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

[Previous] [Table of Contents] [Next]

Conclusions

In summary, the pan-Canadian policy recommendations on the expanded use of the NAS during an influenza pandemic proposes the use of population-based prophylaxis in only one phase of the pandemic, namely for post-exposure prophylaxis in the Pandemic Alert Period, specifically during pandemic phases 4 and 5, prior to any significant spread of the virus in Canada. In phase 6, where pandemic influenza is widespread, it proposes that the focus be almost entirely on early treatment, and that the National Antiviral Stockpile only be used for prophylaxis for outbreak control in closed facilities in which people at high risk of poor outcomes reside.

The scientific evidence requires extrapolation in terms of use, from a known seasonal virus to a novel or pandemic virus, from study populations to target or general populations, and safety data from a limited sample size to potentially a very large sector of the population. The degree of comfort in making these extrapolations depends on the expected and acceptable risk-benefit on a population basis. In addition, decisions are to some extent constrained by the current standards of care and by the legal realities of making a recommendation that would constitute an off-label use of antivirals, or in which implementation challenges might result in inequitable access to this intervention. Specifically, there are logistical difficulties in ensuring that on a population basis all potential target groups for whom prophylaxis might be beneficial can be accessed equally and monitored appropriately. Although considerations of safety, efficiency, cost, legal obligations or existing standards may be accepted as a stronger basis for recommendations than considerations of compliance or logistics, TGAP has attempted to bring elements of both into its recommendations.

TGAP recommends that its proposed strategy be combined with steps for systematic monitoring and appropriate management of a pandemic situation as it proceeds, and that, as relevant new data become available, governments be ready to adjust their policies, plans and priorities accordingly.

[Previous] [Table of Contents] [Next]