Massachusetts Department of Public Health
Massachusetts Vaccine Purchasing Advisory Council (MVPAC) Meeting
Date: Thursday, January 17, 2013
Time: 4-6 PM
Location: Massachusetts Medical Society, 860 Winter Street, Waltham, MA 02451
                Middlesex North Conference Room
Agenda
1.	DPH/Legislative Update

2.	Review and Final Approval of Operating Procedures
3.	Discussion of Guiding Principles for Council Deliberations
4.	Confirmation of future meetings (thru 2014)
Dates (typically 3rd Thursday of every quarter):
April 25, 2013
July 18, 2013
October 17, 2013
January 16, 2014
April 24, 2014
July 17, 2014
October 16, 2014
Time: 4-6PM
Location: Massachusetts Medical Society, 860 Winter Street, Waltham, MA 02451

Attendees:
MVPAC Council Members:
Ronald Adler, MD
David Brumley, MD, MBA
Michael Chin, MD
Kevin Cranston, MDPH
Anthony Dodek, MD
Benjamin Kruskal, MD, PhD
Thomas Hines, MD 
Susan Lett, MD, MPH, MDPH
Richard Moriarty, MD
Sean Palfrey, MD
Ronald Samuels, MD, MPH
Kate Wallis, RN, BSN
Other Attendees:
Beth English, MPH, MDPH
Cynthia McReynolds, MBA, MCAAP Immunization Initiative
Bob Morrison, MDPH
Pejman Talebian, MA, MPH, MDPH
Kristen Cormier, Merck
Jose Costello, Novartis
Michael Goldstein, Merck
Deb Gonyar, GSK
Paul Graml, GSK
Jim Palazzo, GSK
Sherry Schilb, Sanofi Pasteur
Reno Soucy, GSK

Introductions/Administrative
•	Kevin Cranston convened the meeting.
•	Council members and attendees introduced themselves.

DPH/Legislative Update
•	Lauren Smith, MD, is Interim Commissioner of the Department of Public Health, replacing John Auerbach.
•	John Polanowicz, President of St. Elizabeth’s Medical Center, will replace Dr. JudyAnn Bigby as Secretary of Health and Human Services. The process for selection of a permanent Commissioner of DPH will occur once Mr. Polanowicz is in place.
•	The state FY2014 will be introduced by Governor Patrick later this month. It is anticipated that the budget for immunizations will be solid.
•	The proposed legislation, An Act Establishing the Massachusetts Childhood Vaccine Program, did not pass in the prior legislative session. There is reasonable expectation that the legislation will be re-filed in the current legislative sessions.
•	Legislation passed on the last day of the session requiring DPH to annually provide informational influenza materials to parents.
•	The current influenza season began early. The Boston Public Health Commission declared a state-of-emergency on January 9th. It is hoped that the peak has occurred. Massachusetts remains in the top tier of states in influenza coverage.

Review and Final Approval of Operating Procedures
•	The minutes from the previous meeting were reviewed. A question was raised as to whether the minutes should be formally approved by the Council. As the Council is operating by consensus, a vote to approve them is not needed.
•	Meeting minutes will be taken by DPH, reviewed and approved internally, and posted. There was Council consensus about this process.
•	Mr. Cranston noted that the goal at this meeting was to discuss and reach consensus about the operating procedures so that they can be utilized at future meetings to get into the real business of vaccines to be reviewed by the DPH.
•	Mr. Talebian provided an update on the questions with legal implications raised during discussion of the operating procedures at the October 25th meeting.
•	The October Council meeting minutes outlined suggestions for operating procedures.
•	Those items upon which consensus was reached at the October meeting have been incorporated into the current Operating Procedures (distributed at this meeting).

•	Article III (Membership) Section 4.1 (Conflict of Interest)
o	DPH legal counsel suggested that instead of creating a specific Conflict of Interest policy for the Council, the Council should follow the requirements of the Commonwealth’s Conflict of Interest Law.
o	The link to this law can be viewed online and is listed in Section 4.1 of the operating procedures.
o	There was consensus that the Commonwealth’s Conflict of Interest law should be followed by the Council; however, there also was consensus that Council members should be officially notified of any changes made to the law.

•	Article IV (Governance), Section 2 (Attendance)
o	Because the Council must follow state open meetings laws, the Council cannot hold meetings by conference call or email.
o	By open meeting laws, a council member may participate by conference call if (1) there is Council consensus about this type of participation as a general rule (2) if the member meets one of the statutory requirements (e.g. illness, emergency), and a quorum (no fewer than 10 members) is physically present at the meeting site.
o	A Council member meeting the statutory requirement who participates by conference call can vote as long as there is a quorum at the physical meeting.
o	There was consensus about defining and including participation by statutory requirement in the Operating Procedures.
o	An emergency Council meeting can be scheduled with 48 hours’ notice (and posting), but cannot be held remotely.
o	There was consensus that the general principle allowing the Council to call an emergency meeting be included in the Operating Procedures; however, each Council meeting must be convened by the DPH.
o	The DPH is not constrained by the Council in making vaccine decisions during an emergency (Article II, Mission and Purpose; Section 2, Purpose)

•	Article IV, Governance, Section 5, Voting
o	The document will be updated to allow voting by remote participants if there is a quorum.
•	In Summary:
•	Participation rules, including electronic participation, will be clarified in the final Operating Procedures.
•	Remote participants can vote if there is a quorum of at least 10 Council members physically present.
•	Emergency meetings will be allowed, but must be convened by DPH consistent with open meeting law; meetings must still follow quorum requirements.
•	Non-attendance at emergency meetings will not count against Council member attendance requirements.
•	A question was raised about discussing new business during a Council meeting.
•	The Council agenda must be posted 48 hours prior to the meeting. The agenda cannot be changed after that time. There was consensus that agenda items may be recommended up to two weeks prior to the meeting date. An exception to the consensus rule was made by a Council member motion to approve the Operating Principles as written and amended. The motion was seconded and carried unanimously.

Discussion of Guiding Principles for Council Deliberations
•	MVPAC-developed Guiding Principles will be utilized for Council recommendations to the DPH about the purchasing of vaccines by the DPH.
•	The Guiding Principles of the MCAAP Immunization Initiative were distributed as a starting point for discussion about the Council’s Guiding Principles. Mr. Cranston noted that while the MCAAP Guiding Principles would be used as a starting point for discussion, the Council is not bound by these principles.
•	Dr. Palfrey provided background on how the MCAAP Guiding Principles were utilized by the MCAAP for making recommendations to the DPH.
•	Mr. Talebian noted that Article II, Mission and Purpose, Section 2, Purpose, of the Operating Guidelines states that “The Council shall take into account safety and efficacy, and may take into account provider input, vaccine characteristics, cost, availability and other factors as determined by the Council.” Safety and efficacy as detailed above are somewhat binding.
•	After discussion, the following list was compiled for consideration as Guiding Principles:
•	Safety
•	Efficacy
•	Vaccine costs
•	Reducing barriers to optimal vaccination rates
•	Provider and patient issues
•	Factors that enable physicians to get vaccines to as many kids as possible
•	Vaccine supply issues (consideration of recent history and likely supply)
•	Conservatism - minimize changes in vaccines year to year
•	Convenience
•	Market share considerations (if all else equal)
•	These items will be grouped together into broader categories and prioritized as follows: 
1.	safety and efficacy
2.	cost and supply issues
3.	provider and patient issues 
4.	market share.
•	These considerations will be organized into a MVPAC Guiding Principles document and circulated for review.

Confirmation of Future Meetings
•	Proposed agenda items for the next and future Council meetings: 
•	DPH reported that at this time no urgent decisions are needed on specific vaccines;
•	DPH will provide Council members with the budget and current array of DPH vaccines for review;
•	DPH/legislative updates (standing agenda item);
•	Divide vaccines up for review at each meeting so that all vaccines are reviewed annually (standing agenda item);
•	Consideration of principles for recommending purchases of influenza vaccine going forward.
o	Quadrivalent influenza vaccine;
o	Efficacy and cost differentials for influenza vaccines;
o	Pre-ordering prices for influenza vaccine. Multi-dose vials of influenza vaccine for infants versus individual dosing vials;
•	Upcoming ACIP recommendations and vaccines being developed;
•	Ease of use (combination vaccines);
•	Guidance to DPH about process for inviting industry partners to provide written information or presentations on current and future products to be discussed/considered by Council;
•	Vaccine presentations by colleagues who are experts about a vaccine proposed for discussion, but are not Council members.

•	DPH noted that its 2013-2014 influenza vaccine order must be submitted to the CDC prior the next Council meeting.

•	The meeting was adjourned.