Pan-canadian public health network council report and policy recommendations on the use of antivirals for prophylaxis during an influenza pandemic

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Introduction

1. Task Group on Antivirals for Prophylaxis (TGAP) - Origins

A National Antiviral Stockpile (NAS) has been established for early treatment of pandemic influenza. In February 2006, the Public Health Network Council (PHNC) and the Council of Chief Medical Officers of Health (CCMOH) agreed to recommend a pan-Canadian process to facilitate informed decision-making regarding the advisability of F/P/T governments stockpiling antivirals or expanding the use of the NAS for prophylaxis indications (prevention) during an influenza pandemic. At the May 2006 Conference of F/P/T Ministers of Health, officials were directed “to immediately begin a process aimed at the creation of a national policy recommendation on the provision of prophylactic antivirals (prevention) for use during an influenza pandemic.”.¹ (see Annex 1).

The Task Group on Antivirals for Prophylaxis (TGAP) was established by the PHNC to undertake this complex process, leading to the development of pan-Canadian policy options. It was mandated to work on three parallel tracks, namely:

1) a review of scientific evidence and other key considerations (legal, health system/logistical, ethical/societal, First Nations and Inuit, federal/provincial/territorial policy, and international) related to antivirals and their use for prophylaxis;

2) public consultation, to examine the views and priorities of Canadians, including stakeholders and target groups (i.e., potential recipients of prophylactic antivirals) in this area; and

3) a review of groups for whom antivirals might be considered for prophylaxis.

TGAP is co-chaired by a provincial/territorial (P/T) government member and a representative of the Public Health Agency of Canada (PHAC). Its other members represent the areas of public health, emergency management, Aboriginal health, communications, policy, legal services, and ethics (see Annex 2 for TGAP Origins, Mandate, Membership).

A detailed plan of work, including methodology and questions to be considered, was proposed by TGAP and endorsed by PHNC in June 2006.

2. Antiviral Strategy Goals and TGAP Assumptions

The response to an influenza pandemic requires a multifaceted strategy made up of many components, such as surveillance, public health measures, immunization with a pandemic vaccine, public communications, care of the sick, and the use of antivirals for treatment. Immunization with a pandemic vaccine, when available, will be the most effective public health intervention during a pandemic. However, since development of a new vaccine against a novel influenza virus may to take up to six months, antivirals are likely to be the only virus-specific intervention available during the initial pandemic response.

The mandate of TGAP is to consider whether antivirals for prophylaxis should be a further component of this population-based strategy to help attain the goals of the Canadian Pandemic Influenza Plan for the Health Sector (CPIP). If recommended, the provision of prophylactic antivirals would be seen as a complement to (not a replacement for) measures already contained in the strategy, including the use of antivirals for treatment.

In support of the goals of the CPIP, TGAP identified the goals of the Antiviral Strategy for Canada as contributing to:

• reducing serious illness and overall deaths due to pandemic influenza;
• slowing or potentially stopping the spread of a novel influenza virus; and
• mitigating societal disruption, by reducing the impact of absenteeism due to illness in the critical infrastructure sectors.

The role of TGAP is limited to developing policy recommendations on whether F/P/T governments should stockpile antivirals for prophylaxis, or expand the use of the National Antiviral Stockpile to include prophylaxis indications. While its comprehensive analysis of key considerations and findings will be of value to individual health practitioners, to other organizations, and to the private sector, its recommendations are specifically to inform the development of a population-based policy using government funds.

Additionally, TGAP was not tasked with providing recommendations on the use of antivirals for prophylaxis during outbreaks of avian influenza² or as a component of a containment effort should a virus with pandemic potential arise within Canada.³

TGAP’s work was based on the following planning assumptions: pandemic activity of moderate severity in Canada, origin of the pandemic strain outside of Canada; and a pandemic virus consistent with seasonal influenza in terms of high risk groups and epidemiologic parameters, such as incubation period.

3. Report Outline

This Report initially presents a synopsis of background and contextual issues. It then summarizes the expert reviews of key considerations relevant to the proposed use of the National Antiviral Stockpile for prophylaxis, and describes TGAP’s process for development of recommendations, including approaches to the selection of potential target recipient groups. Finally, it presents a recommendation for use of antivirals during an influenza pandemic, together with corollary recommendations.

A sound rationale is put forward for policy recommendations on the potential use of the National Antiviral Stockpile for prophylaxis indications. Should decision-makers decide to expand its use to include prophylaxis, this paper lays the groundwork and provides the recommendations necessary for policy development and implementation.

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