More than $18-million worth of Tamiflu in federal and provincial warehouses has started to expire, forcing health officials to decide on the value of spending public dollars to restock antiviral drugs in case of a future pandemic.
About three million doses of the drug in Ottawa's national emergency stockpile are nearing the end of their five-year shelf life. About six million more have been expiring in British Columbia, Ontario, Quebec and Nova Scotia.
Public health officials, in the midst of evaluating their response to H1N1, are faced with three options: Destroy the expired oseltamivir - Tamiflu's generic name - and purchase more; reprocess the existing stock to prolong its shelf life (a program that has yet to receive regulatory approval and would also come with a hefty price tag); or make do with the millions of antiviral drugs it purchased just before and during the pandemic.
The benefits of bolstering the stockpile of antivirals to treat influenza have to be weighed against shelling out millions of dollars more for an expensive drug, the effectiveness of which is under some debate, and when there's vaccine already on hand. Tamiflu costs $50 for a 10-pack (a five-day supply), although Hoffmann-La Roche, the Swiss maker of the drug, said the Canadian government gets it at a discounted rate.
"We now have the opportunity to look a little bit more rigorously at how large does that stockpile need to be. … I think it's a legitimate question to ask, 'Does it need to be replenished to the level it was?' " said Lynn Johnston, president of the Association of Medical Microbiology and Infectious Disease Canada.
The country's $2-billion campaign to protect Canadians against an influenza pandemic has come under scrutiny. Despite the millions spent, less than half the population was vaccinated. And in yet another controversy, ID Biomedical, which is owned by GlaxoSmithKline, has filed four separate applications in Federal Court to stop the government from making public the contract it received to produce the country's H1N1 vaccine. The contract became a source of controversy during the pandemic as serious issues with supply and delivery of the vaccine occurred and the government failed to release important details about the nature of its relationship with GSK.
John Spika, director general of the centre for immunization and respiratory infectious diseases at the Public Health Agency of Canada, said the government is reviewing its response to the pandemic, including the use of antivirals, and will likely have a decision by the fall on what it will do with its expiring stockpile.
The country's pandemic plan recommended the purchase of enough antivirals for 17.5 per cent of the population, although such provinces as B.C. and Ontario decided to augment that amount when significant stockpiling began in 2004. The federal government's national emergency stockpile system has another 23 million doses of antivirals, which includes Relenza, a less popular option because it must be inhaled.
Tamiflu works best when taken within 48 hours of the onset of symptoms, such as fever, cough and sore throat. Eric Young, B.C.'s deputy provincial health officer, said that even though the H1N1 pandemic was not as severe as feared, the antivirals reduced the death rate and the number of people hospitalized. His province recently exchanged its 2.9 million expired doses for ones with a seven-year shelf life.
"It still behooves us to plan for a moderate pandemic and be prepared to actually treat hundreds of thousands of people," Dr. Young said.
The antiviral drug was seen as an effective way to treat pregnant women in the second wave of the H1N1 virus, before a vaccine became available. But antivirals, unlike antibiotics, don't work well all the time, because viruses are much more wily than bacteria and resistance develops quickly. And studies have shown that taking Tamiflu doesn't reduce the duration of illness by much.
Citing competitive reasons, Hoffmann-La Roche declined to reveal how much it charges Ottawa for the antivirals, although the total cost of the federal government's emergency stockpile shows that each dose costs just over $2. If the pills were to be reprocessed, which entails removing and replacing the expired ingredients within the capsule, the government would pay a fee, a company spokeswoman said.
With a report from Carly Weeks