On March 13, 2020, the president of the United States declared a national emergency in response to the coronavirus disease 2019 (COVID-19) pandemic (1). With reports of laboratory-confirmed cases in all 50 states by that time (2), disruptions were anticipated in the U.S. health care system's ability to continue providing routine preventive and other nonemergency care. In addition, many states and localities issued shelter-in-place or stay-at-home orders to reduce the spread of COVID-19, limiting movement outside the home to essential activities (3). On March 24, CDC posted guidance emphasizing the importance of routine well child care and immunization, particularly for children aged </=24 months, when many childhood vaccines are recommended.

During the influenza A (H1N1) 2009 pandemic, the Countermeasure and Response Administration (CRA) system, a Centers for Disease Control and Prevention (CDC) computer-based informatics application, monitored H1N1 vaccine uptake during the early stages of the US vaccination program, from October through the end of November 2009. CRA, which directly monitors vaccine doses administered, was developed to support the mass tracking of medical countermeasure use during public health events and to complement population-based survey data on vaccination coverage during a pandemic influenza vaccination program. CRA provided weekly near real-time reports of H1N1 vaccine doses administered at national and state levels. On average, during any given week, 58.8 percent of the total data available to be reported was actually reported to CDC. During the 8-week mandatory reporting period, a cumulative total of 13,109,962 first-dose vaccine doses administered were reported through CRA, representing approximately 4.4 percent of the US population. Nearly 60 percent of these doses were administered to individuals aged 6 months to 24 years, an age interval that was included in the initial target groups prioritized to receive vaccine. CRA was a key component of the national surveillance system providing information on early uptake of H1N1 vaccine and monitoring program progress. These accomplishments indicate that CRA can effectively function as an immunization tool to monitor vaccine uptake during a pandemic.

The Countermeasure and Response Administration (CRA) system is a Centers for Disease Control and Prevention informatics application developed to track countermeasures, including medical interventions (eg, vaccinations and pharmaceuticals) and nonmedical interventions (eg, patient isolation, quarantine, and personal protective equipment), administered during a public health response. This case study follows the use of CRA as a supplement to paper-based processes during an exercise in which antimicrobials dispensed to individual exposed persons were captured after a simulated bioterrorist attack of anthrax spores. The exercise was conducted by the New Hampshire Division of Public Health Services on April 14, 2007. Automated systems like CRA can track when medications are dispensed. The data can then be used for performance metrics, statistics, and in locating victims for follow-up study. Given that this case study was limited to a single location in a relatively rural setting, the authors concluded that more study is needed to compare the feasibility of using an automated system rather than paper-based processes for effectively managing a very large-scale urgent public health response.