#19,014
With seasonal influenza raging in North America, Europe, and Asia it isn't terribly surprising that we are - once again - seeing reports of sporadic shortages of the antiviral oseltamivir by both the media, and industry watchdogs.
Two days ago, Becker's Hospital Review published Tamiflu shortages emerge during severe flu season, which reports in some regions pharmacists - and even hospitals - are scrambling to find doses.
Similarly, on the 7th, Bloomberg reported Flu Patients Struggle To Find Tamiflu As Virus Surges Across US. But the problem isn't limited to the United States; Drug Shortages Canada lists both actual and anticipated shortages of several strengths of oseltamivir.
While not every community is affected, shortages are concerning since delays in starting tamiflu can reduce its effectiveness. The CDC urges:
There are prescription flu antiviral drugs that can treat flu illness; those should be started as early as possible and are especially important for patients at higher risk for flu-related complications.1
We've looked at the importance of starting oseltamivir early (1st 48 hrs. of illness) many times before, including in 2024's Clinical Inf. Dis.: Benefit of Early Oseltamivir Therapy for Adults Hospitalized with Influenza A: An Observational Study.
While the FDA hasn't weighed in on these most recent reports, the American Society of Health-System Pharmacists’ (ASHP) drug shortage database lists (as of Jan 7th) 10 oseltamivir products (various manufacturers and strengths) are in short supply.
Sporadic shortages and delays in getting Tamiflu are not uncommon, as we saw in 2022 in the CDC HAN #0482: Prioritizing Antiviral Treatment of Influenza in the Setting of Reduced Availability of Oseltamivir.
That shortage led to the HHS Releasing Some Tamiflu Supplies From the Strategic National Stockpile.
Since the demand for oseltamivir is elevated globally, it isn't clear how long it will take for supply chains to adjust, alleviating these delays. While there are other options such as Baloxavir, they aren't well stocked by many pharmacies in the United States.
All of which makes it more important than ever to take steps to avoid, or at least reduce the impact, of getting the flu.
As we discussed yesterday in Preprint: Antibodies elicited by the 2025-2026 influenza vaccine in humans, serological evidence suggests this year's flu shot isn't a complete miss - and while it might not prevent infection - for many it may help reduce its severity.
While exact numbers have never been disclosed, our National Strategic Stockpile supposedly has somewhere around 50-60 million courses of oseltamivir on hand; sufficient to treat 15-20% of the nation during a severe flu pandemic (assuming a single, standard dose).Masking, avoiding crowds, increasing indoor ventilation, and using hand sanitizers can add additional valuable layers of protection. And if you do get sick, stay home.
Stockpiles of Baloxavir are similarly unknown, but according to a media report in 2024 (see The U.S. strategic drug stockpile is inadequate for a bird flu outbreak) likely numbers only in the hundreds of thousands of doses.
How to get those vital medications from the government warehouses, to thousands of hospitals and pharmacies, and then the `last mile' to the patient (who will need to start them within 24-48 hours of falling ill) - is a legitimate logistical challenge.
While I'm hopeful our antiviral armamentarium will help `take the edge off' the opening months of the next pandemic, it is by no means guaranteed. Meanwhile, vaccines may be a year or more away (see SCI AM - A Bird Flu Vaccine Might Come Too Late to Save Us from H5N1).
Once again, our first line of defense will likely rely heavily on NPIs (non-pharmaceutical interventions), like face masks, hand washing, ventilation, staying home while sick, and avoiding crowds.
Which is why I'm recommending that people consider now (see #Natlprep 2025: Personal Pandemic Preparedness).what they will do if another pandemic flu should embark on a new world tour.
