The Outbreak Observatory is conducting a pilot observation in Taipei, Taiwan. We have coordinated with colleagues at the Taiwan CDC to observe their annual seasonal influenza mass vaccination campaign. This post covers events from Wednesday, October 18.

As part of Taiwan’s seasonal influenza vaccination campaign, all schools are mandated to conduct mass vaccination events. The vaccinations themselves are not mandatory, as consent must be obtained from the children’s parents, but every school, both public and private, must offer the vaccination. Today, Diane and I attended one of these mass vaccinations at a local high school, and we had the opportunity to briefly speak with a member of the local health station (analogous to a local health department in the United States) about the program and her experience.

School-based mass vaccination events are coordinated by the local health bureaus (analogous to state health departments in the United States), but significant engagement with the Taiwan CDC, local health stations, local departments of education, schools, and private sector hospitals and clinics is required to implement them. Each year prior to the vaccination campaign, the director Taiwan CDC’s Division of Preparedness and Emerging Infectious Diseases attends the Ministry of Education (MOE) meeting of school presidents (analogous to principals in the United States) to coordinate planning for school-based vaccination events. Officials from Taiwan CDC also meet with the national parents association, which represents parents of schoolchildren from across Taiwan, to discuss the vaccination program. Involvement of the school presidents, MOE, and parents is critical to ensuring success of the school-based vaccination campaigns.

As discussed in yesterday's post, the local health bureau is responsible for determining the number of doses required for each vaccine delivery, including those for upcoming school-based mass vaccination events. In order to determine this number, health bureaus coordinate with local departments of education to obtain from individual schools the number of students participating in the event. At the beginning of the school year in early September, schools send home educational information and consent forms for parents to sign; these forms are provided by Taiwan CDC and are standardized across the country. The school administration reports the number of participating students to the local health bureau and confirms the number several days in advance, and the health bureau then coordinates distribution of the vaccine to the schools on the day of planned administration.

The health bureaus are also responsible for coordinating with local hospitals and clinics to recruit clinicians to administer the vaccines. Taiwan CDC has developed standardized requirements for school-based mass vaccinations, including the minimum number of clinicians based on the size of the student population. The clinicians conduct the necessary screening and medical examination (e.g., taking temperatures) for each student and administer the vaccine. At the completion of the event, the clinicians report the total number of doses administered to the Influenza Vaccine Information System, and the school maintains individual vaccination records for the children. These clinicians and the clinic where they work are compensated by the local health bureaus using funding from the Taiwan CDC vaccination program budget.

As part of a priority population group, the students receive the vaccine for free during the vaccine event. Those students who are unable to get the vaccine on that day (e.g., if they have an elevated temperature) or elect not to do so can still get vaccinated at a local health clinic or hospital, but they may have to pay a small administration fee. In some cases, the local health district may allocate funding to subsidize members of the school staff to receive the vaccine at the event since they are not part of Taiwan CDC’s priority populations and, therefore, not eligible for subsidized vaccination under this program.

Taiwan CDC added junior and senior high school students as a priority group in 2016 to increase vaccination coverage among this population with the aim of mitigating community transmission, and efforts such as school vaccination events contributed to coverage for this age group exceeding 70% last year. At the school we visited today, approximately 2000 students were set to be vaccinated over the course of the one-day event, a testament to the exhaustive work by Taiwan CDC, the local health bureaus and stations, local clinics, education organizations, schools, and many others to streamline the supply chain and vaccine administration process.