1. Project Charter
• Project: The Establishment of a National
Pandemic Action Plan for Influenza in the US.
• Organization: Center for Disease Control
• Target Completion date: December 2013
• Team Members: Mohamed Sidi Haiba and
Louai El Meqbeli
• Scope: The project will analyze the flaws of
the existing process and propose alternative
solutions to improve it.
2. Project Charter Cont’d
• Healthcare Providers
• General Population
3. Project Charter – Objectives
The Stated Goal: Increasing the supply and
capacity of delivery of influenza vaccines
The Strategies Identified:
• Developing an immunization policy to increase the
demand for seasonal vaccines by an average rate
of 10% a year.
• Increasing influenza vaccine production capacity
• Promoting research and development for new
4. Project Charter – Objectives
Developing an immunization policy to increase demand for
• Map the landscape
• Estimate the disease burden
• Develop regional plans of action and mobilize resources
• Encourage international coordination between between
countries and regions of the world
5. Project Charter – Objectives
Increasing influenza vaccine production capacity
The three most valuable options identified by WHO experts
1.continuing to promote seasonal influenza vaccine programmers,
5. supporting the industry to sustain production capacity beyond
seasonal demand and
7. enabling some vaccine production facilities to change, at the onset of
a pandemic, from producing inactivated vaccines to live attenuated
6. Project Charter – Objectives
Promote research and development for new
Develop more effective influenza vaccines using new technologies.
The ideal product profile is a vaccine which is:
• safe and highly protective, preferably in all target groups, including
infants, the elderly,
pregnant women and immuno-suppressed individuals;
• is easily and economically produced on a large scale;
• is effective – preferably with a low dose of antigen;
• is delivered, ideally, as a single dose
7. Deployment Model
Need Drivers CTQs Requirements
Seasonal clinic Mobile Staff
uptake of the
Enhance efficacy of campaign
exiting vaccines and
promote research for
new ones Client recall reminder Providers feedback
8. Mapping the existing process
• Influenza Vaccine Doses distributed, United States 1964-2004.
• % of persons aged ≥ 65 years who reported receiving Vaccination
during the preceding 12 months, by race/ethnicity and survey year-
national health interview survey, US 1989-2003.
• % of persons aged 18-64 years who reported receiving influenza
vaccination during the preceding 12 months, by race/ethnicity and
survey year-national health interview survey, US 1989-2003.
• Cumulative Monthly Influenza Vaccine Distribution for 1999, 2000,
2001, 2002, 2003-04, 2004-05.
• % of influenza Vaccination by month, selected priority US
populations, BRFSS 2004-05
9. Determining the process variation
To achieve this objective, one needs first to
• examine the nature of the cause effects we are
• Are they common or special?
• Given the data we have so far and the fact that
our strategic approach is already known
(improvement process), we know in advance
that our variation type is stable and our cause
effects are common.
10. Identifying the root causes
Based on the analysis of existing data we
have identified several root causes, but the
most important are:
• Lack of education
• Difficulties to access
• Vaccine shortages
• Gaps in R & D
11. Proposed Solutions
• Creating a robust and effective supply and delivery chain.
• Developing a stockpiles of vaccines.
• Resolving policy regulatory and coordination
• Broaden access to vaccination e.g. workplace, community,
pharmacies, seasonal clinics.
• Raise the awareness of the public about the importance of
vaccination (public information).
• Mandate employers to offer vaccine free of charge or at an affordable
cost (on site if possible).
• Extend the requirement to public schools, nursing homes,
12. Cont’d Solutions
• Enhance demand among vulnerable
segments of the population “elderly people,
infants, pregnant women, children etc…”
• Extend the critical period of coverage beyond
• Link Influenza vaccination with the delivery of
other vaccination among adolescents.
13. Implementation Process
Enhancement year 1 year 2 year 3 year 4
10% 20% 30% 40%
15% 30% 45% 60%
10% 20% 30% 40%
20% 40% 60% 80%
Reducing difficulty to access
10% 20% 30% 40%
Provider reminder /recall
The availability of data is a crucial step in statistical analysis. Although, we
Were unable to obtain/collect all the data we needed, we had enough to kick start
our mapping process and devise some of our proposed solutions. The three
most valuable proposals identified by WHO experts include:
• continuing to promote seasonal influenza vaccine programmers,
• supporting the industry to sustain production capacity beyond seasonal demand
• enabling some vaccine production facilities to change, at the onset of a
pandemic, from producing inactivated vaccines to live attenuated vaccines.
Finally, in order for the process to be efficiently implemented and to take root
In the long run, the improvements achieved need to be maintained and
Ultimately institutionalized. In this regard the institution of a process control
level is of great importance.
15. Critique of the sources:
• Statistical Thinking (improving business performance)
by R. Hoerl and R Snee
• Department of Health & Human Services HHS
16. Thank you for your attention!
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