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 Tuesday, October 17.

This morning, Matt and I visited a hospital in Taipei to observe how influenza vaccines administered during the seasonal influenza vaccination campaign are distributed from the manufacturer to local clinics, hospitals, and health departments. A successful campaign depends on the timely delivery of usable vaccines that have been kept in proper cold-chain storage, and the Taiwan’s process appears to be extremely well planned and executed by Taiwan CDC.

Twice a week throughout the seasonal influenza vaccination campaign, vaccines are distributed from the manufacturer to 22 local health bureaus—roughly analogous to state health departments in the US—and then ultimately to 3500 local hospitals and clinics across the country. This overall process is led by Taiwan CDC, who coordinates with local health bureaus to determine the number of doses required for each delivery as well as vaccine manufacturers who provide delivery services for each health bureau. Before taking custody of the vaccine from the vendor, the temperature of the delivery truck is checked and recorded as well as the lot (or “batch”) number of each box. The local health bureau then coordinates distribution to the local hospitals and clinics. The local health bureaus are responsible for monitoring vaccine storage conditions (e.g., temperature) until the vaccines are transferred to the hospital or clinic to ensure the vaccine remains safe and effective. Any damaged vaccines are reported to the Taiwan CDC so that replacement vaccines can be included in the next distribution shipment.

To ensure an adequate vaccine supply throughout the campaign, local health bureaus are responsible for determining the number of vaccine doses needed by their respective jurisdictions each week and submitting the information to Taiwan CDC. The majority of the delivered inventory is earmarked for hospitals and clinics, and the local health bureau coordinates with these facilities to determine their respective vaccine requirements. Additionally, the local health bureaus must also account for mass vaccination events at schools, nursing homes/long-term care facilities, and nurseries/preschools. The local health bureaus coordinate these vaccination events, and they must ensure that the associated doses needed for the events occurring during the upcoming delivery period are included in the request to Taiwan CDC.

Diane and I hanging out in the vaccine cold storage with our colleagues from Taipei City.

Diane and I hanging out in the vaccine cold storage with our colleagues from Taipei City.

The volume of influenza vaccine administered each year and the limited capacity for local storage combined with multiple vendors supplying vaccines each week requires coordination on the part of Taiwan CDC. Since the start of the 2017 vaccination campaign on October 1, Taiwan has already administered more than 2 million vaccines across the country, nearly two-thirds of the total vaccine administered in during the entire 2015-16 flu season.