Such protocols can be adapted to consider developing epidemiological information and in consultation with advisory groups, thus limiting some of the crucial decision-making needed in the midst of an emergency. Vaccine procurement and access in the Americas was differential and not equitable. The first LAC countries to have access to pandemic vaccine were those with pre-existing agreements with manufacturers. Regional or sub-regional efforts should be undertaken to enhance and extend current transfer of technology agreements for vaccine production

in LAC. PAHO’s RF played a key role in providing countries and territories, especially small ones, ROCK inhibitor access to the vaccine. The vaccine donation coordinated through WHO was an international diplomatic effort aiming to provide vaccine Proteases inhibitor to those countries with less economic resources. Unfortunately, the donation process proved to be lengthy, resulting in recipient countries being the last to receive vaccine in LAC. Efforts to streamline future donation processes are necessary to ensure the timeliness and equity of such endeavors. Many LAC countries successfully implemented pandemic vaccination

campaigns, making use of the current infrastructure of the national immunization programs. They reached, on average, 99% of their pre-defined high risk target populations. However, countries had to face multiple technical and logistical challenges, including multiple vaccine presentations, vaccine with and without adjuvant, multiple vaccine shipments due to ongoing production, and non-traditional target groups. Clear guidelines and training workshops conducted prior to vaccine arrival were critical for capacity building of health-care workers to help them manage said challenges. Pregnant

women had the lowest pandemic influenza (H1N1) vaccine coverage. In some countries health care professionals were reluctant to recommend the vaccine. This issue highlights the need to enhance health-care worker training, increase the participation of scientific societies of obstetricians and gynecologists, and strengthen social communication regarding the benefits of influenza vaccination for pregnant 17-DMAG (Alvespimycin) HCl women. These lessons can also be applied to annual seasonal influenza vaccination. Given the magnitude of vaccination activities in LAC and the commitment of countries to such an effort, it is important to assess the impact of this investment in the reduction of influenza disease burden. Estimations of the impact of vaccination are underway in selected countries and have presented a series of challenges, including the absence of serosurveys conducted prior to vaccine introduction, and a lack of surveillance data stratified by vaccine target groups.