Use of antivirals, antibiotics and pandemic vaccines is included in a consultation launched by the government this week to update its pandemic flu strategy.
The UK Influenza Pandemic Preparedness Strategy, which updates the 2007 National Framework to encompass the lessons learnt from swine flu, proposes:
- that pandemic preparedness and response plans should be "precautionary, proportionate and flexible;"
- the need to plan for a range of scenarios to meet the differing demands of pandemic flu viruses, rather than just focusing on the "worst case" planning assumptions;
- taking greater account of regional differences in the speed and spread of the disease, both across the world and within the UK; and
- taking better account of research on how people are likely to think, feel and behave during a pandemic.
The consultation document notes that while the prescribing of antiviral drugs during seasonal flu outbreaks is usually restricted to people in at-risk groups, the Department of Health is planning to change the regulations to allow general practitioners (GPs) to prescribe antivirals for patients who are not in an at-risk group but who they consider may be at risk of developing serious complications from flu. It is proposed that GPs will be guided by the Chief Medical Officer (CMO) in using this flexibility.
"However, in a pandemic, where infection levels are expected to be widespread due to the absence of population immunity and the nature and severity of the virus is unknown in advance, more widespread deployment of antiviral medicines may be recommended," the document adds.
The government plans to maintain a stockpile of antivirals for use in a new pandemic and, in line with current scientific advice, both Roche's Tamiflu (oseltamivir) and GlaxoSmithKline's Relenza (zanamivir) have been stockpiled to ensure the response can be as flexible and resilient as possible, "particularly against the risk of a pandemic virus strain developing resistance to oseltamivir," it says.
However, in light of scientific and clinical evidence at the time, antiviral treatment may be limited, for part or all of the pandemic, to people in at-risk groups if the pandemic proved to be very mild in nature or if antiviral supplies were being depleted too rapidly.
The government does not currently plan to adopt a general strategy of "household prophylaxis" - ie, giving antivirals to the household contacts of a person with flu - apart from during a very limited initial period as part of a range of measures aimed at slowing the spread of the disease. Such a policy would further result in large numbers of antivirals being wasted or issued unnecessarily, and there is evidence from the H1N1 flu pandemic in 2009 that many people who received the drugs for prophylaxis did not complete the course, it notes.
Turning to antibiotics, the document says a stockpile of those most likely to be useful for complications arising from pandemic flu will be maintained and made available "if there was clear evidence of shortages in the supply chain in primary or secondary are during a pandemic."
On vaccines, it says, the government currently holds a limited supply of H1N1 vaccine and that pre-pandemic vaccines, "if useful," would be prioritised for the protection of front-line healthcare workers and those in clinically at-risk groups.
Pandemic-specific vaccines are unlikely to become available before at last four to six months after the start of a pandemic and, as a contingency measure, the government is currently in discussions with manufacturers about the possibility of securing new advance supply agreements for a pandemic-specific vaccine to be available as soon as it is developed.
On proposals for pandemic vaccination programmes, the document states that "the presumption should be that the prioritisation of vaccine will depend on the emerging profile of at-risk groups for a new pandemic virus, with priority given to clinical risk groups and front-line health and social care workers. There are no plans to prioritise vaccine for any other specific groups or sectors for business continuity reasons."
The consultation will run until Friday, June 17, and the finalised strategy will be published later this year.