Antiviral Stockpiling for Novel Strains of Influenza

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Antiviral Stockpiling for Novel Strains of
Influenza
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Background for Stockpiling
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Strategic National Stockpile (Administered by the
Centers for Disease Control and Prevention)

• The SNS is designed to provide supplies for a
  disaster
• Currently comprised of 12-hour Push Packages and
  Vendor Managed Inventory for rapid response
  measures
• Other special supplies available

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SNS Antiviral Stockpile Creation

• Lack of effective vaccine creates an immediate
  need for antiviral drugs
• Antiviral drugs are limited in supply and may be
  cost prohibitive
• Two types of antiviral medications stockpiled and
  recommended for novel influenza use

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SNS Antiviral Stockpile

• Utah has been given an SNS allotment of 350,518
  courses (held by CDC)
• This allotment would treat approximately 13.6 of
  the States current population

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State Antiviral Stockpiles

• CDC has allowed states to purchase of additional
  courses at their contracted price with a 25
  subsidized match
• Total courses available to Utah for subsidized
  purchase - 246,956
• Total cost estimates for subsidized allotment is
  about 3.6 million dollars (does not include
  storage expenses)

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SNS and State Stockpiles

• The sum of the SNS allotment for Utah and the
  subsidized courses provides a total of 597,475
  courses
• This would treat 23.1 of the current Utah
  population (one course per patient)

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Issues
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Stockpiling Expenses

• Effectiveness of antiviral drugs is not clearly
  established for novel influenza virus strains
• Stockpiles may not effectively be rotated to
  extend shelf-life
• Shelf-life extension programs are not currently
  allowed at the state level

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Assumptions for Public Concern

• The public likely expects preparation efforts to
  be comprehensive
• Antiviral drugs may save lives
• Fairness in rationing and policies for use
• Lack of a significant influenza event may
  discredit the use of funds pumps at the Great
  Salt Lake

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Allowances for Purchasing

• States may pool money from local governments or
  other private organizations to purchase antiviral
  drugs under the federal contract
• The State is responsible for the purchase payment
  and is allowed one delivery
• A letter of intent is required by December 29,
  2006 for purchase

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Priorities for Use

• Multiple stakeholders need to be unified on
  antiviral drug priorities for administration
• The National Vaccine Advisory Committee has
  developed guidance to assist in prioritizing
  administration protocols
• Limited supplies dictate antiviral drugs should
  be used primarily for treatment and limited
  prophylaxis

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Equity in Rationing

• Initial patients may exhaust stockpiles
• Some communities may have outbreaks at later
  dates
• Antiviral medications in the State stockpile
  might be distributed for use follows
• Sixty percent (60) to be distributed according
  to the population of each district
• Twenty percent (20) distributed according to the
  number of general medical beds in each
  jurisdiction
• A reserve of 20 be maintained at the State for
  distribution according to need, including
  coverage of priority groups identified, or for
  outbreak control

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Planning Adaptations

• Uncertainty requires plans be flexible,
  coordinated, and approved effectively
• Stakeholder coordination requires an efficient
  decision making process

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Recommendations

• Pursue funding for antiviral drug purchase
• Approve recommendations of the National Vaccine
  Advisory Committee for use of antiviral drugs
• Allocate purchased stockpiles based on health
  district population, hospital beds, and retain a
  State reserve
• Recommend that hospitals, healthcare providers,
  and others be allowed to purchase under the
  federal contract through the State
• Develop an integrated State plan including
  storage, management, distribution, dispensing,
  accountability of use, assessment of efficacy,
  and adverse events