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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Recommendations

2. Corollary Recommendations

These recommendations may apply to any government initiative, but should be included in any plans for antiviral prophylaxis during an influenza pandemic. In order to enable more effective application of antivirals within the health sector, and to enhance public perception and acceptance of the antiviral strategy, TGAP further recommends that:

1. A comprehensive plan be developed and implemented on how to communicate a post-exposure prophylaxis strategy and how to operationalize it. In particular:
   • an F/P/T communications strategy needs to be developed to support the announcement by the Ministers;
   • an education/outreach campaign should be developed and implemented by jurisdictions, aimed at health care providers, other critical infrastructure workers, and their leaders;
   • education materials be developed for health care providers who will be involved in prescribing and distributing antivirals;
   • specific education campaigns should be developed to improve compliance;
   • the key elements of a public education campaign should be developed for use by jurisdictions. This campaign would be launched in Phase 4 and would increase in intensity as each jurisdiction moves through the various pandemic phases;
   • the continued need to increase public awareness of basic hygiene and emergency preparedness be recognized as the foundation of pandemic preparedness and measures taken; and
   • other specific communications strategies should be developed based on legal, ethical, First Nations and Inuit issues.
2. More research should be conducted on the use of existing antivirals for post-exposure prophylaxis in a broader spectrum of settings, including long-term care facilities, and on pre-exposure prophylaxis in critical infrastructure workers, including health care workers, during outbreaks of seasonal influenza.
3. A focused examination of the available science and other key considerations regarding the provision of prophylaxis to immunocompromised persons should be undertaken. A risk-benefit analysis for this group may yield different results than for other groups at high-risk of poor outcome of influenza.
4. There should be consideration of other key issues related to the implementation of the recommended treatment and prophylaxis strategies, including:
   • identification of “critical” infrastructure workers;
   • drug delivery/security;
   • appropriate storage and stockpile management, including the development of a strategic approach to acquisition and rotation of stockpiles;
   • prescribing, monitoring and compliance systems; and
   • adverse events surveillance.
5. The need for special implementation considerations for particular First Nations and Inuit populations be reviewed and action taken as required.
   For instance, there may be critical infrastructure workers unique to First Nations on reserves and Inuit communities that need to be identified. Pre-pandemic agreements on roles and responsibilities specific to F/P/T and FN governments, relating to the purchasing, storage, delivery and administration of the antivirals, should be established, kept up-to-date, and adhered to. Clear communication policy is needed that is written in a culturally appropriate way and in several First Nations and Inuit languages.
6. Although not required by law, particular effort should be directed to adoption of a consistent policy decision across Canada. This may be more easily defended to the public as being reasonable and justifiable. If not, governments should provide full justification of the reasons for alternative decisions/approaches.
7. TGAP’s full documentation, recommendations and background material be shared with other governments, on request, once a policy decision has been made.
8. Specific to health care delivery settings, occupational health and safety measures, including infection control, should be strengthened to enable effective delivery of early treatment and post-exposure prophylaxis strategies in health care settings. Such an approach will confer the added benefits of addressing broader infection control and occupational health issues in health care workplaces.

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