Flu drug shortage has wide-ranging impact
GLORIA GALLOWAY
From Saturday's Globe and Mail
OTTAWA — Doctors, nurses and other emergency workers are unlikely to
receive preventive doses of a drug that is predicted to be the best defence
against infection during an influenza pandemic because the existing
stock will be needed to treat the seriously ill.
This is the reality, officials say, despite the fact that Canada's pandemic
influenza plan states that antiviral drugs, in particularly oseltamivir
(marketed as Tamiflu), could be used as a "prophylactic" to prevent or
reduce the severity of the disease among people essential to keeping
society functioning. These include firefighters, police, elected officials,
funeral directors, utility workers and even truck drivers who transport
food and medicine.
"Prophylaxis of this group will minimize societal disruption," the plan
says. And some public-service sectors are building their own pandemic
preparations around the assumption the drug will be available to at least
some of their essential personnel -- even though its effectiveness is
something of a question mark.
Given the recommended course of 10 pills over five days for each infected
person, the existing stockpile of 35 million tablets is unlikely to be
enough to treat the estimated 4.5 million to 10.6 million Canadians
predicted to fall ill should a flu pandemic occur.
And even the front-line medical workers -- who are further up the
priority list than those responsible for keeping the peace, feeding and
heating the country, and burying the dead -- would not likely get access
to Tamiflu until they themselves fell ill.
The plan estimates that if a flu pandemic hit, between 15 per cent and 35
per cent of Canadians would become so ill that they would be at least
temporarily debilitated; it also estimates that as many as 58,000 would
die. To be effective in reducing the severity of the disease, Tamiflu must
be administered within two days after its onset, but not all of the infected
would get treatment in that time period.
"If we wanted to stockpile for 35 per cent, we don't have enough, and
we're continuing to work on what the actual numbers should be and
calculating the resources that would be required to add to the reserve,"
said Dr. Paul Gully, a deputy chief public health officer at the Public
Health Agency of Canada.
And "if we wanted to use antivirals for prophylaxes of health-care
workers in direct contact with sick individuals . . . again, we would not
have sufficient" amounts.
Canada has the largest per capita stockpile of the drug of any country in
the world. But its maker, F. Hoffman La Roche Ltd., has the annual
capacity to produce enough of the drug to treat 300 million people. Given
the number of countries clamouring for it, it is extremely short supply. So
if a pandemic were to hit, it is clear that there would not be enough of the
drug to go around.
"Obviously the main aim is to get a vaccine. That has always been the
pillar," Dr. Gully said.
But a vaccine could take some time to develop.
"Antivirals would fill in the gap before we had a vaccine," he said. "Having
said that, we want to tell people that there are other things they can do to
protect themselves and to protect others if they are in fact sick."
Those include simple measures such as hand washing and staying home
when one feels sick.
Dr. Ruth Collins-Nakai, president of the Canadian Medical Association,
said large numbers of health-care workers would fall sick during a
pandemic. And there is no "surge capacity" in the system to accommodate
the loss of those doctors and nurses at a time when so many more people
would be seriously ill, she said.
"I don't think anybody should be counting on antivirals," Dr. Collins-Nakai
said. Not only is there a limited supply, "the influenza virus mutates
sufficiently fast enough that, by the time we're in the middle of the
pandemic, the virus is likely to have developed a resistance."
So she too is counting on the rapid development of a vaccine.
A prophylactic like Tamiflu would be helpful for the first few cases, she
said.
"But the trick is going to be [building> flexibility into the system and the
communication between front-line workers and the people making
decisions, so you can change the strategy as you get information from
the ground," Dr. Collins-Nakai said.
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