Dr. Richard Mandsager was in Juneau, Alaska, last week urging legislators to fund a stockpile of the anti-viral drug Tamiflu for Alaskans — just in case a flu pandemic hits.
Questions remain whether Tamiflu will be effective against the H5N1 bird flu virus. No clinical trials have focused on H5N1, but laboratory studies have shown it is susceptible to the drug, state health officials say. So far, 177 people have contracted the illness worldwide, 98 of whom died. Some treated with Tamiflu lived, while others did not, said chief state epidemiologist Jay Butler.
Still, health officials say it may be the best bet for battling a possible widespread outbreak of a new flu strain.
The drug Mandsager, state public health director, is trying to reserve for Alaskans is not a new medication created specifically for a flu pandemic. Instead, the U.S. Food and Drug Administration approved Tamiflu in 1999 to treat early cases of uncomplicated flu. A year later, the federal agency expanded its approval to use the drug marketed by Roche Laboratories Inc. to prevent influenza.
Tamiflu, which also goes by the name oseltamivir phosphate, requires a doctor’s prescription and comes in pill form. The length of the course you take depends on whether you’re treating a flu illness or trying to prevent one.
The typical treatment course is 10 pills taken twice a day for five days. For someone exposed to the flu but not yet sick, a single pill taken for 10 days is designed to prevent illness, Butler said.
A complication is that the medicine prevents illness only as long as it is taken. In case of a pandemic, people wanting to ward off sickness would take the drug for as long as they were exposed to the virus, which could mean multiple courses of the drug, he said.
Building a Stockpile: The federal government is building up its own supply of Tamiflu. It has 5.5 million courses in reserve, with another 12.4 million more of Tamiflu and 1.75 million courses of another anti-viral drug on order.
Meanwhile, federal health officials want states to set aside their own supplies. Alaska health officials and Anchorage leaders have plans for limited stockpiles for the state and the state’s largest city.
Mandsager initially requested about $1.23 million to buy courses of the drug. Gov. Frank Murkowski supported the bid. The bulk of that money would come from state funding, with the rest coming from the federal government. State health officials hoped to use the funding to buy 20,000 to 25,000 courses of Tamiflu for Alaska.
After talks with state health officials, the House Finance Budget Subcommittee recommended reducing the allocation to $563,600. How much Tamiflu that would buy is unknown because the buying price isn’t determined yet.
Estimates have ranged from $20 to $40 a course, according to Mandsager. At $20, that may mean the state could still order the original request of 20,000 to 25,000 courses and stay within the proposed reduced budget. Otherwise, state health officials may come back next year to request more anti-viral drugs.
Right now, Alaska has only about 1,000 courses in reserve, Mandsager said. The total number of courses Mandsager would like to order would cover only about 4 percent of Alaska’s population, meaning the stockpile will have to be prioritized strictly.
Anchorage’s health department also is looking into creating a small stockpile of Tamiflu for its health care providers and other critical workers.
“It’s not economically feasible to buy enough doses for the entire population,” said Nathan Johnson, manager for community health planning for the Anchorage Department of Health and Human Services. Johnson said he’s looking for $50,000 in grant money to cover the expense of Anchorage’s stockpile of about 1,000 to 1,500 Tamiflu courses; at the moment, there’s no definite funding source.
Who gets the Tamiflu? At the state level, Tamiflu will be used to treat people who are sick or those at risk of getting sick. That means people who are hospitalized with flulike symptoms, those with other medical conditions, children younger than 2 years old, adults older than 65 and pregnant women. The state also wants to give Tamiflu first to health care workers and first-responders, Butler said.
If there are enough Tamiflu courses to prescribe some for preventative purposes, Butler said priority would be given to people who are critical to maintaining health care and other necessary services. That might mean giving preventative doses to a health worker who was the only person in a community providing care, he said. That medication might help the provider stay healthy and continue treating the rest of the community.
Anchorage’s stockpile is meant solely for people who keep the city running. That means giving the drug first to 1,000 to 1,500 public health workers, police, firefighters and other first-responders. These people are needed to keep the city safe and healthy, Johnson said. If they don’t feel safe coming to work, then the city’s safety and health also are threatened.
“We need to be able to offer them some sort of protection, and although the Tamiflu is not a silver bullet, it’s better than nothing,” Johnson said.
Priority also would be given to utility workers, such as those who supply gas to residents’ homes, and port workers who offload barges carrying food to the city and state.
“If there was a big scare and all the people at the port walked off, there wouldn’t be enough food for the people in Anchorage,” he said.
Ideally, and if funding is available, Johnson, Butler and Mandsager said the stockpiles of Tamiflu will be ordered and in hand by the end of 2006.