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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Key Considerations and Expert Reviews

2. Program Implementation – Health System/Logistical Considerations

A decision to use antivirals for prophylaxis would require consideration of how to operationalize this in a timely and cost-effective way. Pandemic preparedness plans should address ways to identify and reach those eligible to receive antivirals; how best to securely transport and store the medications; as well as questions of prescribing, dispensing, and monitoring their use. Assessment of the capability of the health system to manage this added requirement would be needed, together with an evaluation of the potential need for additional resources for implementation.

TGAP’s review of these considerations involved consultation with operational leads for pandemic planning at the provincial/territorial level, and others involved in emergency planning in Canada (see Annex 3.2).

Key Findings

The decision to use antivirals for treatment was made in May 2006, by Ministers of Health, and in concert with this, plans are being developed across jurisdictions to address the associated logistical challenges to ensure that antivirals are appropriately located to enable timely access. Any decision to extend the program to antivirals for prophylaxis requires resolution of several significant issues, most of which have an impact on logistics planning and implementation.

Consideration of which target groups should receive antivirals for prophylaxis (discussed in Section D of the Report) involves identifying critical infrastructure sectors, establishing how many positions (and individuals) are considered truly critical within them, and where these positions are located - questions which significantly impact logistics issues.

Administration of the drug in any phase of the pandemic involves consideration of how to ensure that the prophylaxis regime is initiated at the right time, as well as who is responsible for making that decision and who monitors compliance. Related supply chain issues raised by the multiplicity of delivery sites and security of product need to be examined.

Health care professionals must be able to fulfill their obligations to the end user in terms of appropriateness of a drug for the individual, informed consent, and related health teaching. One fundamental issue requiring early resolution is reassurance of those responsible for prescribing that there is a sound rationale for prescribing these medications for large groups, in the absence of clinical trial data. Those in the relevant health care professions should engage in joint discussions to plan policies and procedures, while establishing relevant information and communications strategies.

Conclusions

Logistical considerations, although significant in terms of efficient management and delivery of a prophylaxis program, cannot be the sole driver for the final policy recommendations. It is important that the decision attempt to weave together the breadth of issues considered by TGAP.

Review of issues specifically related to the prescribing, monitoring, delivery and security of antivirals for prophylaxis should benefit from and build on discussion of these issues as they relate to early treatment.

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