By Dr Tomislav Meštrović, MD, PhD
Influenza pandemics have occurred over the past few centuries at intervals of between 10 and 40 years, resulting with high morbidity and mortality, as well as huge economic impacts. Considering the uncertainties regarding the origin, timing and virulence of future pandemic strains, planning strategies for an effective response have become the chief priority of global public health efforts.
Many countries started to practice stockpiling on antiviral drugs such as oseltamivir (known under a brand name Tamiflu) prior to the emergence of influenza A as an essential strategy for pandemic response before a new vaccine could be widely distributed. Such approach might substantially reduce morbidity, hospitalizations and mortality. In parallel to that, stockpiling for personal usage has also gained momentum.
Government vs. personal stockpiling
Pandemic stockpiling of oseltamivir is considered cost-saving to the economy over a wide array of treatment stratagems. It can also be cost-saving to the healthcare system directly, if the drug use is limited for patients at high risk. Furthermore, favorable cost-benefit ratio can be achieved if stockpiled drug is administered either solely as a therapeutic approach, or as short-term prophylaxis for exposed contacts.
In the United States, oseltamivir and other antiviral drug stockpiles have been established at the Federal level and many States have also established stockpiles. The Federal Government also encourages employers to consider stockpiling oseltamivir for use during an influenza pandemic as part of a comprehensive tactic.
The research suggests that, in order to reduce the risk of a subsequent wave of infections with a theoretical novel influenza similar to the one that caused the 1918 pandemic, pandemic plans should consider stockpiling oseltamivir and other antiviral drugs with a minimum capacity of 20% (relative to the population size).
Other analyses suggest that treatment with oseltamivir is always beneficial when compared to no action and that the optimal treatment stockpile is 40%–60%; 40% maximizes economic benefits, whereas 60% maximizes treatment benefits.
Personal stockpiling of oseltamivir has also become widespread during this century. For example, in the fall of 2005 there were many reports of personal stockpiling of this drug for use during an eventual future outbreak of H5N1 influenza virus infection (i.e. avian influenza), coincident with increased media coverage of the potential for a worldwide pandemic.
Controversies of personal oseltamivir stockpiling
Even though stockpiling may be useful in specific contexts, panicked and disorganized personal stockpiling of oseltamivir and other antivirals could reduce the availability of drugs for individuals with active infection and impede the strategic use of a limited drug supply when it is needed.
Greater pessimism regarding the probability of being affected by influenza is encountered among those likely to stockpile; furthermore, differences that lead to personal stockpiling reflect individuals’ personalities and their degree of apprehension about influenza (rather than differences in their basic knowledge).
The potential ramifications of self-medication with this drug include the propagation of oseltamivir resistance, unwarranted risk of adverse events, as well as suboptimal care for individuals who should receive more extensive clinical evaluation.
Given the nature of their specialty, infectious diseases physicians are often asked to prescribe oseltamivir for personal stockpiles more than the typical provider. Therefore education campaigns about appropriate use of antiviral medications that target patients during seasonal epidemics and pandemics may reduce inappropriate requests for this and other drugs.
Last Updated: Sep 1, 2015