Over half of US state and territorial public health preparedness directors (PHPDs) surveyed said they experienced shortages of flu antiviral drugs such as oseltamivir (Tamiflu) during the 2022-23 respiratory virus season, forcing many to turn to national or state stockpiles, according to a research letter published late last week in JAMA.
Researchers from the Centers for Disease Control and Prevention (CDC) and the Association of State and Territorial Health Officials surveyed 38 PHPDs from states, territories, and large independent metropolitan health departments from January to August 2023.
The 38 PHPDs represented all 10 US Department of Health and Human Services (HHS) regions, although the anonymous nature of the survey precluded identifying specific jurisdictions.
In December 2022, the CDC issued a public health advisory encouraging prioritization of oseltamivir for hospitalized flu patients, as well as outpatients at increased risk for severe illness. HHS's Administration for Strategic Preparedness and Response for the first time allowed jurisdictions to access Tamiflu from state, territorial, or national stockpiles.
Early, more active flu season
Twenty respondents (52.6%), including at least one in each HHS region, said certain formulations of oseltamivir, baloxavir, and zanamivir were in limited supply.
Sixteen respondents (42.1%) said that, amid the shortages, local clinicians and public health officials promoted flu vaccination. Thirteen PHPDs (34.2%) reported flu outbreaks in long-term care facilities, with no access to oseltamivir for symptomatic residents or prevention in those exposed to the virus.
It is possible that local antiviral shortages were due to earlier and higher than expected influenza activity in the 2022-2023 influenza season compared with the 2020-2021 and 2021-2022 influenza seasons,
Of 22 PHPDs in states or territories with stockpiles for pandemic flu, 10 (45.5%) reported obtaining stockpiled oseltamivir in response to shortages. Seven of 15 respondents (46.7%) in jurisdictions with no stockpile said they requested oseltamivir from the Strategic National Stockpile.
"It is possible that local antiviral shortages were due to earlier and higher than expected influenza activity in the 2022-2023 influenza season compared with the 2020-2021 and 2021-2022 influenza seasons, with consequent higher demand for oseltamivir," the study authors wrote, adding that the results highlight the need to monitor local and national antiviral supply distribution.