:</bold>
Conceptualization, Data curation, Formal analysis, Writing-original draft, Writing-review & editing. <bold>Kathryn E. Lafond:</bold>
Conceptualization, Formal analysis, Methodology, Writing-original draft, Writing-review & editing. <bold>Lisa Hedman:</bold>
Data curation, Writing-review & editing. <bold>Mellissa Ungkuldee:</bold>
Data curation, Writing-review & editing. <bold>Jordan Kurzum:</bold>
Data curation, Writing-review & editing. <bold>Eduardo Azziz-Baumgartner:</bold>
Conceptualization, Methodology, Writing-review & editing. <bold>Claudia Nannei:</bold>
Conceptualization, Writing-review & editing. <bold>Joseph S. Bresee:</bold>
Conceptualization, Methodology, Writing-original draft, Writing-review & editing. <bold>Ann Moen:</bold>
Conceptualization, Methodology, Writing-original draft, Writing-review & editing.</p>
</fn>
<corresp id="CR1"><label>*</label>
Corresponding author at: Influenza Division, National Center for Immunization and Respiratory Disease, Centers for Disease Control and Prevention, 1600 Clifton Road, NE, Atlanta, GA 30333, USA. <email>ocd8@cdc.gov</email>
(R.M. Porter).</corresp>
</author-notes>
<pub-date pub-type="nihms-submitted"><day>19</day>
<month>12</month>
<year>2019</year>
</pub-date>
<pub-date pub-type="epub"><day>12</day>
<month>12</month>
<year>2019</year>
</pub-date>
<pub-date pub-type="ppub"><day>29</day>
<month>1</month>
<year>2020</year>
</pub-date>
<pub-date pub-type="pmc-release"><day>31</day>
<month>1</month>
<year>2020</year>
</pub-date>
<volume>38</volume>
<issue>5</issue>
<fpage>1152</fpage>
<lpage>1159</lpage>
<pmc-comment>elocation-id from pubmed: 10.1016/j.vaccine.2019.11.025</pmc-comment>
<permissions><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc-nd/4.0/"><license-p>This is an open access article under the CC BY-NC-ND license (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by-nc-nd/4.0/">http://creativecommons.org/licenses/by-nc-nd/4.0/</ext-link>
).
</license-p>
</license>
</permissions>
<abstract id="ABS1"><sec id="S1"><title>Background:</title>
<p id="P3">National seasonal influenza programs have been recommended as a foundation for pandemic preparedness. During the 2009 pandemic, WHO aimed to increase Member States’ equitable access to influenza vaccines through pandemic vaccine donation.</p>
</sec>
<sec id="S2"><title>Methods:</title>
<p id="P4">This analysis explores whether the presence of a seasonal influenza program contributed to more rapid national submission of requirements to receive vaccine during the 2009 influenza pandemic. Data from 2009 influenza vaccine donation, deployment, and surveillance initiatives were collected during May-September 2018 from WHO archival material. Data about the presence of seasonal influenza vaccine programs prior to 2009 were gathered from the WHO-UNICEF Joint Reporting Form. Cox proportional hazards models were used to assess the relationship between presence of a seasonal influenza program and time to submission of a national deployment and vaccination plan and to vaccine delivery.</p>
</sec>
<sec id="S3"><title>Finding:</title>
<p id="P5">Of 97 countries eligible to receive WHO-donated vaccine, 83 (86%) submitted national deployment and vaccination plans and 77 (79%) received vaccine. Countries with a seasonal influenza vaccine program were more likely to submit a national deployment and vaccination plan (hazards ratio [HR] 2.1; 95% confidence interval [CI]. Countries with regulatory delays were less likely to receive vaccine than those without these delays (HR 0.4, 95% CI: 0.2–0.6).</p>
</sec>
<sec id="S4"><title>Interpretation:</title>
<p id="P6">During the 2009 pandemic, eligible countries with a seasonal influenza vaccine program were more ready to receive and use donated vaccines than those without a program. Our findings suggest that robust seasonal influenza vaccine programs increase national familiarity with the management of influenza vaccines and therefore enhance pandemic preparedness.</p>
</sec>
</abstract>
<kwd-group><kwd>Influenza</kwd>
<kwd>Pandemic</kwd>
<kwd>Vaccination</kwd>
<kwd>Preparedness</kwd>
<kwd>Program</kwd>
<kwd>Deployment plan</kwd>
</kwd-group>
</article-meta>
</front>
<floats-group><fig id="F1" orientation="portrait" position="float"><label>Fig. 1.</label>
<caption><p id="P35">Timeline of 2009 A(H1N1) influenza pandemic, including virus identification, and WHO response, April 2009-November 2010.</p>
</caption>
<graphic xlink:href="nihms-1063731-f0001"></graphic>
</fig>
<fig id="F2" orientation="portrait" position="float"><label>Fig. 2.</label>
<caption><p id="P36">Flow chart of member states eligible for WHO deployed influenza vaccine during the 2009.</p>
</caption>
<graphic xlink:href="nihms-1063731-f0002"></graphic>
</fig>
<fig id="F3" orientation="portrait" position="float"><label>Fig. 3.</label>
<caption><p id="P37">Likelihood of completing a national deployment and vaccination plan and likelihood of receiving pandemic influenza vaccine donation through WHO deployment initiative by key predictors, adjusted for World Bank income status and WHO prioritization. *All adjusted models were adjusted for the initial WHO prioritization matrix and World Bank Income classification (low, lower-middle, and upper-middle/high).</p>
</caption>
<graphic xlink:href="nihms-1063731-f0003"></graphic>
</fig>
<fig id="F4" orientation="portrait" position="float"><label>Fig. 4.</label>
<caption><p id="P38">Percent of specimens that tested influenza positive globally and percent of A(H1N1)pdm09 vaccine doses distributed by seasonal program and month, April 2009-November 2010.</p>
</caption>
<graphic xlink:href="nihms-1063731-f0004"></graphic>
</fig>
<table-wrap id="T1" position="float" orientation="landscape"><label>Table 1</label>
<caption><p id="P39">Characteristics of countries eligible for WHO influenza pandemic vaccine donation during the 2009 A(H1N1) influenza pandemic, January - November 2010. (n = 97).</p>
</caption>
<table frame="hsides" rules="none"><colgroup span="1"><col align="left" valign="middle" span="1"></col>
<col align="left" valign="middle" span="1"></col>
<col align="left" valign="middle" span="1"></col>
<col align="left" valign="middle" span="1"></col>
<col align="left" valign="middle" span="1"></col>
</colgroup>
<thead><tr><th align="left" valign="top" rowspan="1" colspan="1"></th>
<th align="left" valign="middle" rowspan="1" colspan="1">Eligible to Receive Donation</th>
<th align="left" valign="middle" rowspan="1" colspan="1">Received Donation</th>
<th align="left" valign="top" rowspan="1" colspan="1"></th>
<th align="left" valign="top" rowspan="1" colspan="1"></th>
</tr>
<tr><th align="left" valign="top" rowspan="1" colspan="1"></th>
<th colspan="4" align="left" valign="top" rowspan="1"><hr></hr>
</th>
</tr>
<tr><th align="left" valign="top" rowspan="1" colspan="1"></th>
<th align="left" valign="top" rowspan="1" colspan="1">N</th>
<th align="left" valign="top" rowspan="1" colspan="1">N</th>
<th align="left" valign="top" rowspan="1" colspan="1">Row %</th>
<th align="left" valign="top" rowspan="1" colspan="1">p-value<sup><xref rid="TFN1" ref-type="table-fn">1</xref>
</sup>
</th>
</tr>
<tr><th align="left" valign="bottom" rowspan="1" colspan="1">Entire Sample</th>
<th align="left" valign="bottom" rowspan="1" colspan="1">97</th>
<th align="left" valign="bottom" rowspan="1" colspan="1">77</th>
<th align="left" valign="bottom" rowspan="1" colspan="1">79</th>
<th align="left" valign="top" rowspan="1" colspan="1"></th>
</tr>
<tr><th colspan="5" align="left" valign="top" rowspan="1"><hr></hr>
</th>
</tr>
</thead>
<tbody><tr><td align="left" valign="top" rowspan="1" colspan="1"><italic>WHO Region</italic>
</td>
<td align="left" valign="top" rowspan="1" colspan="1"></td>
<td align="left" valign="top" rowspan="1" colspan="1"></td>
<td align="left" valign="top" rowspan="1" colspan="1"></td>
<td align="left" valign="top" rowspan="1" colspan="1">0.34</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> Africa</td>
<td align="left" valign="top" rowspan="1" colspan="1">45</td>
<td align="left" valign="top" rowspan="1" colspan="1">34</td>
<td align="left" valign="top" rowspan="1" colspan="1">76</td>
<td align="left" valign="top" rowspan="1" colspan="1"></td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> Americas</td>
<td align="left" valign="top" rowspan="1" colspan="1">11</td>
<td align="left" valign="top" rowspan="1" colspan="1">10</td>
<td align="left" valign="top" rowspan="1" colspan="1">91</td>
<td align="left" valign="top" rowspan="1" colspan="1"></td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> Eastern Mediterranean</td>
<td align="left" valign="top" rowspan="1" colspan="1">6</td>
<td align="left" valign="top" rowspan="1" colspan="1">4</td>
<td align="left" valign="top" rowspan="1" colspan="1">67</td>
<td align="left" valign="top" rowspan="1" colspan="1"></td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> Europe</td>
<td align="left" valign="top" rowspan="1" colspan="1">9</td>
<td align="left" valign="top" rowspan="1" colspan="1">6</td>
<td align="left" valign="top" rowspan="1" colspan="1">67</td>
<td align="left" valign="top" rowspan="1" colspan="1"></td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> South-East Asian</td>
<td align="left" valign="top" rowspan="1" colspan="1">9</td>
<td align="left" valign="top" rowspan="1" colspan="1">7</td>
<td align="left" valign="top" rowspan="1" colspan="1">78</td>
<td align="left" valign="top" rowspan="1" colspan="1"></td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> Western Pacific</td>
<td align="left" valign="top" rowspan="1" colspan="1">17</td>
<td align="left" valign="top" rowspan="1" colspan="1">16</td>
<td align="left" valign="top" rowspan="1" colspan="1">94</td>
<td align="left" valign="top" rowspan="1" colspan="1"></td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"><italic>Income Classification (World Bank)</italic>
</td>
<td align="left" valign="top" rowspan="1" colspan="1"></td>
<td align="left" valign="top" rowspan="1" colspan="1"></td>
<td align="left" valign="top" rowspan="1" colspan="1"></td>
<td align="left" valign="top" rowspan="1" colspan="1">0.18</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> Low</td>
<td align="left" valign="top" rowspan="1" colspan="1">40</td>
<td align="left" valign="top" rowspan="1" colspan="1">28</td>
<td align="left" valign="top" rowspan="1" colspan="1">70</td>
<td align="left" valign="top" rowspan="1" colspan="1"></td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> Lower Middle</td>
<td align="left" valign="top" rowspan="1" colspan="1">41</td>
<td align="left" valign="top" rowspan="1" colspan="1">34</td>
<td align="left" valign="top" rowspan="1" colspan="1">83</td>
<td align="left" valign="top" rowspan="1" colspan="1"></td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> Upper Middle/High</td>
<td align="left" valign="top" rowspan="1" colspan="1">12</td>
<td align="left" valign="top" rowspan="1" colspan="1">11</td>
<td align="left" valign="top" rowspan="1" colspan="1">92</td>
<td align="left" valign="top" rowspan="1" colspan="1"></td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> Missing</td>
<td align="left" valign="top" rowspan="1" colspan="1">4</td>
<td align="left" valign="top" rowspan="1" colspan="1">4</td>
<td align="left" valign="top" rowspan="1" colspan="1">100</td>
<td align="left" valign="top" rowspan="1" colspan="1"></td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"><italic>Program Description (prior to 2009)</italic>
</td>
<td align="left" valign="top" rowspan="1" colspan="1"></td>
<td align="left" valign="top" rowspan="1" colspan="1"></td>
<td align="left" valign="top" rowspan="1" colspan="1"></td>
<td align="left" valign="top" rowspan="1" colspan="1">0.39</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> Presence of a program</td>
<td align="left" valign="top" rowspan="1" colspan="1">23</td>
<td align="left" valign="top" rowspan="1" colspan="1">20</td>
<td align="left" valign="top" rowspan="1" colspan="1">87</td>
<td align="left" valign="top" rowspan="1" colspan="1"></td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> No program</td>
<td align="left" valign="top" rowspan="1" colspan="1">74</td>
<td align="left" valign="top" rowspan="1" colspan="1">57</td>
<td align="left" valign="top" rowspan="1" colspan="1">77</td>
<td align="left" valign="top" rowspan="1" colspan="1"></td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> Presence of a NITAG</td>
<td align="left" valign="top" rowspan="1" colspan="1">13</td>
<td align="left" valign="top" rowspan="1" colspan="1">10</td>
<td align="left" valign="top" rowspan="1" colspan="1">77</td>
<td align="left" valign="top" rowspan="1" colspan="1">0.73</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> No NITAG</td>
<td align="left" valign="top" rowspan="1" colspan="1">84</td>
<td align="left" valign="top" rowspan="1" colspan="1">67</td>
<td align="left" valign="top" rowspan="1" colspan="1">80</td>
<td align="left" valign="top" rowspan="1" colspan="1"></td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> National Influenza Center (NIC)</td>
<td align="left" valign="top" rowspan="1" colspan="1">30</td>
<td align="left" valign="top" rowspan="1" colspan="1">25</td>
<td align="left" valign="top" rowspan="1" colspan="1">83</td>
<td align="left" valign="top" rowspan="1" colspan="1">0.52</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> No NIC</td>
<td align="left" valign="top" rowspan="1" colspan="1">67</td>
<td align="left" valign="top" rowspan="1" colspan="1">52</td>
<td align="left" valign="top" rowspan="1" colspan="1">78</td>
<td align="left" valign="top" rowspan="1" colspan="1"></td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> Experienced Regulatory Delay</td>
<td align="left" valign="top" rowspan="1" colspan="1">47</td>
<td align="left" valign="top" rowspan="1" colspan="1">44</td>
<td align="left" valign="top" rowspan="1" colspan="1">94</td>
<td align="left" valign="top" rowspan="1" colspan="1">0.003</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> No regulatory delay</td>
<td align="left" valign="top" rowspan="1" colspan="1">37</td>
<td align="left" valign="top" rowspan="1" colspan="1">25</td>
<td align="left" valign="top" rowspan="1" colspan="1">68</td>
<td align="left" valign="top" rowspan="1" colspan="1"></td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> Missing</td>
<td align="left" valign="top" rowspan="1" colspan="1">13</td>
<td align="left" valign="top" rowspan="1" colspan="1">8</td>
<td align="left" valign="top" rowspan="1" colspan="1">62</td>
<td align="left" valign="top" rowspan="1" colspan="1"></td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> AEFI Monitoring System</td>
<td align="left" valign="top" rowspan="1" colspan="1">56</td>
<td align="left" valign="top" rowspan="1" colspan="1">51</td>
<td align="left" valign="top" rowspan="1" colspan="1">91</td>
<td align="left" valign="top" rowspan="1" colspan="1">0.030</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> No AEFI monitoring system</td>
<td align="left" valign="top" rowspan="1" colspan="1">28</td>
<td align="left" valign="top" rowspan="1" colspan="1">20</td>
<td align="left" valign="top" rowspan="1" colspan="1">71</td>
<td align="left" valign="top" rowspan="1" colspan="1"></td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> Missing</td>
<td align="left" valign="top" rowspan="1" colspan="1">13</td>
<td align="left" valign="top" rowspan="1" colspan="1">6</td>
<td align="left" valign="top" rowspan="1" colspan="1">46</td>
<td align="left" valign="top" rowspan="1" colspan="1"></td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> Consistent Reporting to FluNet</td>
<td align="left" valign="top" rowspan="1" colspan="1">20</td>
<td align="left" valign="top" rowspan="1" colspan="1">16</td>
<td align="left" valign="top" rowspan="1" colspan="1">80</td>
<td align="left" valign="top" rowspan="1" colspan="1">0.92</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> No reporting to FluNet</td>
<td align="left" valign="top" rowspan="1" colspan="1">76</td>
<td align="left" valign="top" rowspan="1" colspan="1">60</td>
<td align="left" valign="top" rowspan="1" colspan="1">79</td>
<td align="left" valign="top" rowspan="1" colspan="1"></td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> Missing</td>
<td align="left" valign="top" rowspan="1" colspan="1">1</td>
<td align="left" valign="top" rowspan="1" colspan="1">1</td>
<td align="left" valign="top" rowspan="1" colspan="1">100</td>
<td align="left" valign="top" rowspan="1" colspan="1"></td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> Private Sector Vaccine</td>
<td align="left" valign="top" rowspan="1" colspan="1">19</td>
<td align="left" valign="top" rowspan="1" colspan="1">14</td>
<td align="left" valign="top" rowspan="1" colspan="1">74</td>
<td align="left" valign="top" rowspan="1" colspan="1">0.15</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> No private sector vaccine</td>
<td align="left" valign="top" rowspan="1" colspan="1">29</td>
<td align="left" valign="top" rowspan="1" colspan="1">26</td>
<td align="left" valign="top" rowspan="1" colspan="1">90</td>
<td align="left" valign="top" rowspan="1" colspan="1"></td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> Missing</td>
<td align="left" valign="top" rowspan="1" colspan="1">49</td>
<td align="left" valign="top" rowspan="1" colspan="1">37</td>
<td align="left" valign="top" rowspan="1" colspan="1">76</td>
<td align="left" valign="top" rowspan="1" colspan="1"></td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> Public Sector Vaccine</td>
<td align="left" valign="top" rowspan="1" colspan="1">17</td>
<td align="left" valign="top" rowspan="1" colspan="1">14</td>
<td align="left" valign="top" rowspan="1" colspan="1">82</td>
<td align="left" valign="top" rowspan="1" colspan="1">0.89</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> No public sector vaccine</td>
<td align="left" valign="top" rowspan="1" colspan="1">31</td>
<td align="left" valign="top" rowspan="1" colspan="1">26</td>
<td align="left" valign="top" rowspan="1" colspan="1">84</td>
<td align="left" valign="top" rowspan="1" colspan="1"></td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> Missing</td>
<td align="left" valign="top" rowspan="1" colspan="1">49</td>
<td align="left" valign="top" rowspan="1" colspan="1">37</td>
<td align="left" valign="top" rowspan="1" colspan="1">76</td>
<td align="left" valign="top" rowspan="1" colspan="1"></td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> National Regulatory Agency</td>
<td align="left" valign="top" rowspan="1" colspan="1">9</td>
<td align="left" valign="top" rowspan="1" colspan="1">6</td>
<td align="left" valign="top" rowspan="1" colspan="1">67</td>
<td align="left" valign="top" rowspan="1" colspan="1">0.73</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> No NRA</td>
<td align="left" valign="top" rowspan="1" colspan="1">30</td>
<td align="left" valign="top" rowspan="1" colspan="1">21</td>
<td align="left" valign="top" rowspan="1" colspan="1">70</td>
<td align="left" valign="top" rowspan="1" colspan="1"></td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> Missing</td>
<td align="left" valign="top" rowspan="1" colspan="1">58</td>
<td align="left" valign="top" rowspan="1" colspan="1">50</td>
<td align="left" valign="top" rowspan="1" colspan="1">86</td>
<td align="left" valign="top" rowspan="1" colspan="1"></td>
</tr>
</tbody>
</table>
<table-wrap-foot><fn id="TFN1"><label>1</label>
<p id="P40">Chi-square tests and Fisher’s Exact Test used.</p>
</fn>
</table-wrap-foot>
</table-wrap>
<table-wrap id="T2" position="float" orientation="landscape"><label>Table 2</label>
<caption><p id="P41">Demographics of countries eligible for pandemic influenza vaccine donation during the 2009 A(H1N1) influenza pandemic, by presence of a seasonal influenza program. (n = 97).</p>
</caption>
<table frame="hsides" rules="none"><colgroup span="1"><col align="left" valign="middle" span="1"></col>
<col align="left" valign="middle" span="1"></col>
<col align="left" valign="middle" span="1"></col>
<col align="left" valign="middle" span="1"></col>
<col align="left" valign="middle" span="1"></col>
</colgroup>
<thead><tr><th align="left" valign="top" rowspan="1" colspan="1"></th>
<th align="left" valign="middle" rowspan="1" colspan="1">Seasonal Influenza Program<sup><xref rid="TFN2" ref-type="table-fn">1</xref>
</sup>
</th>
<th colspan="2" align="left" valign="middle" rowspan="1">Countries Eligible for Vaccine Donation</th>
<th align="left" valign="top" rowspan="1" colspan="1"></th>
</tr>
<tr><th align="left" valign="top" rowspan="1" colspan="1"></th>
<th colspan="4" align="left" valign="top" rowspan="1"><hr></hr>
</th>
</tr>
<tr><th align="left" valign="top" rowspan="1" colspan="1"></th>
<th align="left" valign="top" rowspan="1" colspan="1">N</th>
<th align="left" valign="top" rowspan="1" colspan="1">N</th>
<th align="left" valign="top" rowspan="1" colspan="1">Row %</th>
<th align="left" valign="top" rowspan="1" colspan="1">p-value<sup><xref rid="TFN3" ref-type="table-fn">2</xref>
</sup>
</th>
</tr>
<tr><th align="left" valign="top" rowspan="1" colspan="1">Entire Sample</th>
<th align="left" valign="top" rowspan="1" colspan="1">23</th>
<th align="left" valign="top" rowspan="1" colspan="1">97</th>
<th align="left" valign="top" rowspan="1" colspan="1"></th>
<th align="left" valign="top" rowspan="1" colspan="1"></th>
</tr>
<tr><th colspan="5" align="left" valign="top" rowspan="1"><hr></hr>
</th>
</tr>
</thead>
<tbody><tr><td align="left" valign="top" rowspan="1" colspan="1"><italic>WHO Region</italic>
</td>
<td align="left" valign="top" rowspan="1" colspan="1"></td>
<td align="left" valign="top" rowspan="1" colspan="1"></td>
<td align="left" valign="top" rowspan="1" colspan="1"></td>
<td align="left" valign="top" rowspan="1" colspan="1"><0.0001</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> Africa</td>
<td align="left" valign="top" rowspan="1" colspan="1">3</td>
<td align="left" valign="top" rowspan="1" colspan="1">45</td>
<td align="left" valign="top" rowspan="1" colspan="1">7</td>
<td align="left" valign="top" rowspan="1" colspan="1"></td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> Americas</td>
<td align="left" valign="top" rowspan="1" colspan="1">9</td>
<td align="left" valign="top" rowspan="1" colspan="1">11</td>
<td align="left" valign="top" rowspan="1" colspan="1">82</td>
<td align="left" valign="top" rowspan="1" colspan="1"></td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> Eastern Mediterranean</td>
<td align="left" valign="top" rowspan="1" colspan="1">0</td>
<td align="left" valign="top" rowspan="1" colspan="1">6</td>
<td align="left" valign="top" rowspan="1" colspan="1">0</td>
<td align="left" valign="top" rowspan="1" colspan="1"></td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> Europe</td>
<td align="left" valign="top" rowspan="1" colspan="1">5</td>
<td align="left" valign="top" rowspan="1" colspan="1">9</td>
<td align="left" valign="top" rowspan="1" colspan="1">56</td>
<td align="left" valign="top" rowspan="1" colspan="1"></td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> South-East Asian</td>
<td align="left" valign="top" rowspan="1" colspan="1">1</td>
<td align="left" valign="top" rowspan="1" colspan="1">9</td>
<td align="left" valign="top" rowspan="1" colspan="1">11</td>
<td align="left" valign="top" rowspan="1" colspan="1"></td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> Western Pacific</td>
<td align="left" valign="top" rowspan="1" colspan="1">5</td>
<td align="left" valign="top" rowspan="1" colspan="1">17</td>
<td align="left" valign="top" rowspan="1" colspan="1">29</td>
<td align="left" valign="top" rowspan="1" colspan="1"></td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"><italic>Income Classification (World Bank)</italic>
</td>
<td align="left" valign="top" rowspan="1" colspan="1"></td>
<td align="left" valign="top" rowspan="1" colspan="1"></td>
<td align="left" valign="top" rowspan="1" colspan="1"></td>
<td align="left" valign="top" rowspan="1" colspan="1"><0.0001</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> Low</td>
<td align="left" valign="top" rowspan="1" colspan="1">2</td>
<td align="left" valign="top" rowspan="1" colspan="1">40</td>
<td align="left" valign="top" rowspan="1" colspan="1">3</td>
<td align="left" valign="top" rowspan="1" colspan="1"></td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> Lower Middle</td>
<td align="left" valign="top" rowspan="1" colspan="1">14</td>
<td align="left" valign="top" rowspan="1" colspan="1">41</td>
<td align="left" valign="top" rowspan="1" colspan="1">34</td>
<td align="left" valign="top" rowspan="1" colspan="1"></td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> Upper Middle/High</td>
<td align="left" valign="top" rowspan="1" colspan="1">6</td>
<td align="left" valign="top" rowspan="1" colspan="1">12</td>
<td align="left" valign="top" rowspan="1" colspan="1">50</td>
<td align="left" valign="top" rowspan="1" colspan="1"></td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> Missing (n = 4)</td>
<td align="left" valign="top" rowspan="1" colspan="1">2</td>
<td align="left" valign="top" rowspan="1" colspan="1">4</td>
<td align="left" valign="top" rowspan="1" colspan="1">50</td>
<td align="left" valign="top" rowspan="1" colspan="1"></td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"><italic>Experienced Regulatory Delays</italic>
</td>
<td align="left" valign="top" rowspan="1" colspan="1"></td>
<td align="left" valign="top" rowspan="1" colspan="1"></td>
<td align="left" valign="top" rowspan="1" colspan="1"></td>
<td align="left" valign="top" rowspan="1" colspan="1">0.004</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> Yes</td>
<td align="left" valign="top" rowspan="1" colspan="1">6</td>
<td align="left" valign="top" rowspan="1" colspan="1">47</td>
<td align="left" valign="top" rowspan="1" colspan="1">13</td>
<td align="left" valign="top" rowspan="1" colspan="1"></td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> No</td>
<td align="left" valign="top" rowspan="1" colspan="1">15</td>
<td align="left" valign="top" rowspan="1" colspan="1">37</td>
<td align="left" valign="top" rowspan="1" colspan="1">41</td>
<td align="left" valign="top" rowspan="1" colspan="1"></td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> Missing (n = 13)</td>
<td align="left" valign="top" rowspan="1" colspan="1">2</td>
<td align="left" valign="top" rowspan="1" colspan="1">13</td>
<td align="left" valign="top" rowspan="1" colspan="1">15</td>
<td align="left" valign="top" rowspan="1" colspan="1"></td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"><italic>Additional Donations Outside of WHO</italic>
</td>
<td align="left" valign="top" rowspan="1" colspan="1"></td>
<td align="left" valign="top" rowspan="1" colspan="1"></td>
<td align="left" valign="top" rowspan="1" colspan="1"></td>
<td align="left" valign="top" rowspan="1" colspan="1">0.66</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> Yes</td>
<td align="left" valign="top" rowspan="1" colspan="1">5</td>
<td align="left" valign="top" rowspan="1" colspan="1">12</td>
<td align="left" valign="top" rowspan="1" colspan="1">42</td>
<td align="left" valign="top" rowspan="1" colspan="1"></td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> No</td>
<td align="left" valign="top" rowspan="1" colspan="1">10</td>
<td align="left" valign="top" rowspan="1" colspan="1">29</td>
<td align="left" valign="top" rowspan="1" colspan="1">34</td>
<td align="left" valign="top" rowspan="1" colspan="1"></td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> Missing (n = 56)</td>
<td align="left" valign="top" rowspan="1" colspan="1">8</td>
<td align="left" valign="top" rowspan="1" colspan="1">56</td>
<td align="left" valign="top" rowspan="1" colspan="1">14</td>
<td align="left" valign="top" rowspan="1" colspan="1"></td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"><italic>Country Purchase of Pandemic Vaccine</italic>
</td>
<td align="left" valign="top" rowspan="1" colspan="1"></td>
<td align="left" valign="top" rowspan="1" colspan="1"></td>
<td align="left" valign="top" rowspan="1" colspan="1"></td>
<td align="left" valign="top" rowspan="1" colspan="1">0.03</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> Yes</td>
<td align="left" valign="top" rowspan="1" colspan="1">9</td>
<td align="left" valign="top" rowspan="1" colspan="1">12</td>
<td align="left" valign="top" rowspan="1" colspan="1">75</td>
<td align="left" valign="top" rowspan="1" colspan="1"></td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> No</td>
<td align="left" valign="top" rowspan="1" colspan="1">7</td>
<td align="left" valign="top" rowspan="1" colspan="1">25</td>
<td align="left" valign="top" rowspan="1" colspan="1">28</td>
<td align="left" valign="top" rowspan="1" colspan="1"></td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> Missing (n = 60)</td>
<td align="left" valign="top" rowspan="1" colspan="1">7</td>
<td align="left" valign="top" rowspan="1" colspan="1">60</td>
<td align="left" valign="top" rowspan="1" colspan="1">12</td>
<td align="left" valign="top" rowspan="1" colspan="1"></td>
</tr>
</tbody>
</table>
<table-wrap-foot><fn id="TFN2"><label>1</label>
<p id="P42">Presence of a seasonal influenza program was obtained from data collected on the WHO-UNICEF Joint Reporting Form (JRF).</p>
</fn>
<fn id="TFN3"><label>2</label>
<p id="P43">Chi-square tests and Fisher’s Exact Test used to compare proportions of countries with or without a seasonal influenza program.</p>
</fn>
</table-wrap-foot>
</table-wrap>
</floats-group>
</pmc>
<affiliations><list><country><li>Suisse</li>
<li>États-Unis</li>
</country>
<region><li>Connecticut</li>
<li>Géorgie (États-Unis)</li>
<li>Pennsylvanie</li>
</region>
</list>
<tree><country name="États-Unis"><region name="Géorgie (États-Unis)"><name sortKey="Porter, Rachael M" sort="Porter, Rachael M" uniqKey="Porter R" first="Rachael M." last="Porter">Rachael M. Porter</name>
</region>
<name sortKey="Azziz Baumgartner, Eduardo" sort="Azziz Baumgartner, Eduardo" uniqKey="Azziz Baumgartner E" first="Eduardo" last="Azziz-Baumgartner">Eduardo Azziz-Baumgartner</name>
<name sortKey="Bresee, Joseph S" sort="Bresee, Joseph S" uniqKey="Bresee J" first="Joseph S." last="Bresee">Joseph S. Bresee</name>
<name sortKey="Kurzum, Jordan" sort="Kurzum, Jordan" uniqKey="Kurzum J" first="Jordan" last="Kurzum">Jordan Kurzum</name>
<name sortKey="Lafond, Kathryn E" sort="Lafond, Kathryn E" uniqKey="Lafond K" first="Kathryn E." last="Lafond">Kathryn E. Lafond</name>
<name sortKey="Ungkuldee, Mellissa" sort="Ungkuldee, Mellissa" uniqKey="Ungkuldee M" first="Mellissa" last="Ungkuldee">Mellissa Ungkuldee</name>
</country>
<country name="Suisse"><noRegion><name sortKey="Goldin, Shoshanna" sort="Goldin, Shoshanna" uniqKey="Goldin S" first="Shoshanna" last="Goldin">Shoshanna Goldin</name>
</noRegion>
<name sortKey="Hedman, Lisa" sort="Hedman, Lisa" uniqKey="Hedman L" first="Lisa" last="Hedman">Lisa Hedman</name>
<name sortKey="Moen, Ann" sort="Moen, Ann" uniqKey="Moen A" first="Ann" last="Moen">Ann Moen</name>
<name sortKey="Nannei, Claudia" sort="Nannei, Claudia" uniqKey="Nannei C" first="Claudia" last="Nannei">Claudia Nannei</name>
</country>
</tree>
</affiliations>
</record>
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