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Pinder, Leila (2017) An international study of the use of pandemic vaccines during the 2009-10 influenza A(H1N1) pandemic: a qualitative methodological study. PhD thesis, University of Nottingham.

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Abstract

Background: The 2009-10 influenza A(H1N1) pandemic was the first pandemic influenza of the twenty-first century and presented the first major opportunity for the use of influenza vaccines en-masse during a pandemic scenario. National anticipatory policies of pandemic influenza vaccine preparedness were implemented, and vaccine guarantee agreements were activated. Large quantities of vaccines were purchased and made available to identified citizens over the course of the pandemic. The use of pandemic influenza vaccines has been examined in this research.

Methods: A comparative health policy approach in five study countries (Sweden, New Zealand, Japan, Singapore, and Canada) was conducted. Qualitative interviews (n= 36) were undertaken in each country with key pandemic influenza response personnel (n = 39). Participants included public health officials, policy makers and clinicians engaged at national country response level. Interviews facilitated discussions surrounding the 2009-10 influenza A(H1N1) pandemic response and use of vaccines. Documentary examination of available records supplemented the analysis of the interview data.

Results: Several interview themes were identified following data analysis of the use of pandemic vaccines in the study countries. Themes of the vaccine use included: single or multiple vaccine supplier routes; hemisphere variation; historical pandemic legacy; targeted populations; setting vaccination priorities; side effect concerns; perceived effectiveness of vaccines during the pandemic influenza response. The themes which were most prominent comprised the sourcing and distribution of the vaccines during the response and the associated communication challenges. The necessary prioritisation of vaccines caused extensive discussions and uneasiness by the pandemic influenza response personnel as the initial vaccines arrived in small quantities and required allocation, especially in circumstances where country’s intended for all/most citizens to eventually have access to the vaccine. The variation in timing of the vaccination campaigns and disease activity would suggest that subsequent influenza wave morbidities and mortalities could have been reduced if vaccines had been available more promptly. The southern hemisphere country, New Zealand, exemplified the circumvention of vaccine safety concerns through the use of a trivalent vaccine inclusive of H1N1.

Conclusions: Pandemic vaccines were the cornerstone of two countries responses and were associated with high uptake rates. Vaccine discussions, such as prioritisation and essential workers estimates, can be established during interpandemic phases by pandemic influenza response personnel. The use of annual seasonal influenza vaccines that are inclusive of the novel pandemic influenza strain should play a greater role in future pandemic influenzas, should the vaccination campaign timing be appropriate, as this may reduce public anxiety concerning the perceived safety of novel vaccines. The use of the 2009-10 influenza A(H1N1) pandemic vaccines had varied in success and the lessons learnt from this event have important implications for future policy. Pandemic influenza response personnel are recommended to prepare as fully as possible during this interpandemic period.

Item Type:	Thesis (University of Nottingham only) (PhD)
Supervisors:	Van-Tam, J.S. Shaw, I.
Keywords:	Influenza vaccines; Influenza A Virus, H1N1 Subtype; Influenza pandemic
Subjects:	W Medicine and related subjects (NLM Classification) > WC Communicable diseases
Faculties/Schools:	UK Campuses > Faculty of Medicine and Health Sciences > School of Medicine
Item ID:	40590
Depositing User:	Pinder, Leila
Date Deposited:	01 Nov 2017 14:53
Last Modified:	01 Nov 2017 22:00
URI:	https://eprints.nottingham.ac.uk/id/eprint/40590

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