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

6. International Trends Regarding Antivirals for Prophylaxis

Few national governments have made firm decisions to stockpile antivirals for prophylaxis during an influenza pandemic (see Annex 3.6). Therefore, little guidance is available to assist the development of a policy on this issue. However, some relevant benchmarking information was found in a review of approaches in Australia, France, Germany, Italy, Japan, Mexico, the UK, and the US. Data was drawn from a survey conducted in 2006 by the Global Health Security Action Group (GHSAG), and from national plans posted on the Internet. There is international interest in Canada’s process, including the public and stakeholder consultations, for addressing this complex issue.

Key Findings

The available data indicate that six of the eight countries examined by TGAP have committed to using antivirals for treatment, but not yet for prophylaxis, during the pandemic period. (Several countries have indicated that prophylaxis may be used as part of containment or rapid response efforts). Five of these six countries have set stockpiling targets that, when compared on a per capita basis, exceed our current Canadian target of 55 million doses. The plans of all eight countries exclude amantadine stockpiling.

None of the six countries with treatment-focused strategies has committed to providing antivirals for prophylaxis, and although five have indicated that use for post-exposure prophylaxis is under discussion, many uncertainties have delayed final decisions. Where prophylaxis is being discussed, the focus is on post-exposure prophylaxis for health care workers and for household contacts of cases.

The other two countries (of the eight examined) plan to use their antivirals primarily for prophylaxis. One, with the smallest per capita stockpile of the eight, will focus its limited supply on post-exposure prophylaxis of health care workers and other first responders. It has not committed to other uses of antivirals and has insufficient supplies for a treatment strategy. The other country, with a high per capita stockpile, is currently focused on defending its territory against pandemic influenza for as long as possible or ideally until a vaccine becomes available. If this defence strategy fails, the focus is expected to shift to preventing infection in essential service providers and in those whose work puts them at high risk of exposure to and spreading of the virus.

The continuing absence of firm policy decisions regarding the prophylactic use of antivirals was confirmed in updates provided by European countries at a 2007 conference in France.

Conclusions

Many developed countries are evaluating the potential uses of antivirals for prophylaxis during an influenza pandemic, although few have committed to such uses. Canada will continue to monitor progress internationally and could enter into an exchange of information with other countries, once a policy decision is reached.

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