2009 H1N1 Flu: Resource Guide for American Indian/Alaska Native Tribal Governments

November 2, 2009, 2:00 PM ET

American Indian/Alaska Native (AI/AN) Tribal governments and communities and the Indian Health Service will be essential partners in the response to the 2009 H1N1 influenza pandemic. Information on how AI/AN governments, organizations and communities can participate in existing pandemic influenza preparedness activities and receive resources is included below. This information is meant to serve as a resource for tribal governments and tribal emergency preparedness planners, IHS, Tribal and Urban (I/T/U) Indian health care facilities, and state and local partners.

Funding for 2009 H1N1 response planning and implementation

The HPP funds will be distributed by HHS to states. While IHS and Tribal hospitals cannot apply directly for HPP funds, they are eligible to receive funds through their state to supplement existing federal funds that they receive.

Strategic National Stockpile

Antiviral Medication and Personal Protective Equipment (PPE*) Distribution
Use of antiviral medications is an important strategy for preventing serious disease in those infected with 2009 H1N1. In addition, antivirals and PPE are also used to prevent infection in exposed people (e.g. healthcare personnel and contacts of influenza cases). Antivirals and PPE are included in the SNS, though this is not the only source. Sources of PPE are different for HHS healthcare personnel and the rest of the population:

• For HHS healthcare personnel at high risk for exposure** to 2009 H1N1(includes federal, tribal and contract personnel employed at an I/T/U facility):HHS is securing antiviral medications and certain PPE items (N-95 respirators) that will be distributed through the IHS National Supply Service Center.
• For the general population (including patients at I/T/U facilities) and other critical infrastructure personnel (including healthcare personnel who are not high risk for exposure): To supplement facility supplies in the case of a severe outbreak, antiviral medications and PPE will be distributed from the Strategic National Stockpile (SNS) to states who will then distribute them to healthcare facilities and communities as needed. In some states, tribes may need to work with local/county health departments to clarify logistics of this process.

2009 H1N1 Vaccine

Production of 2009 H1N1 vaccine is currently underway, and vaccine is expected to be available starting in mid-October. Vaccine will NOT be distributed through the SNS. The federal government will purchase the vaccine, and CDC will coordinate vaccine distribution using procedures similar to those used in the Vaccine for Children (VFC) program. Discussions are underway at the Federal interagency level about the feasibility and utility of implementing a parallel vaccination program for the Federal healthcare personnel workforce separate from State-managed programs. This would include all IHS, tribal and contract HCP who provide care in an IHS, Tribal, or Urban Indian (I/T/U) facility. Vaccine for IHS or tribal entities for the general patient population will come out of state allocations.

• For healthcare personnel employed in IHS, Tribal and Urban (I/T/U) facilities: Currently I/T/U facilities should work with their state counterparts to receive 2009 H1N1 vaccine for their HCP. If there is a separate allocation for federal HCP, vaccine orders will be placed by IHS to CDC and distributed to sites via the IHS National Supply Service Center. Allocations will be based on the HCP estimates provided by each facility
• For the general population, including patients at I/T/U facilities:
  States are responsible for identifying providers who will participate in administration of 2009 H1N1 vaccine. Vaccine will be shipped to participating providers through a centralized distribution process where placing of orders is facilitated by the health department and this information is transferred to the distributor. In most areas, vaccination will be made available through public mass vaccination clinics, school-located clinics, and a range of private sector providers (provider offices, retail pharmacy chains, workplaces, etc…). It will be important for tribes to collaborate with the state and with local health jurisdictions (LHJs) in planning school-based and community-based mass vaccination campaigns. Links to information on each state’s 2009 H1N1 vaccine distribution plan is available.

Initial Target Groups for Vaccination

CDC’s Advisory Committee on Immunization Practices (ACIP) has recommended that certain groups of the population receive the 2009 H1N1 vaccine when it first becomes available. These target groups include:

• Pregnant women
• People who live with or care for children younger than 6 months of age
• Healthcare and emergency medical services personnel
• Persons between the ages of 6 months and 24 years old
• People ages 25 through 64 years of age who are at higher risk for 2009 H1N1 because of chronic health disorders or compromised immune systems.

It is important to note that target groups may change depending on the 2009 H1N1 disease burden and vaccine availability. More information on target groups for vaccination is available.

Summary of the Crisis and Emergency Risk Communications (CERC) Tribal Communicators Training

• December 8-9, 2009
• Crowne Plaza Ravinia (Atlanta)
• Total Attendees: 55
• Number of unique tribes represented: 29
• Number of Western tribes (west of Mississippi): 30
• Number of Eastern tribes (east of Mississippi): 12

The training included "Basic" and "Pandemic Flu" modules. All of the attendees participated in a tabletop exercise based on the current H1N1 pandemic. Twenty participants (selected based on first-come basis) traveled to CDC (bus-sponsored by CDC), late-afternoon of 12/8/09, for a tour of the CDC EOC and CDC Museum.

The first CERC training course for communicators to tribal nations was held April 10-11, 2007 in Phoenix, Arizona and the second was held in San Antonio on October 29-21, 2007. The CERC/Pandemic Influenza course is a 1½ day training that offers a combination of influenza communication tabletop exercises and informative group discussions. CERC is an approach used by scientists and public health professionals to provide information that allows an individual, stakeholders or an entire community, to make the best possible decisions about their well-being, under nearly impossible time constraints, while accepting the imperfect nature of their choices. The CERC training program draws from lessons learned during public health emergencies, and incorporates best practices from the fields of risk and crisis communication. With this comprehensive training program, the CDC has moved forward in meeting the needs of partners and stakeholders in preparing for, responding to and recovering from the threat of bioterrorism, emergent diseases, and other hazards.

Questions and Answers

Questions Related to Funding

Can tribal governments receive 2009 H1N1 planning and implementation funds?
Yes. While tribes cannot apply for the PHER funds allocated by CDC, they can receive funds from their state.

Why can’t tribes apply directly for PHER funds?
In order to get the funding out quickly, CDC had to look to existing funding mechanisms, such as PHEP grants. The original legislation which created the PHEP grants did not include tribes, and since this is the mechanism being used to distribute the 2009 H1N1 funds, tribes are not eligible to apply for funds directly.

Can IHS and tribal hospitals receive 2009 H1N1 funds through the Hospital Preparedness Program?
Yes. While IHS and tribal hospitals cannot apply directly for 2009 H1N1 HPP funds, they are eligible to receive funding through the states.

Who should we contact with questions or concerns related to funds for planning and vaccination implementation?
You can contact the IHS Emergency Management Point of Contact (EMPOC) for your Area (contact information below). In addition, each project area has a CDC project officer with the Division of State and Local Readiness assigned to oversee the PHER funds. Contact information for the CDC Project Officers is included below.

Question Related to the Strategic National Stockpile (SNS)

Who should we contact with questions or concerns related to SNS supplies?
Each IHS Area has an Emergency Management Point of Contact (EMPOC) who can assist in putting you in touch with your state SNS coordinator. EMPOC information is included below.

Questions Related to Vaccine

Should we wait until we receive 2009 H1N1 vaccine to begin seasonal influenza vaccination?
No. Seasonal influenza vaccine is currently available in many places, and providers are encouraged to begin vaccination with seasonal influenza as soon as they receive the vaccine.

How do we get 2009 H1N1 vaccine for our population?
Vaccine for the general population will be distributed through states under a state health department-managed process. Providers who want to receive 2009 H1N1 vaccine should contact their state immunization contact. A list of state 2009 H1N1 vaccine contacts is available. Many states are asking providers to pre-register to receive 2009 H1N1 vaccine – your state or local immunization program can provide more information.

Can I/T/U facilities purchase their own supply of 2009 H1N1 vaccine?
No. 2009 H1N1 vaccine is not a commercially available product. This vaccine is only available from the Federal government through CDC and State/local health departments. There is no charge for the vaccine and no option to purchase extra doses of the vaccine through private channels.

Will there be a separate vaccine allocation for IHS-served populations and other tribal communities?
No. There will not be a separate allocation for tribal populations. Vaccine for tribal populations will come out of state allocations. States and local areas need to work with their tribal populations to ensure access to vaccine.

Will there be a separate vaccine allocation for healthcare personnel working in an IHS, Tribal or Urban Indian (I/T/U) facility?
Maybe. There may be a separate vaccine allocation for all federal healthcare personnel, including those employed in an I/T/U facility. This would include federal, tribal and contract employees. Until this is decided, sites should work with their state/local contacts to secure 2009 H1N1 vaccine for their healthcare personnel.

What are the requirements for I/T/U providers to receive and administer 2009 H1N1 vaccine?
All providers of 2009 H1N1 vaccine will need to complete a provider agreement, which outlines the conditions the provider agrees to, including adherence to recommendations for use of vaccine and submission of vaccine utilization reports to the state.

Can we bill third party payers for 2009 H1N1 doses administered?
You cannot bill for the cost of the vaccine, as the federal government will be covering the cost of the vaccine. An administration fee for patients who have insurance or who are enrolled in Medicaid or Medicare can be billed.

Will there be enough 2009 H1N1 vaccine for everyone?
Eventually there will be sufficient 2009 H1N1 vaccine to vaccinate everyone in the United States who wants to be vaccinated. Initially, however, there will be a limited supply of 2009 H1N1 vaccine, which is why recommendations for target and priority groups have been developed. Because they are at higher risk for getting and spreading 2009 H1N1 influenza and/or suffering complications, these priority groups should receive the vaccine first. Once the priority groups have been vaccinated, vaccine can be offered to others as outlined in the ACIP recommendations.

Protecting our elders is important. Why aren't people 65 and older a priority group for 2009 H1N1 vaccine?
Studies show that people 65 years and older are less likely to be infected with 2009 H1N1 then younger age groups. People of any age who take care of infants less then 6 months, however, are among the initial target groups for 2009 H1N1 vaccine. Once demand for vaccine has been met among the initial target groups, other groups, including those 65 years and older, can be vaccinated.

Who should we contact with questions or concerns related to 2009 H1N1 vaccine distribution?
State immunization programs are coordinating vaccine distribution in each state. Questions concerning vaccine distribution should be referred to your state immunization program. A list of state immunization program contacts is available. In addition, each IHS Area has an IHS Emergency Management Point of Contact (EMPOC) and an IHS Area Immunization Coordinator who may be able to assist. EMPOC information is included below. A list of the IHS Area Immunization Coordinators is available.

Where can I find more information on 2009 H1N1?
General information on 2009 H1N1 as well as a link to the CDC website with specific guidance for certain groups and settings can be found at Flu.gov. Some specific links for certain topics include:

• Schools
• 2009 H1N1 Vaccine
• Clinical and Public Health Guidance
• 2009 H1N1 Vaccine Planning

Contact Information

IHS Emergency Management Points of Contact

IHS Area	Name	Telephone	Email
HQ	CDR Darrell LaRoche	(301) 443-0046 office	Darrell.laroche@ihs.gov
HQ Alternate	CAPT B. Kevin Molloy	(615) 467-1504 office	Bruce.molloy@ihs.gov
Aberdeen	CDR Jon Fogarty	(605) 226-7510	Jon.fogarty@ihs.gov
Alaska	LT Kevin Bingley	(907) 729-3610	Kevin.Bingley@ihs.gov
Albuquerque	CDR Brian Hroch	(505) 248-4594	Brian.hroch@ihs.gov
Bemidji	Mr. Louis Erdrich	(218) 444-0507	Louis.erdrich@ihs.gov
Billings	CDR Gary Carter	(406) 247-7090	Gary.carter@ihs.gov
California	Mr. Ed Fluette	(916) 930-3945 ext. 334	Edwin.fluette@ihs.gov
Nashville	CAPT B. Kevin Molloy	(615) 467-1504 office	Bruce.molloy@ihs.gov
Navajo	Ms. Sherri Helton	(928) 871-1370	sherri.helton@ihs.gov
Oklahoma	CAPT Richard Turner	(405) 951-3877	Richard.turner2@ihs.gov
Phoenix	CAPT Greg Heck	(602) 364-5062	Gregory.heck@ihs.gov
Portland	LCDR Celeste Davis	(503) 326-7273	Celeste.davis@ihs.gov
Tucson	George Bearpaw	(520) 295-2402	George.bearpaw@ihs.gov

CDC Division of State and Local Readiness Project Officers

Projects	Project Officer	Telephone	E-mail
Arkansas, New Mexico, Oklahoma, Louisiana, Texas	Roy "Clint" Matthews Brandy Peterson	404-639-7638 404-553-8226	div8@cdc.gov ftn6@cdc.gov
Iowa, Colorado, Kansas, Missouri, Nebraska	Terence Sutphin   Leslie Gross	404-639-7441   404-553-8226	tus9@cdc.gov  ftm2@cdc.gov
Montana, N. Dakota, S. Dakota, Utah, Wyoming	Greg Smith   Wilma Jackson	404-639-7703	gqs0@cdc.gov cvn8@cdc.gov
American Samoa, CNMI, FSM, Guam, Hawaii, Marshall Islands, Palau, Arizona, Nevada, California, and Los Angeles County	Janice McMichael Tara Brown	404-639-7943   404-639-7836	jrm6@cdc.gov hju0@cdc.gov
Alaska, Idaho, Oregon, Washington	Andrea Davis Leslie Gross	404-639-7177   404-553-8226	goa9@cdc.gov ftm2@cdc.gov
Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, Vermont	Thelma Williams Carol Chiv	404-639-7305 404-553-8226	tdw6@cdc.gov ftl5@cdc.gov
New York City, New York State, New Jersey, Puerto Rico, U.S. Virgin Islands	David Culp Maureen Turner	404-639-5962	isq7@cdc.gov
Delaware, District of Columbia, Maryland, Pennsylvania, Virginia, West Virginia	Trevia Brooks Re' Dhonda Malone	404-639-7613 404-553-8226	tnb9@cdc.gov ftm8@cdc.gov
Alabama, Florida, Georgia, Kentucky, Mississippi, N. Carolina, S. Carolina, Tennessee	Mark Green Elizabeth Martinez	404-639-7268 404-639-7086	mlg5@cdc.gov esm5@cdc.gov
Chicago, Illinois, Indiana, Michigan, Minnesota, Ohio, Wisconsin	Terrance Jones Ngozi Ogbuawa	404-639-7047 404-553-8226	tcj9@cdc.gov ftn3@cdc.gov
Guam - Pedro (Peter) Judicpa		(w) 671-735-7283 (c) 671-898-3202	pjudicpa@cdc.gov
New Mexico - Lisa Davis		505-476-8248(w) (c) 404-512-4428	lbd2@cdc.gov
Tennessee - Robert Newsad		TBD
Kentucky - Angela Deokar		502-564-7243 X3603 815-501-0775	ftm4@cdc.gov
Wisconsin - Diane Downie		608-267-2887 919-672-1709	ftl9@cdc.gov
Georgia - Charles Reneau		706-833-6531	iub2@cdc.gov
District of Columbia - Anupama Tantri		212-676-2940	fvq1@cdc.gov
District of Columbia - Artensie Flowers		(w) 202-671-0706 (c) 301-806-1873	gtr4@cdc.gov

* PPE includes surgical masks, N-95 respirators, gowns and gloves

** HCP at high risk include those providing direct patient care to known or suspected 2009 HIN1 patients or lab personnel collecting or handling specimens from possible 2009 H1N1 influenza patients.