# 2499
In August we learned that the UK intends to double their antiviral stockpile (see UK To Double Pandemic Flu Drug Stockpile) to cover 50% of that nation's population.
This is less than the target suggested by the UK's Scientific Advisory Group (SAG), which last November recommended (see How Much Tamiflu Is Enough?) a tripling of their stockpile.
The SAG stated that they believed that coverage for 75% of their population is essential if they are to "exert reasonable control over the scale and severity of the national outbreak"
Japan, which has announced plans to begin using millions of doses of their soon-to-expire pre-pandemic vaccine early next year (see Japan: Pre-Pandemic Vaccination Priority List) to inoculate high risk workers, has now announced their plan to double their antiviral stockpiles as well.
Japan, as you can see, takes the pandemic threat very seriously.
The United States currently has roughly 71 million courses (5-day treatments) of antivirals in State and Federal stockpiles. The goal is to reach 81 million courses, although the failure of some states to purchase antivirals puts that target in doubt.
The idea that 25% coverage of the population with 5-day courses of antivirals would suffice is based on two early assumptions, both of which are now called into question.
- The attack rate of a pandemic would be roughly 25%
- The 10-pill regimen of Tamiflu over 5 days is sufficient for H5N1
It has been widely reported over the past two years that doctors treating H5N1 patients have routinely exceeded the `standard' 10-pills-over-5-days course of Tamiflu. Research is ongoing to determine if `double the dose, for double the duration', or some other extended regimen isn't a more effective treatment.
In April of 2008, the IOM (Institute of Medicine) issued a report urging the United States to double our antiviral stockpile. The report, Antivirals for Pandemic Influenza: Guidance on Developing a Distribution and Dispensing Program, may be read online.
While antivirals, such as Tamiflu, have been used with moderate success in the treatment of H5N1 infections, in all fairness the decision to increase stockpiles isn't a complete slam dunk.
Antivirals are expensive, and treatment must begin in the first 24-48 hours of infection to have their greatest effects. This would present major logistical problems of early diagnosis and delivery of the medication to patients in a country the size of the United States.
Concerns remain that a pandemic virus might quickly acquire resistance to these drugs, rendering them ineffective, as we've seen happen with Amantadine in the past.
It becomes a difficult decision on how much reliance to place on these drugs.
Still, with little or no vaccine likely in the first six months of a pandemic, antivirals represent one of our few pharmacological options against a novel influenza virus.
This story from Bloomberg.
Japan to Double Anti-Flu Drug Stockpile for Pandemic (Update1)
By Kanoko Matsuyama
Nov. 28 (Bloomberg) -- Japan plans to almost double its stockpile of anti-flu drugs in case of a pandemic that could kill millions of people worldwide, the government said.
The country will hold medicine for 45 percent of its 128 million people from 23 percent now, according to guidelines by the Cabinet Office, the ministry of health and other ministries. No timeframe was provided to boost the stockpile.
Governments and the World Health Organization are stockpiling medicines in case of an avian influenza pandemic in humans. A flu pandemic could kill 71 million people worldwide and lead to a ``major global recession'' costing more than $3 trillion, according to a worst-case scenario outlined by the World Bank last month.
GlaxoSmithKline Plc's Relenza will account for about 10 percent of Japan's supplies and the government will also consider using drugs under development, Yoshinori Ito, a counselor at the Cabinet Office, told journalists in Tokyo today.
