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Biosecurity Briefing
IOM Report Provides Recommendations for Antiviral Distribution and Dispensing Planning; Toronto Stockpiles Antivirals for Workers By Brooke Courtney, May 2, 2008 On April 25, 2008, the Institute of Medicine’s (IOM) Committee on Implementation of Antiviral Medication Strategies for an Influenza Pandemic released a report, Antivirals for Pandemic Influenza: Guidance on Developing a Distribution and Dispensing Program, which was requested by the U.S. Department of Health and Human Services (HHS) to assess best practices and policies for antiviral prophylaxis and treatment during a pandemic event.1 According to the report, the use of the antiviral medications oseltamavir (Tamiflu™) and zanamivir (Relenza™) will be one of several strategies employed to mitigate a pandemic, particularly because of the lead time required to develop an effective vaccine. Recognizing that the pandemic influenza planning process is evolving and characterized by uncertainty, changing parameters, and scarcity of resources, the committee concluded that “several overarching goals need to be kept in the forefront: developing in advance an ethical framework, communication and education of the public with clear and consistent messages, the need to reconcile actual supply and antiviral program goals, and flexibility to on the one hand react to the changes in the course of the pandemic and on the other hand, address the diverse needs of localities.”1 In addition, the committee issued the following 8 recommendations:
However, a Center for Infectious Disease Research and Policy (CIDRAP) article on the report stated that “because of the limited size of the national antiviral stockpile and the unclear [national] goals for its use, the committee was unable to provide specific guidance regarding the best methods and sites for dispensing.”2 The U.S. has approximately 72 million treatment courses of antivirals (with an ultimate goal of obtaining 81 million courses) in federal and state stockpiles, but it is estimated that more than twice the goal of 81 million courses would be needed to treat 25 percent of the U.S. population and provide prophylaxis to groups that would have occupational exposure.1,2 In addition, “[b]ased on federal government documents, it is not yet clear whether the goal of antiviral use is treatment, or a combination of treatment and prophylaxis,” according to the IOM report.1 In a National Academies News Release on April 25, the antiviral committee chair, June Osborn, stated, “We need to engage the public in a discussion about the use and distribution of antiviral drugs in advance of a pandemic when there will be limited time for deliberations because large numbers of people will be getting sick. Through a similar public dialogue, state and federal officials already have effectively built broad understanding of how a pandemic vaccine would be allocated.”3 In related news, an April 29, 2008, CIDRAP article reported that the city council for Toronto recently approved a $1.5 million plan to purchase the antiviral medication oseltamivir (Tamiflu™) to treat 13,000 city employees, or nearly one-half of the municipal employee workforce, in the event of an influenza pandemic. This plan for purchasing antivirals was executed based on the recommendation of the city’s medical officer of health, David McKeown.4 Toronto, which also appropriated over $600,000 for warehouse storage of these medicines, is the first major city in Canada to stockpile antivirals.4 The article noted that although most of the city council members support the plan, some have questioned how officials would dispense the antivirals, which employees would receive the medicine, and whether the city rushed into the decision to purchase the stockpile.4 The CIDRAP article noted that “many countries have made stockpiling oseltamivir and other antiviral medications a component of their pandemic planning.”4 According to McKeown, “it is a prudent measure to take for an event that is highly likely to occur.”5 References
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