Antiviral Stockpiling for Antiviral Stockpiling for Novel Strains of Novel Strains of

InfluenzaInfluenza

Background for StockpilingBackground for Stockpiling

Strategic National Stockpile Strategic National Stockpile ((Administered by the Centers for Administered by the Centers for Disease Control and Prevention)Disease Control and Prevention)

The SNS is designed to provide The SNS is designed to provide supplies for a disastersupplies for a disaster

Currently comprised of 12-hour Push Currently comprised of 12-hour Push Packages and Vendor Managed Packages and Vendor Managed Inventory for rapid response measuresInventory for rapid response measures

Other special supplies availableOther special supplies available

SNS Antiviral Stockpile CreationSNS Antiviral Stockpile Creation

Lack of effective vaccine creates an Lack of effective vaccine creates an immediate need for antiviral drugsimmediate need for antiviral drugs

Antiviral drugs are limited in supply Antiviral drugs are limited in supply and may be cost prohibitiveand may be cost prohibitive

Two types of antiviral medications Two types of antiviral medications stockpiled and recommended for stockpiled and recommended for novel influenza usenovel influenza use

SNS Antiviral StockpileSNS Antiviral Stockpile

Utah has been given an SNS allotment Utah has been given an SNS allotment of 350,518 courses (held by CDC)of 350,518 courses (held by CDC)

This allotment would treat This allotment would treat approximately 13.6% of the State’s approximately 13.6% of the State’s current populationcurrent population

State Antiviral StockpilesState Antiviral Stockpiles CDC has allowed states to purchase of CDC has allowed states to purchase of

additional courses at their contracted additional courses at their contracted price with a 25% subsidized matchprice with a 25% subsidized match

Total courses available to Utah for Total courses available to Utah for subsidized purchase - 246,956 subsidized purchase - 246,956

Total cost estimates for subsidized Total cost estimates for subsidized allotment is about $3.6 million dollars allotment is about $3.6 million dollars (does not include storage expenses)(does not include storage expenses)

SNS and State StockpilesSNS and State Stockpiles

The sum of the SNS allotment for Utah The sum of the SNS allotment for Utah and the subsidized courses provides a and the subsidized courses provides a total of 597,475 courses total of 597,475 courses

This would treat 23.1% of the current This would treat 23.1% of the current Utah population (one course per patient)Utah population (one course per patient)

IssuesIssues

Stockpiling ExpensesStockpiling Expenses

Effectiveness of antiviral drugs is not Effectiveness of antiviral drugs is not clearly established for novel clearly established for novel influenza virus strainsinfluenza virus strains

Stockpiles may not effectively be Stockpiles may not effectively be rotated to extend shelf-liferotated to extend shelf-life

Shelf-life extension programs are not Shelf-life extension programs are not currently allowed at the state levelcurrently allowed at the state level

Assumptions for Public ConcernAssumptions for Public Concern

The public likely expects preparation The public likely expects preparation efforts to be comprehensiveefforts to be comprehensive

Antiviral drugs may save livesAntiviral drugs may save lives Fairness in rationing and policies for Fairness in rationing and policies for

useuse Lack of a significant influenza event Lack of a significant influenza event

may discredit the use of funds – may discredit the use of funds – pumps at the Great Salt Lake pumps at the Great Salt Lake

Allowances for PurchasingAllowances for Purchasing

States may pool money from local States may pool money from local governments or other private governments or other private organizations to purchase antiviral organizations to purchase antiviral drugs under the federal contractdrugs under the federal contract

The State is responsible for the The State is responsible for the purchase payment and is allowed purchase payment and is allowed one deliveryone delivery

A letter of intent is required by A letter of intent is required by December 29, 2006 for purchaseDecember 29, 2006 for purchase

Priorities for UsePriorities for Use

Multiple stakeholders need to be Multiple stakeholders need to be unified on antiviral drug priorities for unified on antiviral drug priorities for administrationadministration

The National Vaccine Advisory The National Vaccine Advisory Committee has developed guidance Committee has developed guidance to assist in prioritizing administration to assist in prioritizing administration protocolsprotocols

Limited supplies dictate antiviral Limited supplies dictate antiviral drugs should be used primarily for drugs should be used primarily for treatment and limited prophylaxistreatment and limited prophylaxis

Equity in RationingEquity in Rationing Initial patients may exhaust stockpilesInitial patients may exhaust stockpiles Some communities may have outbreaks at later Some communities may have outbreaks at later

datesdates Antiviral medications in the State stockpile might be

distributed for use follows:1. Sixty percent (60%) to be distributed according to

the population of each district2. Twenty percent (20%) distributed according to the

number of general medical beds in each jurisdiction3. A reserve of 20% be maintained at the State for

distribution according to need, including coverage of priority groups identified, or for outbreak control

Planning AdaptationsPlanning Adaptations

Uncertainty requires plans be Uncertainty requires plans be flexible, coordinated, and approved flexible, coordinated, and approved effectivelyeffectively

Stakeholder coordination requires an Stakeholder coordination requires an efficient decision making processefficient decision making process

RecommendationsRecommendations Pursue funding for antiviral drug purchasePursue funding for antiviral drug purchase Approve recommendations of the National Vaccine Approve recommendations of the National Vaccine

Advisory Committee for use of antiviral drugsAdvisory Committee for use of antiviral drugs Allocate purchased stockpiles based on health Allocate purchased stockpiles based on health

district population, hospital beds, and retain a district population, hospital beds, and retain a State reserveState reserve

Recommend that hospitals, healthcare providers, Recommend that hospitals, healthcare providers, and others be allowed to purchase under the and others be allowed to purchase under the federal contract through the Statefederal contract through the State

Develop an integrated State plan including storage, Develop an integrated State plan including storage, management, distribution, dispensing, management, distribution, dispensing, accountability of use, assessment of efficacy, and accountability of use, assessment of efficacy, and adverse eventsadverse events