States' emergency orders regarding the 2004-05 influenza vaccine shortage

Influenza vaccine shortages during the 2004-05 season led some states to issue emergency orders that prioritized high-risk groups and in some cases threatened criminal penalties. Decision-making that led states to issue - or not issue - these orders has not been examined. Therefore, we conducted analyses of semi-structured, in-depth interviews with health officials in 23 states, in order to identify principal decision-making factors and patterns regarding emergency flu vaccine orders. Four of 14 issuing states and one of 9 non-issuing states had a formal structure for decisions of this nature; 3 states utilized a bioterrorism preparedness infrastructure. Eight issuing states cited inadequate or uncertain supply as most important in their decision-making. Four issuing states said that informing the public that high-risk prioritization was a state decision (and not a provider-specific decision) was most important. Among non-issuing states, 7/9 believed they could accomplish their objectives without issuing an order. No states had formal mechanisms to assess vaccine supply or monitor physicians' adherence to prioritization guidelines. We conclude that broad differences in states' approaches to influenza vaccine supply illustrate 3 salient themes: decentralization of vaccine supply control and management, lack of monitoring and enforcement capacity, and benefits of disaster preparedness efforts.