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 Monday, October 16.

This morning, Diane and I met with the division director and senior technical specialist for Taiwan CDC’s Division of Preparedness and Emerging Infectious Diseases to discuss the history, operation, and impact of Taiwan’s seasonal influenza mass vaccination program. The program began in 1998 with the goal of improving vaccination coverage for the elderly population (i.e., age 64 years and older), and it now includes as eligible populations children age 6 months to 18 years; adults age 50 years and older; pregnant women; healthcare workers and first responders; individuals with chronic health conditions; nursing home and long-term care facility staff; poultry and livestock workers; and newly added this year, parents of children under 6 months and nursery school/preschool caretakers. This program subsidizes the cost of vaccinations for these high-risk groups, with an out-of-pocket cost of approximately US$5 or less.

Diane learning about the seasonal flu vaccine medical screening process in Taiwan.

Diane learning about the seasonal flu vaccine medical screening process in Taiwan.

The seasonal influenza mass vaccination campaign in Taiwan grew steadily from 1 million doses in 1998 to 3 million doses in 2015. But a particularly severe flu season in 2015-16 provided impetus for the Taiwan government to allocate additional resources to the program, doubling the number of available doses to 6 million for the 2016-17 and 2017-18 flu seasons. This increase enabled Taiwan CDC to expand the eligible high-risk groups to include adults age 50-64, who were struck particularly hard in 2015-16, and junior high and high school students. It also likely improved vaccine availability for those in priority groups with renewed interest in getting vaccinated after the unusually severe 2015-16 flu season.

The increased vaccine purchase allowed Taiwan CDC to expand its list of targeted high-risk populations again this year to include parents of children less than 6 months old and nursery school/preschool staff. The goal: improve protection for young children—who are particularly susceptible to complications associated with influenza—by surrounding them with vaccinated adults. Taiwan CDC included nursery/preschool-age children as a priority population in 2009, and while public health officials have made steady progress in improving vaccine coverage for this high-risk group, they felt an additional step was required to ensure protection. Taiwan CDC continues to promote vaccination in young children, but this new effort provides a secondary means of protection.

Taiwan is one of just a few countries that have domestic vaccine production capacity, but rather than rely on a 100% domestic production, they have elected to supply only a fraction of their total demand via the local manufacturer. Taiwan CDC contracts through two overseas manufacturers to provide the remaining vaccine inventory, which they say is a decision made to ensure a reliable vaccine supply should domestic production be interrupted. The foreign manufacturers are contracted to deliver the vaccine to Taiwan, arrange local storage, and distribute the inventory throughout the country as directed by Taiwan CDC. Utilizing multiple vaccine manufacturers from multiple counties provides critical redundancy to Taiwan’s seasonal, and potentially pandemic, influenza preparedness efforts.

Our visit so far has been amazing, and we have already learned so much about Taiwan’s seasonal influenza mass vaccination program.  Tomorrow morning, Diane and I will observe vaccine distribution operations in Taipei and then attend a weekly press conference with the Taiwan CDC Deputy Director-General.