IDSA says US antiviral supply for flu falls far short

Jun 17, 2005 (CIDRAP News) – The Infectious Diseases Society of America (IDSA) is calling the US government's stockpile of antiviral drugs "totally inadequate" in the face of a potential influenza pandemic.

The IDSA says the current stockpile of antivirals for flu is enough for only 2.3 million courses of treatment. IDSA President Walter Stamm, in a Jun 15 letter to Health and Human Services (HHS) Secretary Mike Leavitt, called that amount "totally inadequate and unlikely to provide any meaningful benefit to our population."

"When the next pandemic hits, antivirals will be our only defense for at least the first six to nine months it takes to make a new vaccine," Stamm stated in an IDSA news release. "But right now, if Asia's bird flu or another strain turns into a pandemic, we'll be caught nearly empty-handed."

The IDSA, an organization of about 8,000 physicians and others dealing with infectious diseases, asserts that HHS should have an antiviral stockpile sufficient to treat at least 52 million to 84 million flu patients and to use preventively in at least another 15 million to 40 million essential healthcare workers and emergency responders.

The IDSA statement says government officials are cool to the idea of stockpiling antiviral drugs because they are not convinced the drugs could reduce the death toll in a pandemic.

But the IDSA asserts that research on existing flu strains has shown that antiviral drugs, if used within the first 48 hours of symptoms, can cut the number of hospitalizations in half, reduce complications such as pneumonia, and shorten the illness. They also can prevent flu in the first place, the group says.

The society estimates that an adequate stockpile could cost up to $1 billion. Kathleen Neuzil, MD, a member of IDSA's Pandemic Influenza Task Force, said in the news release, "But we are spending far more than that preparing for smallpox and anthrax attacks. Those are serious threats, but they are unlikely—compared to the serious and very likely threat of a flu pandemic."

Stamm's letter said the government should begin expanding its stockpile now, because it will take several years to build an adequate amount.

Marc Wolfson, a spokesman for the HHS Office of Public Health Emergency Preparedness in Washington, DC, provided information confirming that the HHS has enough oseltamivir (Tamiflu) to treat 2.3 million people. He cited an October 2004 HHS news release stating that by December (2004) the agency expected to have that amount in hand. Oseltamivir is considered the most effective antiviral for H5N1 influenza, the avian flu strain that has infected more than 100 people in Asia.

By e-mail, Wolfson told CIDRAP News, "There are plans to purchase additional antiviral medication for the stockpile, but I have not been given any specific quantities at this point."

A recent report in the British magazine Nature said that Britain has ordered enough oseltamivir for about 25% of its population and Canada has stockpiled enough to cover about 5% of Canadians. The current US stockpile would cover less than 1% of the population.

The World Health Organization has been urging countries to stockpile the drug in advance, the Nature report said. It takes about a year to make a batch of the drug, and the manufacturer, Roche, has no spare production capacity, the magazine reported. The cost of one treatment course is between $10 and $30.

In related news, health experts held a news conference yesterday in Washington, DC, to warn that the world is poorly prepared for a flu pandemic. The event marked the publication by the journal Foreign Affairs of four articles on the threat of pandemics, primarily focusing on the risk of a flu pandemic.

Though they didn't try to predict when a pandemic might erupt, the experts said governments around the world should increase research and preparedness efforts immediately, according to a report in the Minneapolis Star Tribune. Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said, "This [threat] is not going to go away. Get rid of the 'if.' This is going to occur."

Michael T. Osterholm, PhD, MPH, said policy makers should figure out how to maintain food supplies if a pandemic cripples transportation and food processing, according to a Canadian Press report on the news conference. He said a pandemic erupting very soon would put the world in difficult straits: "We're pretty much screwed right now if it happens tonight." Osterholm is director of the University of Minnesota Center for Infectious Disease Research and Policy, publisher of this Web site.

See also:

Nature report on antivirals

Jun 10 CIDRAP News report "Foreign Affairs focuses on pandemic threat"

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