The United States does not have nearly enough antiviral drugs on hand to fight a coming influenza pandemic, according to the Infectious Diseases Society of America (IDSA).
"When the next pandemic hits, antivirals will be our only defense for at least the six to nine months it takes to make a new vaccine," says IDSA President Walter E. Stamm, MD. "But right now, if Asia's bird flu or another strain turns into a pandemic, we'll be caught nearly empty-handed."
Currently, the Department of Health and Human Services (HHS) has only 2.3 million treatment courses of antiviral drugs available. In a June 15 letter to HHS Secretary Michael Leavitt, Dr. Stamm calls that stockpile "totally inadequate and unlikely to provide any meaningful benefit to our population."
IDSA calculates that HHS should have available at least 52 to 84 million courses to treat those who become sick with flu. At least another 15 to 40 million courses would be needed to provide preventive treatment to even a small set of essential health care workers and emergency responders.
The 1918 pandemic, the most devastating flu outbreak in the last century, killed up to 50 million people worldwide and overwhelmed public health systems. Less-severe pandemics occurred in 1957 and 1968. Infectious diseases experts agree it's only a matter of time before the next one strikes. The H5N1 bird flu strain spreading in Asia looks like a likely candidate. The Centers for Disease Control and Prevention (CDC) estimates that even a "mild" flu pandemic could kill 100,000 to 250,000 Americans if the nation is not prepared.
But government officials are cool to the idea of stockpiling antiviral drugs. They contend that studies have not been done to determine if they can reduce the number of deaths from pandemic flu strains. However, IDSA notes, research on flu strains currently circulating in the United States shows that if given in the first 48 hours of symptoms, antiviral drugs can cut the number of hospitalizations in half and can reduce the number of complications such as pneumonia. Antivirals have repeatedly been shown to reduce the duration of symptoms and the time to return to work. And they can be very effective in preventing infection.
"Building a stockpile won't be cheap," says Kathleen Neuzil, MD, member of IDSA's Pandemic Influenza Task Force. IDSA estimates that the cost of building an adequate stockpile may reach $1 billion. "But we're spending far more than that preparing for smallpox and anthrax attacks. Those are serious threats, but they're unlikely--compared to the serious and very likely threat of a flu pandemic." Furthermore, in a pandemic, direct medical care costs alone are estimated to climb above $100 billion, and the costs to the U.S. and world economies will likely be in the hundreds of billions of dollars.
"Measured against tens of thousands of American lives saved, the continued functioning of our health care system and economy, and the trust our citizens have in our public health system, the cost of an adequate antiviral response will be a bargain," IDSA's letter states.
"We recognize that these drugs are not a panacea, and many other steps are needed--better vaccine supplies, better distribution plans, and requiring vaccination for health care workers, to name a few," Dr. Stamm says. "But it will take several years to build an adequate stockpile, because production capacity is limited and the demand from other countries is high. So, now is the time for the government to commit to stockpiling these drugs, before the next pandemic starts."