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

5. Federal/Provincial/Territorial (F/P/T) Considerations

A pan-Canadian policy decision on whether F/P/T governments should stockpile antivirals or expand the use of the NAS to include prophylaxis could provide the basis for related policies in all jurisdictions in Canada. The policy may establish guiding principles that will allow consistent and equitable application to Canadians across the country, while including sufficient flexibility to accommodate the differences in management and structure of health systems from one jurisdiction to another. This may present challenges in communicating the strategy to the public and to target groups (see Annex 3.5).

Key Findings

The NAS was established to secure a supply of antiviral drugs for early treatment during an influenza pandemic, and to facilitate equitable distribution and consistent use of this limited resource. The stockpile of 55 million doses has been distributed among provinces and territories on a per capita basis, with costs shared between the federal and P/T governments according to a 60:40 formula. Some jurisdictions may have purchased additional doses, at their own cost.

The ability of jurisdictions to pay their share of any recommended increase in the stockpile for prophylaxis, or to purchase additional doses on their own, may vary. An agreed F/P/T cost-sharing formula will be a key factor in determining jurisdictions’ ability and/or willingness to support a pan-Canadian policy recommendation. There is currently no F/P/T agreement on cost-sharing to replace NAS stocks used or expired.

There is some uncertainty as to the total size and proposed utilization of publicly-funded stockpiles in Canada. Additionally, purchases of antivirals by private sector and other organizations provide a currently unknown degree of access to early treatment and/or prophylaxis for some employees/citizens which may lead to differential access to antivirals within Canada and impact on local public health antiviral implementation strategies.

Implementation of a decision to use antivirals for prophylaxis will require robust public health capacity as well as clear roles and responsibilities. Management of large numbers of people, including the organization of health care delivery, antiviral storage and distribution, must be well coordinated. There will be challenges related to remote communities, and consistency, e.g., similar workers, such as nurses or police, working side by side but employed by different jurisdictions.

Conclusions

Implementation of the pan-Canadian early treatment strategy could serve as a model for a pan-Canadian prophylaxis strategy. It would assist in addressing logistical challenges, such as adverse events surveillance programs, prescription-related activities, and distribution systems.

Transparency across jurisdictions regarding the intent and current status of each jurisdiction’s stockpile of antivirals for prophylaxis is important because it would facilitate uniformity of decisions and allow for an informed decision-making process on whether the use of the NAS should be expanded to include prophylaxis.

A specific agreement, with costs of additional antivirals shared between the F/P/T governments, is required to pursue the prophylaxis strategy.

There must be close cooperation and information-sharing among all levels of government, including regional/local health and public safety authorities. Ongoing communication from governments to the public should include open discussion of the strategy and its purpose, and explanation of any apparent operational incongruities.

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