Toronto officials approve antivirals for city workers

Apr 29, 2008 (CIDRAP News) – Toronto's city council yesterday approved a $1.5 million plan to treat nearly half of the municipal employee workforce with antiviral medication in the event of a pandemic scenario, making it the first major Canadian city to stockpile the drugs.

In approving the proposal to stockpile antiviral medications for some city employees, the Toronto city council heeded the recommendations of its medical officer of health, David McKeown, who advised that the city should act now to avoid a delay in acquiring a supply of oseltamivir (Tamiflu), according to a report today from the National Post, a newspaper based in Toronto.

Oseltamivir, a neuraminidase inhibitor, is used to treat seasonal flu and is both the first-choice drug for treating people infected with H5N1 avian influenza and the best hope for treatment if H5N1 evolves into a pandemic strain. Many countries have made stockpiling osteltamivir and other antiviral medications a component of their pandemic planning.

"I believe it is a prudent measure to take for an event that is highly likely to occur," McKeown said, according to the Post report.

In addition to the initial $1.5 million purchase that would treat up to 13,000 employees, the council also appropriated $606,000 to store the drug in a warehouse, the Post reported. Toronto could spend up to $5 million to stockpile drugs to keep the city workforce in place during an influenza pandemic, the report said.

Though most council members supported the plan, some questioned which of Toronto's 24,000 municipal employees would receive the drug and how city officials would dispense the antivirals, according to the Post report. Other council members asked whether the city was rushing into the antiviral purchase and if the city was taking on an extra burden that provincial and federal officials should shoulder.

However, council member John Filion said after the SARS (severe acute respiratory syndrome) epidemic, extra precautions were warranted and that the council should consider a stockpile for the whole city, the Post reported.

Though federal and state governments are the groups that typically fund and manage antiviral stockpiles, some major cities are organizing their own stockpiles. Terence Hurley, a spokesman for Roche, the maker of Tamiflu, pointed out that a US federal plan to subsidize state antiviral purchases contains a mechanism for some localities—Chicago, Los Angeles County, and New York City—to purchase the drug with federal support.

According to a December 2007 report from Trust for America's Health (TFAH), Chicago has purchased 67% of its federal subsidy (301,238 courses), Los Angeles County, 100% (1,036,444 courses), and New York City, 0% (only 30 courses).

On Apr 25 the Institute of Medicine (IOM) released a report that said the US government should expand its stockpile of antiviral drugs if its goal is to have enough doses to treat all patients and provide preventive treatment for some others at risk in an influenza pandemic. The expert committee that wrote the report also advised the federal government to clarify its antiviral use goals, because planning documents provide little concrete information on the prophylactic use of the medications.

See also:

Dec 2007 TFAH report on public health readiness

Apr 25 CIDRAP News story "IOM: US likely to need bigger antiviral stockpile"

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