Influenza pandemics have occurred over the past few centuries at intervals of between 10 and 40 years, resulting in high morbidity and mortality rates, as well as significant economic impacts. Considering the uncertainties regarding the origin, timing, and virulence of future influenza strains, planning strategies for an effective response have become a chief priority of global public health efforts.
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Many countries started to stockpile antiviral drugs such as oseltamivir, which is more commonly known under the 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. This type of approach might substantially reduce morbidity, hospitalizations, and mortality rates. In parallel to that, stockpiling for personal usage has also gained momentum.
Government vs. personal stockpiling
Pandemic stockpiling of oseltamivir is considered to be a cost-saving measure to the economy over a wide array of treatment stratagems. Furthermore, this practice can also be cost-saving to the healthcare system directly, particularly if the drug use is limited for patients at high risk. A favorable cost-benefit ratio can also be achieved if the stockpiled drug is administered either solely as a therapeutic approach, or as short-term prophylaxis for exposed individuals.
In the United States, oseltamivir and other antiviral drug stockpiles have been established at the Federal level. Following suit, many states throughout the U.S. have also established their own stockpiles. The federal government of the U.S. 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 virus that is 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. The optimal treatment stockpile is between 40% and 60%; 40% maximizes economic benefits, whereas 60% maximizes treatment benefits.
Personal stockpiling of oseltamivir has also become widespread during this century. In the fall of 2005, for example, there were many reports of personal stockpiling of oseltamivir for use during a potential future outbreak of the H5N1 influenza virus infection (i.e. avian influenza). This increase in personal stockpiling was directly related to the increased media coverage of the potential for a worldwide pandemic.
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Controversies of personal 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. Additionally, personal stockpiling can also 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 a more extensive clinical evaluation.
Given the nature of their specialty, infectious disease physicians are often asked to prescribe oseltamivir for personal stockpiles more than the typical provider. Therefore, educational campaigns about the appropriate use of antiviral medications that target patients during seasonal epidemics and pandemics may reduce inappropriate requests for this and other drugs.