SANTA CRUZ COUNTY BOARD OF SUPERVISORS INDEX SHEET

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1 SANTA CRUZ COUNTY BOARD OF SUPERVISORS INDEX SHEET Creation Date: 10/15/04 Source Code: HSAXX Agenda Date: /04 I NVENUM : Resolution(s): Ordinance@): contract(s1: Continue Date@): Index: --Letter of the Health Services Agency Director of October 13, Resolution --Fact sheetdpress releases item: 47.2 ADOPTED RESOLUTION NO proclaiming the existence of a local emergency in Santa Cruz County resulting from the shortage of influenza vaccine and approved related actions, as recommended by the Health Services Agency Director

2 -. --, I County of Santa Cruz HEALTH SERVICES AGENCY P.O. BOX 962, 1080 EMELINE AVENUE SANTA CRUZ, CA (831) FAX: (831) HEALTH SERVICES AGENCY ADMINISTRATION October 13, 2004 October 19,2004 BOARD OF SUPERVISORS County of Santa Cruz 701 Ocean Street Santa Cruz, CA RE: Declaration of Emergency Resulting from Shortage of Influenza Vaccine Dear Members of the Board: SUMMARY The Health Services Agency (HSA) has received official notification from the California State Department of Health Services (CADHS) and the federal Centers for Disease Control and Prevention (CDC) that the available doses of influenza vaccine this year will be half of what is expected. In response to this national and state shortage of influenza vaccine, HSA is recommending that your Board adopt the attached resolution declaring a state of local emergency resulting from this shortage. This declaration of a local emergency recognizes that a critical public health crisis exists in that there is extreme peril to the health and safety of vulnerable populations including the medically fragile, the elderly and young children caused by the influenza vaccine shortage. The official declaration of the existence of a local emergency will educate the public and health care providers about the seriousness of the issue, expedite the necessary processes for the reallocation of vaccine to those most at-risk individuals, and discourage price gouging. BACKGROUND The nation is facing an enormous public health challenge. Almost half of the nation's 100 million doses of flu vaccine will not be delivered this year. Chiron, a major manufacturer of flu vaccine, will not be distributing any influenza vaccine this flu season. Chiron was to make million doses of vaccine for use in the United States. The remaining 54 million doses of adult flu vaccine expected to be available in the United States for this flu season has been manufactured by Aventis-Pasteur. Due to this national shortage, it is imperative that the public, the medical community, and the public health community cooperate to ensure that this remaining flu vaccine goes to those who need it the most. Although 30 million doses of the Aventis influenza vaccine have already been shipped, the remaining 22.4 million doses will be allocated throughout the country in an unprecedented collaboration between CDC, Aventis, and state and local health departments. The attached a/

3 oz CDC Announcement of Allocation Plan to Address Influenza Vaccine Shortages underscores the extraordinary measures needed to ensure that the flu vaccine gets to those people who need it the most. Local public health agencies have long played important roles in promoting flu vaccination. This year s shortage is the fifth time in six years that the nation has experienced disruptions in supply and distribution of influenza vaccine. Because of the vaccine shortage, CDC has changed its guidance about who should get vaccinated this flu season. HSA issued the attached Public Health Advisory on October 6, 2004, to our local health care providers that listed the CDC definitions for persons included in the high-risk categories. On Friday, October 8, HSA also forwarded to our local health care providers the attached Public Health Order by the California State Health Officer, Richard Jackson, ordering all health care providers in California to limit influenza vaccination to persons in high-risk groups. HSA is working diligently to ensure that our local community works together in collaboration to minimize the adverse effects of this year s shortage on the health of our most vulnerable residents. Therefore, in compliance with the State s Public Health Order and in consultation with the County Administrative Office and the County Personnel Department, HSA has canceled the 2004 County Employee Flu clinics. A notice went out to County employees on Friday, October 8. The Executive Committee of the California Conference of Local Health Officers (CCLHO) has issued the attached Position Statement urging the state to consider declaring a state of emergency. At the local level, several counties have already declared local states of emergency or are in the process of doing so. Attached is an in-depth explanation from the County of Alameda supporting the need for an emergency declaration. The National Association of County & City Health Officials has prepared the attached Statement on Flu Vaccine Shortage that underscores the close collaboration necessary to achieve optimal distribution of flu vaccine. Additionally, the California Attorney General s Office has said that the state is prepared to take legal action against any company it finds has unlawfully acted to price gouge the public by inflating their charge for the vaccine. Complaints to the Attorney General s Office can be filed online at or by writing to the Public Inquiry Unit of the Attorney General s Office at P.O. Box , Sacramento, California CONCLUSION Santa Cruz County is part of a national, state, and local emergency response system to combat natural and man-made disasters, including epidemics. While we have long planned for an influenza pandemic, we have not had to respond to the sudden and unexpected loss of half of the vaccine supply needed to prevent hospitalizations and deaths. This Declaration of Emergency provides community-wide education and recognition of the serious situation before us. It expedites the strategies we will employ to protect the public during the forthcoming influenza season and ensures that the vaccine will be redirected to those most at risk. The Health Services Agency will provide regular updates to your Board on our community s response to this crisis. It is, therefore, RECOMMENDED that your Board: 1. Adopt the attached resolution proclaiming the existence of a local emergency in Santa Cruz County resulting from the shortage of influenza vaccine; and 47 a 2

4 3 2. Authorize the Health Services Agency to purchase influenza vaccine from local health care providers for redistribution to the most high-risk, vulnerable population in Santa Cruz County. Sincerely, Rama Khalsa, Ph.D. Health Services Agency Director RECOMMENDED: fl SusaFA. Mauriello County Administrative Officer RK:gk:dg Attachments: Resolution proclaiming existence of local emergency Santa Cruz County Health Services Agency Public Health Advisory CDC Announcement of Allocation Plan to Address Influenza Vaccine Shortages Order by the State Public Health Officer to Control Influenza Vaccination CCLHO Position Statement: Influenza Vaccine Shortage County of Alameda Rationale for Declaring an Emergency NACCHO Statement on Flu Vaccine Shortage cc: County Administrative Office County Counsel Personnel Auditor-Controller State Senator Bruce McPherson Assemblymember John Laird Assemblymember Simon Salinas HSA Administration SElU Local

5 BEFORE THE BOARD OF SUPERVISORS OF THE COUNTY OF SANTA CRUZ, STATE OF CALIFORNIA RESOLUTION NO On the motion of Supervisor Pirie Duly seconded by Supervisor Campos The following resolution is adopted. RESOLUTION DECLARING A STATE OF LOCAL EMERGENCY IN SANTA CRUZ COUNTY RESULTING FROM INFLUENZA VACCINE SHORTAGE WHEREAS, approximately one half of the expected supply of influenza vaccine for the United States will not be available for the current influenza season; and WHEREAS, the Santa Cruz County Health Services Agency receives most of its supply of influenza vaccine from the California Department of Health Services; and WHEREAS, California does not have any State purchased adult vaccine available to distribute to local health jurisdictions; and WHEREAS, persons at highest risk for complications of influenza include adults over 65 years of age and children under 2 years of age; and WHEREAS, in the United States, more than 36,000 people die annually of complications related to influenza; and WHEREAS, the California State Public Health Officer, Dr. Richard Jackson issued a Public Health Order on October 8, 2004, directing all health care providers in California to limit provision of flu vaccine only to persons in high-risk categories and to refrain from immunizing healthy persons; and WHEREAS, there exists a critical local public health crisis in that there is extr,eme peril to the health and safety of vulnerable populations including the medically fragile, the elderly and young children caused by the influenza vaccine shortage; and WHEREAS, immediate action is needed to protect the limited supply of vaccine and ensure that vaccine is promptly reallocated to the most at risk individuals; and WHEREAS, California Government Code Sections 8558 and 8630 authorize the Board of Supervisors to proc1aim.a local emergency to address the extreme peril created by the shortage of influenza vaccine.

6 RESOLUTION DECLARING A STATE OF LOCAL EMERGENCY IN SANTA CRUZ COUNTY RESULTING FROM INFLUENZA VACCINE SHORTAGE Page 2 of 2 NOW, THEREFORE, BE IT RESOLVED that the Board of Supervisors of the County of Santa Cruz hereby proclaims the existence of a state of local emergency within the county due to the shortage of influenza vaccine. BE IT F'URTHER RESOLVED that the Board of Supervisors authorizes the Health Officer to take all necessary and feasible steps to ensure that all health care providers in Santa Cruz County limit influenza vaccination to persons in high-risk categories as defined by the Centers for Disease Control and Prevention and to refrain from the vaccination of healthy individuals not at high risk of serious illness or death from influenza. PASSED AND ADOPTED by the Board of Supervisors of the County of Santa Cruz, State of California, this 19* day of October 2004, by the following vote: AYES: SUPERVISORS Beautz, Pirie, Campos, Stone and Wormhoudt NOES: SUPERVISORS None ABSENT: SUPERVISORS None ABSTAIN: SUPERVISORS None!dAaDJ WORMHOUQT Chair of the Board of Supervisors ATTEST: GAl l T. BORKOWSM Clerk of the Board DISTRIBUTION: CAO Health Services Agency STATE OF CALIFORNIA ) ss COUNTY OF SANTA CAUZ ) I. SUSAN A. MAURIEUO. County Administrative Officer and ex-officio Clerk of the Board of Supervtsm of the County of Santa Cruz, State Sf California do hereby certify that the foregoing is a true and correct mpy of the resolution passed and adopted by and entered in the minutes Ofthe said board. In" wi e ereof I ha* h dtr set my h%.ai@i&( 2 + Board on *. 4?*

7 k PRESS RELEASE October 12,2004 For immediate release Contact: CDC Media Relations CDC, Aventis Pasteur Announce Allocation Plan to Address Influenza Vaccine Shortages The Centers for Disease Control and Prevention (CDC) and Aventis Pasteur announced today the first phase of the plan to allocate influenza vaccine in response to the recently announced loss of half of the nation s expected flu vaccine supply for the season. The plan, announced by CDC Director Dr. Julie Gerberding and Aventis Pasteur US President Damian Braga, calls for CDC to work closely with Aventis to distribute in phases 22.4 million doses of unshipped vaccine to identified areas of need throughout the country. Beginning immediately, about 14.2 million doses of vaccine will be allocated over the next 6-8 weeks through Aventis Pasteur contracts directly to high-priority vaccine providers, including hospitals, long-term care facilities, nursing homes, and private providers who care for young children. This plan will help ensure that vaccine gets to those people who need it most, said CDC Director Dr. Julie Gerberding. This is a troubling, frustrating situation for all of us and we need for all Americans to pull together in the weeks to come to meet this challenge head on. This plan is the result of unprecedented collaboration between CDC, Aventis Pasteur, and state and local health departments across the country. And we must not forget the other public health heroes on the front lines in grocery stores, pharmacies, and health clinics working to prioritize vaccine. CDC will continue to work with Aventis Pasteur and state and local health departments to identify people, by region, on the vaccination priority list. The approximately 8.2 million doses remaining after the first phase is completed will be shipped to other high-need areas. Since Dr. Gerberding contacted us last week, we at Aventis Pasteur have worked with the CDC around the clock to tackle the complex task of getting millions of doses of influenza vaccine to thousands of health care providers around the country. Our goal has been to direct remaining doses as quickly as possible to those areas where large numbers

8 of at-risk individuals are in need," said Damian Braga, president, Aventis Pasteur US. "It is a huge logistical feat and we are proud to have contributed our knowledge and expertise to this plan." Last week CDC announced priority groups for vaccination with inactivated influenza vaccine for the influenza season: all children aged 6-23 months, adults aged 65 years and older, persons aged 2-64 years with underlying chronic medical conditions, all women who will be pregnant during influenza season, residents of nursing homes and long-term care facilities, children 6 months- 18 years of age on chronic aspirin therapy, health-care workers with direct patient care, and out-of-home caregivers and household contacts of children aged <6 months. Influenza season typically peaks in the United States between December and March. Because each season is unpredictable, it's not known how severe the season might be. Although vaccination is the best protection against influenza, everyone can take practical steps to help prevent spread of flu, such as avoiding close contact with people who are sick and keeping your distance from others if you're sick; when possible, staying home from work, school, and errands when you are sick; covering your mouth and nose when coughing or sneezing, and cleaning your hands often. For more information about the flu and this year's recommendations, visit the CDC Website: ###

9 Q I County of Santa Cruz, HEALTH SERVICES AGENCY ALL HAZARDS PUBLIC HEALTH AUTHORITY I PREPARE PREVENT PROTECT FOR IMMEDIATE RELEASE October 6,2004 PUBLIC HEALTH ADVISORY Communicable Disease: Influenza Contact: Barbara Rice, Immunization Program Manager Phone: Fritzi Nelson, Communicable Disease Manager Phone: INCIDENT Santa Cruz County Health Services Agency (HSA) has received official notification from the California State Department of Health Services (CADHS) and U.S.Centers for Disease Control (CDC) that the available doses of influenza vaccine this year will be just over half of what was expected. The U.S. will have about 56 million doses, far less than anticipated due to manufacturing issues. Our goal is to assure that the people who need the vaccine will receive the vaccine. Because of the vaccine shortage, the following CDC recommendations must be implemented immediately. INFORMATION Influenza vaccine must be administered only to the following patient groups: All children aged 6-23 months Adults aged 65 and older Persons aged 2-64 years with underlying chronic medical conditions All women who will be pregnant during the influenza season Residents of nursing homes and long term care facilities Children aged 6 months-1 8 years on chronic aspirin therapy Health care workers involved in direct patient care of high risk patients (see Other Vaccine Recommendations below) Out-of-home care givers and household contacts of children <6 months of age All others should forgo receiving the influenza vaccine. The Health Officer strongly urges health care providers in the community to revise their influenza vaccine administration policies to fit the above guidelines immediately. HSA staff will continue to forward recommendations as CADHS and CDC develop them, Post Office Box 962, 1080 Emeline Avenue, Santa Cruz, CA TEL FAX TDD

10 9 OTHER VACCINATION RECOMMENDATIONS 0 Healthy persons who are 5-49 years of age and not pregnant, including health-care workers and persons caring for children aged < 6 months, should be encouraged to be vaccinated with intranasally administered live, attenuated influenza vaccine. Health-care workers who care for severely immunocompromised patients in special care units should only receive the inactivated vaccine. 0 High risk groups identified above should be encouraged to search locally for vaccine if their usual healthcare provider does not have vaccine available. 0 Certain chldren aged < 9 years require two doses of vaccine if they have not previously been vaccinated. All children at high risk of complications fkom influenza, including those aged 6-23 months, who present for vaccination should be vaccinated with a first or second dose, depending on vaccination status. However, doses should not be held in reserve to ensure that two doses will be available. Rather, available vaccine should be used to vaccinate persons in priority groups on a first come first serve basis. Vaccination of Persons in Non-High Risk Groups 0 Persons who are not included in one of the priority groups above should be informed about the urgent vaccine supply situation and asked to forgo vaccination. OTHER PREVENTIVE MEASURES The following public health practices should always be followed: Frequent hand washing remains one of the best ways to stay healthy. Be especially careful to wash after shaking hands, opening doors, using public phones and before eating. Try to keep hands away from your face. Always use a tissue when coughing or sneezing, and dispose of it after one use. If a tissue is not available, cough into your upper sleeve. If you are visiting the doctor for a respiratory illness, please wear a mask while in the waiting room. Stay home from work if you exhibit flu-like symptoms. Keep sick children home from school. HSA staff will be conducting a flu vaccine inventory survey. Due to the uncertainty of the vaccine supply, HSA will announce its high risk patient clinic schedule at a later date. Post Office Box 962, 1080 Emeline Avenue, Santa Cruz, CA TEL FAX TDD Y7*&

11 CALIFORNIA STATE PUBLI&&ALTH OFFiCER DATE / 47* 1501 Capitol Avenue, Suite 6001 P.O. Box , MS 0000 Sacramento, CA (91 ti) , Fax (916)

12 California Conference of Local Health Officers Position Statement: Influenza Vaccine Shortage October 7,2004 The California Conference of Local Health Officers (CCLHO) strongly urges the California Department of Health Services to adopt the following recommendations: 1) Declare that the current shortage of influenza vaccine in California is an emergency to convey the seriousness of the situation. 2) Immediately and until further notice, NO vaccine shall be given to anyone who is NOT in a high-risk category. 3) Declare that all providers of influenza vaccine must work with their respective local health departments to a) Report the amount of vaccine they have on a regular basis and b) Cooperate in the redistribution of vaccine in order to protect those at highest risk of getting influenza. 4) Analyze hospitalization rates and death rates due to influenza and modify the highrisk categories in order to further prioritize the CDC high risk categories. 5) In order to convey a unified message communicating the declaration of the state of emergency based on the urgency of the situation to the public and providers, the Department shall hold a joint press conference with CCLHO, CHEAC, and organizations representing physicians, hospitals and clinics. 6) It is imperative that providers and the public understand that all must abide by this declaration for the common good CCLHO volunteers its services in any way necessary to assist the Department of Health Services.

13 County of Alameda Rationale for Declaring an Emergency Page 1 of 2 1. By definition, a local emergency exists when a significant threat to human health exists or is imminent, local resources are inadequate to manage the threat, AND additional or extraordinary resources can be called in to mitigate the threat. In this case the threat is one of irreparable harm (profound illness and/or death) to local residents and the local resources are influenza vaccine, inpatient capacity, ER capacity, and hospital staffing. The extraordinary resources are the ability to (if necessary) confiscate and redistribute vaccine and to penalize price gouging. These are tools.that can be used to mitigate the emergency but include the deprivation of private property, which presents clear due process issues, and thus can and should only be invoked under a state of emergency. Other important tools include the ability to circumvent onerous purchasing rules at the county level if the need to quickly purchase vaccine arises. The impact of such a local declaration benefits local physicians who are being asked to discriminate among their patients in a way that can easily engender hostility and criticism from their paying patients. An emergency order allows them to point to both the state and local health officer orders to defend themselves against the potential consequences from angry low-risk patients. It also provides a potential shield against liability. The local state of emergency declaration also maximizes local awareness among both low risk and high-risk populations about the urgency of the situation and the need for low risk people to behave in social responsible ways. It also provides a teaching opportunity that permits local health departments to remind the public about other means of avoiding respiratory diseases (hand washing, respiratory hygiene, Flu Mist, anti-virals). 2. There are 400,000 individuals in Alameda County who fit the CDC high-risk categories. Alameda has identified less than 60,000 vaccines in their county, most of which is in Kaiser's hands. In a typical year, -200,000 high-risk individuals will be vaccinated, this year they are expecting only -50,000 to be vaccinated. In a typical year Alameda sees excess hospitalizations during the flu season (this is calculated by looking at hospitalizations by month for the past three years subtracting out injuries and births). Alameda also sees about 300 excess deaths during flu season. They estimate that somewhere between 20-33% of this excess hospitalization and mortality during flu season is due to influenza. So about up to 600 hospitalizations and up to 100 deaths each year from the flu during normal conditions (400,000 high risk: 200,000 vaccinated and 200,000 unvaccinated). This year, if nothing changes with the vaccine supply) among their 400,000 high risk individuals, Alameda anticipates that only 50,000 will be vaccinated and -350,000 will be unvaccinated. That translates roughly up to 75 additional deaths and 450 additional hospitalizations. The total bed capacity in Alameda County is 3028 general acute medical beds. During the flu season, they are frequently overwhelmed. Thus an additional 450 hospitalizations, with the attendant increase in ER visits, in the setting of increased nurse patient mandates, could cripple their system. On this basis, the County of Alameda declared a local state of emergency under which they will do the following: Under California Health & Safety Code , under a local state of emergency, "the county health officer may take any preventive measure that may be necessary to protect and preserve the public health from any public health hazard". Prudent preventive measures in this situation include: 1. Working closely with physician offices, nursing homes and community clinics to facilitate the vaccination of high-risk populations by maintaining an updated inventory of vaccine supply around the County and sharing this information in a timely fashion with healthcare providers.

14 --. County of Alameda Rationale for Declaring an Emergency Page 2 of 2 2. Monitoring commercial and other non-clinical sites where flu vaccine is being administered to ensure that the CDC guidelines are being strictly applied. 3. Reallocating scarce vaccine supply from County vaccine stocks or subsequently obtained supplies as needed to maximize the vaccination of high-risk populations. 4. Articulating a clear and uniform message to low risk individuals about the need to forgo influenza vaccination this flu season in favor of high-risk groups, and instructing low risk populations on other protective measures that can be taken. If necessary, Alameda also reserves the right to confiscate vaccine from any providers who flagrantly disregard the CDC guidelines or engage in price gouging.

15 NACCHO Statement on Flu Vaccine Shortage The nation is facing an enormous public health challenge. NACCHO joins HHS Secretary Tommy Thompson and CDC Director Julie Gerberdmg, MD, MPH in urging the cooperation of the public, the medical community and the public health community in ensuring that flu vaccine goes to those who need it the most. The vast majority of the existing doses of flu vaccine are in private hands. In light of the current shortage, it is essential that vaccine manufacturers and distributors, mass vaccinators, health care providers, and governmental public health agencies collaborate closely to aclueve optimal distribution of flu vaccine. We call on all parties in all communities that have a role in flu vaccine distribution and adrmtllstration to cooperate closely with public health agencies to implement and adhere to CDC s interim guidelines for the flu season. Entities that have more flu vaccine than they need to vaccinate members of high-priority groups should participate in collaborative arrangements that will reallocate such vaccine to providers who do not have enough vaccine for high-priority clients or patients. Individuals who are not included in one of the defined high-priority groups should forego vaccination unless or until additional supplies become available. Local public health agencies have long played important roles in promoting flu vaccination. This year s shortage is the firh in six years that the nation has experienced disruptions in supply and distribution of mfluenza vaccine. In response, local public health agencies have increasingly engaged in monitoring vaccine supplies in their communities and facilitating reallocation to health care providers for persons most in need. NACCHO urges all communities to develop vaccine reallocation plans collaboratively to minimize the adverse effects of this year s shortage on the health of their most vulnerable residents. This shortage will test the capacities of the nation s system for acquiring and judiciously distributing flu vaccine. NACCHO urges policymakers to undertake a bold, far-reaching examination of how the nation can assure a reliable future supply of essential vaccines. We advocate a candid public discussion about effective public-private collaboration to protect our most vulnerable populations. We must find ways not only to address vaccine shortages when they occur, but also to prevent them from recurring.