Discussion Guide Public Engagement Project on the 2009 Novel H1N1 Influenza Vaccination ProgramIntroduction Background: The purpose of this project is to engage the public in discussions and deliberations about the policy dilemma associated with planning for a novel HIN1 influenza mass vaccination program to begin in October 2009. Meetings like this one are being convened by The Keystone Center, a neutral facilitator organization, under contract with the Centers for Disease Control and Prevention at 10 different sites during the month of August. For these meetings, CDC is relying on a model that has effectively engaged both stakeholders and citizens-at-large in past projects. Public Dilemma: Uncertainties remain and will continue to remain about how widespread and severe HIN] influenza will be in the US next fall, the occurrence of relatively rare adverse effects, if any, and about how much public demand there will be at the time for vaccine. These uncertainties and complexities pose a difficult dilemma because of the complexities and amounts of resources required to plan for mass vaccination well in advance of the pandemic---Should the US take a “full throttle” or a “go-easy” approach to mass vaccination, or an approach somewhere in-between? Each option has pros and cons and a difficult choice must be made in advance to reach the desired level of preparedness. Scaling up during the epidemic itself may be “too little too late” to avoid cases that snight otherwise have been prevented, and scaling down may be “too much too soon” to avoid a loss of credibility for overreacting and an unnecessary use of limited resources in a period of economic hardship.Question: ‘Whaat type of implementation planning strategy should the U.S. adopt for vaccinating Americans against the novel HIN] influenza virus? Assumptions: Severity: The severity of illness and groups at higher risk for infection ot complications will be similar to what has already been observed in the US in the spring of 2009, i.e., Pregnant women, children, young adults and individuals with underlying conditions. Safety: The safety profile of novel HIN1 vaccines will be similar to that of seasonal influenza vaccines for common, less serious reactions and the estimated risk for more serious reactions (e.g, Guillain-Barre syndrome) is between 1-10 per million persons vaccinated, HINI1 Vaccine Supply: Supplies of licensed vaccine will become available in October 2009 but enough vaccines for all will not be available until February 2010. Cost: Vaccine will be purchased by the federal government and made available to all states on a per capita basis. ‘Vaccine Recommendations: Vaccine will be recommended for 5 subgroups of the population but not for everyone at first. 2 doses will be needed for protection. Seasonal Vaccine: Novel HIN1 vaccine and seasonal vaccine availability will overlap and both will be recommended for many populations groups.