Stockpiling antiviral medications for pandemic influenza


An antiviral stockpile is a reserve supply of essential antiviral medications in case of shortage. Many countries have chosen to stockpile antiviral medications against pandemic influenza. Because of the time required to prepare and distribute an influenza vaccine, these stockpiles are the only medical defense against widespread infection for the first six months. The stockpiles may be in the form of capsules or simply as the active pharmaceutical ingredient, which is stored in sealed drums and, when needed, dissolved in water to make a bitter-tasting, clear liquid.
There are no evidence-based guidelines to guide the use of these stockpiled drugs, and plans are based on assumed similarities to seasonal influenza. The most common antivirals are neuraminidase inhibitors, which, if begun during the first 48 hours after symptoms appear, will reduce the duration of seasonal influenza by about one day. Taken before symptoms appear, it may prevent disease in about three-quarters of people treated prophylactically. Currently, this is recommended in institutionalized elderly people and other high-risk groups as a form of post-exposure prophylaxis during seasonal influenza outbreaks. However, since pandemic influenza differs somewhat from normal seasonal influenza, it is not clear that these drugs will prove either safe or effective for their intended purpose.
For a person that has very recently been exposed to seasonal influenza, effective post-exposure prophylaxis generally requires taking a drug like oseltamivir for seven to ten days, at half the daily dose needed for treatment. A person that is repeatedly exposed, such as hospital staff members, may require continuous treatment throughout the duration of the outbreak in a community. Based on experience with seasonal influenza in nursing homes, control of influenza requires full treatment of any ill persons and prophylactic treatment of all their contacts. In a pandemic situation, before a vaccine becomes available, this level of treatment and medical prevention may require providing drugs to 80% of the people in an affected community. Consequently, very large supplies of the drugs must be made available — much larger supplies than could be produced on demand. Stockpiles are generally arranged in advance by government health authorities, due to fear of shortages and an awareness of manufacturing limitations during an outbreak.

Supplies in each country

List of available treatments of antiviral per country.
RankCountry / TerritoryPopulationTreatmentsDate Last UpdatedSource
1'1,337,722,000
2'
3'50,000,000April 27, 2009Bloomberg.com
4'230,014,115
5'
6'166,146,000
7'162,221,000
8'154,729,000
9'141,833,393
10'127,630,00047,700,000November 27, 2017Ministry of Health, Labour and Welfare
11'109,610,000
12'92,226,600
13'88,069,000
14'82,062,200
15'79,221,000
16'76,030,000
17'71,517,100
18'70,495,782
19'66,020,000
20'65,073,482
21'63,389,730
22'61,612,30030,000,000April 28, 2009BBC News
23'60,090,400
24'50,020,000
25'48,697,000
26'48,333,00021,100,000August 21, 2009The Korea Times
27'46,143,700
28'45,853,000
29'44,830,423
30'43,739,000
31'42,272,000
32'39,802,000
33'39,745,613
34'38,130,300
35'34,895,000
36'33,476,6881,400,000April 27, 2009Bloomberg.com
37'32,710,000
38'31,394,044
39'30,747,000
40'29,331,000
41'29,165,000
42'28,685,400
43'28,200,000
44'28,150,000
45'27,488,000
46'25,721,000
47'23,906,000
48'23,837,000
49'23,580,000
50'23,027,672
51'22,894,000
52'21,906,000
53'21,745,000
54'21,496,700
55'21,075,000
56'20,238,000
57'19,625,000
58'19,522,000
59'18,498,000
60'950,000June 6, 2009Ministerio de Salud de Chile
61'16,508,734
62'15,757,000
63'15,571,506
64'15,290,000
65'15,263,000
66'14,027,000
67'13,938,115
68'13,388,910
69'13,010,000
70'12,935,000
71'12,534,000
72'12,523,000
73'11,262,500
74'11,206,000
75'11,204,000
76'10,741,0003,000,0001 Jan. 2007Influenza
77'10,631,800
78'10,474,600
79'10,327,800
80'10,090,000
81'10,069,000
82'10,033,000
83'10,029,900
84'9,998,000
85'9,863,000
86'9,850,000
87'9,690,000
88'9,264,000
89'9,133,000
90'8,935,000
91'8,629,900
92'8,356,700
93'8,303,000
94'7,705,800
95'7,602,100
96'7,466,000
97'7,411,000
98'6,952,000
99'6,732,000
100'6,619,000
101'6,420,000
102'6,349,000
103'6,320,000
104'6,316,000
105'6,163,000
106'5,743,000
107'5,696,000
108'5,511,451
109'5,482,000
110'5,411,100
111'5,333,089
112'5,110,000
113'5,073,000
114'4,839,400500,000April 28, 2009
115'4,814,0751,400,000April 28, 2009
116'4,599,000
117'4,579,0003,000April 28, 2009
118'4,517,800
119'4,432,000
120'4,422,000
121'4,382,100
122'4,306,500
123'4,224,000
124 3,982,000
125'3,955,000
126'3,767,000
1273,761,646
128'3,683,000
129'3,572,700
130'3,454,000
131'3,361,000
132'3,350,400
133'3,291,000
134'3,230,100
135'3,170,000
136'2,985,000
137'2,845,000
138'2,719,000
139'2,671,000
140'2,259,400
141'2,171,000
142'2,067,000
143'2,053,355
144'2,048,900
145'1,950,000
146'1,705,000
147'1,611,000
148'1,475,000
149'1,409,000
150'1,340,341
151'1,339,000
152'1,288,000
153'1,185,000
154'1,134,000
155'864,000
156'849,000
157'801,600
158'791,000
159'762,000
160'697,000
161'676,000
162'676,000
163'624,000
164'523,000
165'520,000
166513,000
167'506,000
168'491,700
169'412,600
170'400,000
171'342,000
172'319,326
173'309,000
174'307,000
175'256,000
176'240,000
177 198,000
178'179,000
179 178,000
180'172,000
181'163,000
182'111,000
183 110,000
184'109,000
185 107,000
186'104,000
187'104,000
188'98,000
189 89,300
190'88,000
191 87,000
192'86,000
193'84,000
194 80,000
195'67,000
196 67,000
197 65,000
198'62,000
199 61,811
200 57,000
201 56,000
202'52,000
203 48,797
204'35,700
205'33,000
206 33,000
207'30,800
208 31,000
209 23,000
210 20,000
211'20,000
212 15,000
213'10,000
214'10,000
215 6,600
216 5,900
217 3,000
218 1,500
219 1,400
220'800
221 50