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When Flu Season and COVID-19 Collide

How McKesson’s flu vaccine team mobilized to prepare for a potential flu and COVID-19 “twindemic”

Unprecedented. It’s the word that many people will use to define 2020, and one that also reflects how what happened this year led to a number of “firsts” across many industries. This undoubtedly rings true for the team that oversees McKesson’s seasonal flu vaccine program.

To-date this year, McKesson has sent roughly 49 percent more doses of flu vaccines to customers throughout the U.S. than it did last season.

It’s already more than the company – the country’s largest distributor of seasonal flu vaccines – has ever distributed throughout any given season in its history.

“Even in the season immediately following the H1N1 flu pandemic in 2009, we didn’t send that many seasonal flu doses,” says Omar Bateh, director of vaccines, McKesson Medical-Surgical. “This is a new record.”

It’s a feat that certainly wasn’t part of McKesson’s original plan going into this year. But then COVID-19 hit.

Planning for the Unplanned

No two flu seasons are alike. As flu strains mutate year over year, so too do infection rates, severity, vaccine efficacy and, consequently, the number of vaccines needed throughout the country.

“We have this saying in the industry – ‘If you’ve seen one flu season, you’ve seen one flu season,’” quips Jon Schwarze, director of vaccines, Pharmaceutical Solutions and Services, McKesson. “Every flu season brings something different. We have our processes, but it really boils down to being agile and ready to handle whatever happens. That’s never been truer than it is this year.”

Every spring, McKesson begins the process of negotiating distribution agreements with vaccine manufacturers. These agreements culminate from months of close planning that starts with manufacturers, who begin the year with a baseline number of vaccines they plan to develop. McKesson then works with its customers – hospitals, physicians’ offices and retail pharmacies – to pre-book the number of vaccines they plan to administer for the upcoming season. By March of this year, McKesson had already completed this part of the process and was prepared to distribute a similar number of doses throughout this season as it did during the last.

But then COVID-19 began spreading through the country the same month. Faced with the threat of flu season and COVID-19 combining to create a “twindemic,” McKesson realized it needed to re-evaluate the number of doses its customers would require to help protect people throughout an extremely challenging respiratory season.

With the possibility of higher demand, avoiding a vaccine shortage meant McKesson had to go back to the drawing board with manufacturers and customers – and fast.

“Manufacturers can’t just flip the switch and start making more flu vaccines when demand changes,” Bateh explains. “Typically, it takes them about seven to eight months to grow, fill and finish a flu vaccine, and then also get FDA approval on that lot before it can be released for distribution.”

The McKesson team contacted its customers to communicate these unforeseen variables potentially impacting their success in the season ahead. As a result, additional pre-booking demand for flu vaccines in the U.S. market went up significantly. For retail pharmacy customers, requests soared.

To meet this surge in demand, McKesson went back to the manufacturers and the Centers for Disease Control and Prevention (CDC) to forecast how many additional vaccines needed to be produced. It also evaluated the timetable to deliver them once ready – an event that usually happens between July and September each year. With additional lots potentially not ready until November or December, McKesson needed to account for not only an extended distribution timeline to continue supporting demand throughout the season, but also the possibility that the pandemic could directly impact where those doses would be most needed.

Historically, the majority of patients get their flu shot during annual check-ups at their doctor’s office. With social distancing measures in place, however, Schwarze and Bateh anticipated those typical behaviors could change this year.

“In the event we experienced a spike in COVID-19 cases this flu season, we knew people might not go to their physicians’ offices for a routine visit, meaning they wouldn’t be getting vaccinated there,” Bateh says. “But they might still go to a retail location or a local pharmacy to get their flu shot. So we are closely monitoring our inventory in case we need to shift doses across our supply chains to make sure they’re going to the appropriate place at the appropriate time.”

Schwarze added that his team has always utilized an inventory sequestration tool that’s integrated across all McKesson distribution centers. As potential customer supply needs arise this season, McKesson can move any unused flu vaccines across the supply chain to those who need it.

Delivering Success in a Year of Disruption

In October, the CDC officially announced the beginning of the U.S.’ 2020-2021 flu season. And, as predicted, it’s one that’s already anything but ordinary.

As Bateh and Schwarze had anticipated, pharmacies are currently handling a surge in vaccinations. By Oct. 2, they had experienced a 72 percent increase in vaccinations over the same time last year, according to October 2020 IQVIA data. And McKesson teams have continued meeting this record demand.

It’s an early success driven in part by McKesson’s ability to mobilize when plans fall apart. In a year of virtually no constants, the two that have carried McKesson’s flu vaccine team to success in the past are the same that have helped them do so throughout COVID-19 – a versatile and adaptive supply chain, and continuous communication with customers, with industry partners, and with each other throughout every step of the process.

“You might think that because of COVID-19 we’re doing things very differently this season,” says Schwarze. “But from an operational standpoint, we’re doing it the same way we always have – leveraging everything that our supply chain and team of experts can offer so we can help our customers succeed during flu season – pandemic or not.”

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