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.[1] 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.[2] 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.[3]

There are no evidence-based guidelines to guide the use of these stockpiled drugs,[1] 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.[4] Currently, this is recommended in institutionalized elderly people and other high-risk groups as a form of post-exposure prophylaxis during seasonal influenza outbreaks.[2] 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.[4]

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.[3] 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.[3]

Supplies in each country

List of available treatments of antiviral per country.

RankCountry / TerritoryPopulationTreatmentsDate Last UpdatedSource
1 China1,337,722,000
2 India1,326,070,000
3 United States330,377,00050,000,000April 27, 2009Bloomberg.com
Report of antiviral stockpile sales
4 Indonesia230,014,115
5 Brazil217,654,780
6 Pakistan166,146,000
7 Bangladesh162,221,000
8 Nigeria154,729,000
9 Russia141,833,393
10 Japan127,630,00047,700,000November 27, 2017Ministry of Health, Labour and Welfare
11 Mexico109,610,000
12 Philippines92,226,600
13 Vietnam88,069,000
14 Germany82,062,200
15 Ethiopia79,221,000
16 Egypt76,030,000
17 Turkey71,517,100
18 Iran70,495,782
19 Dem. Rep. of Congo66,020,000
20 France65,073,482
21 Thailand63,389,730
22 United Kingdom61,612,30030,000,000April 28, 2009BBC News
Swine flu: How serious a threat?
23 Italy60,090,400
24 Myanmar50,020,000
25 South Africa48,697,000
26 South Korea48,333,00021,100,000August 21, 2009The Korea Times
More Flu Virus Vaccines to Be Stockpiled
27 Ukraine46,143,700
28 Spain45,853,000
29 Colombia44,830,423
30 Tanzania43,739,000
31 Sudan42,272,000
32 Kenya39,802,000
33 Argentina39,745,613
34 Poland38,130,300
35 Algeria34,895,000
36 Canada33,476,6881,400,000April 27, 2009Bloomberg.com
Report of Antiviral Stockpile Sales
37 Uganda32,710,000
38 Morocco31,394,044
39 Iraq30,747,000
40   Nepal29,331,000
41 Peru29,165,000
42 Venezuela28,685,400
43 Malaysia28,200,000
44 Afghanistan28,150,000
45 Uzbekistan27,488,000
46 Saudi Arabia25,721,000
47 North Korea23,906,000
48 Ghana23,837,000
49 Yemen23,580,000
50 Taiwan23,027,672
51 Mozambique22,894,000
52 Syria21,906,000
53 Australia21,745,000
54 Romania21,496,700
55 Côte d'Ivoire21,075,000
56 Sri Lanka20,238,000
57 Madagascar19,625,000
58 Cameroon19,522,000
59 Angola18,498,000
60 Chile18,657,000950,000June 6, 2009Ministerio de Salud de Chile
Nueva Influenza Humana A (H1N1)
61 Netherlands16,508,734
62 Burkina Faso15,757,000
63 Kazakhstan15,571,506
64 Niger15,290,000
65 Malawi15,263,000
66 Guatemala14,027,000
67 Ecuador13,938,115
68 Cambodia13,388,910
69 Mali13,010,000
70 Zambia12,935,000
71 Senegal12,534,000
72 Zimbabwe12,523,000
73 Greece11,262,500
74 Chad11,206,000
75 Cuba11,204,000
76 Belgium10,741,0003,000,0001 Jan. 2007Influenza
77 Portugal10,631,800
78 Czech Republic10,474,600
79 Tunisia10,327,800
80 Dominican Republic10,090,000
81 Guinea10,069,000
82 Haiti10,033,000
83 Hungary10,029,900
84 Rwanda9,998,000
85 Bolivia9,863,000
86 Serbia9,850,000
87 Belarus9,690,000
88 Sweden9,264,000
89 Somalia9,133,000
90 Benin8,935,000
91 Azerbaijan8,629,900
92 Austria8,356,700
93 Burundi8,303,000
94  Switzerland7,705,800
95 Bulgaria7,602,100
96 Honduras7,466,000
97 Israel7,411,000
98 Tajikistan6,952,000
99 Papua New Guinea6,732,000
100 Togo6,619,000
101 Libya6,420,000
102 Paraguay6,349,000
103 Laos6,320,000
104 Jordan6,316,000
105 El Salvador6,163,000
106 Nicaragua5,743,000
107 Sierra Leone5,696,000
108 Denmark5,511,451
109 Kyrgyzstan5,482,000
110 Slovakia5,411,100
111 Finland5,333,089
112 Turkmenistan5,110,000
113 Eritrea5,073,000
114 Singapore4,839,400500,000April 28, 2009Referenced. Confirmation expected.
115 Norway4,814,0751,400,000April 28, 2009
116 United Arab Emirates4,599,000
117 Costa Rica4,579,0003,000April 28, 2009Nacion.com (Spanish)
118 Ireland4,517,800
119 Croatia4,432,000
120 Central African Republic4,422,000
121 Georgia4,382,100
122 New Zealand4,306,500
123 Lebanon4,224,000
124 Puerto Rico (US)3,982,000
125 Liberia3,955,000
126 Bosnia and Herzegovina3,767,000
127 Palestine3,761,646
128 Republic of the Congo3,683,000
129 Moldova3,572,700
130 Panama3,454,000
131 Uruguay3,361,000
132 Lithuania3,350,400
133 Mauritania3,291,000
134 Armenia3,230,100
135 Albania3,170,000
136 Kuwait2,985,000
137 Oman2,845,000
138 Jamaica2,719,000
139 Mongolia2,671,000
140 Latvia2,259,400
141 Namibia2,171,000
142 Lesotho2,067,000
143 Slovenia2,053,355
144 Republic of Macedonia2,048,900
145 Botswana1,950,000
146 Gambia1,705,000
147 Guinea-Bissau1,611,000
148 Gabon1,475,000
149 Qatar1,409,000
150 Estonia1,340,341
151 Trinidad and Tobago1,339,000
152 Mauritius1,288,000
153 Eswatini (Swaziland)1,185,000
154 East Timor1,134,000
155 Djibouti864,000
156 Fiji849,000
157 Cyprus801,600
158 Bahrain791,000
159 Guyana762,000
160 Bhutan697,000
161 Comoros676,000
162 Equatorial Guinea676,000
163 Montenegro624,000
164 Solomon Islands523,000
165 Suriname520,000
166 Western Sahara513,000
167 Cape Verde506,000
168 Luxembourg491,700
169 Malta412,600
170 Brunei400,000
171 Bahamas342,000
172 Iceland319,326
173 Maldives309,000
174 Belize307,000
175 Barbados256,000
176 Vanuatu240,000
177 Netherlands Antilles (Netherlands)198,000
178 Samoa179,000
179 Guam (US)178,000
180 Saint Lucia172,000
181 São Tomé and Príncipe163,000
182 Federated States of Micronesia111,000
183 U.S. Virgin Islands (US)110,000
184 Saint Vincent and the Grenadines109,000
185 Aruba (Netherlands)107,000
186 Grenada104,000
187 Tonga104,000
188 Kiribati98,000
189 Jersey (US)89,300
190 Antigua and Barbuda88,000
191 Northern Mariana Islands (US)87,000
192 Andorra86,000
193 Seychelles84,000
194 Isle of Man (UK)80,000
195 Dominica67,000
196 American Samoa (US)67,000
197 Bermuda (UK)65,000
198 Marshall Islands62,000
199 Guernsey (UK)61,811
200 Greenland (Denmark)57,000
201 Cayman Islands (UK)56,000
202 Saint Kitts and Nevis52,000
203 Faroe Islands (Denmark)48,797
204 Liechtenstein35,700
205 Monaco33,000
206 Turks and Caicos Islands (UK)33,000
207 San Marino30,800
208 Gibraltar (UK)31,000
209 British Virgin Islands (UK)23,000
210 Cook Islands (New Zealand)20,000
211 Palau20,000
212 Anguilla (UK)15,000
213 Tuvalu10,000
214 Nauru10,000
215 Saint Helena (UK)6,600
216 Montserrat (UK)5,900
217 Falkland Islands (UK)3,000
218 Niue (New Zealand)1,500
219 Tokelau (New Zealand)1,400
220  Vatican City800
221 Pitcairn Islands (UK)50

References
  1. Schünemann HJ, Hill SR, Kakad M, et al. (January 2007). "WHO Rapid Advice Guidelines for pharmacological management of sporadic human infection with avian influenza A (H5N1) virus". Lancet Infect Dis. 7 (1): 21–31. doi:10.1016/S1473-3099(06)70684-3. PMID 17182341.
  2. de Jong JC, Beyer WE, Rimmelzwaan GF, Fouchier RA, Osterhaus AD (January 2004). "[Neuraminidase inhibitors oseltamivir and zanamivir: new means of defence against influenza]". Ned Tijdschr Geneeskd (in Dutch and Flemish). 148 (2): 73–9. PMID 14753128.CS1 maint: unrecognized language (link)
  3. Ward P, Small I, Smith J, Suter P, Dutkowski R (February 2005). "Oseltamivir (Tamiflu) and its potential for use in the event of an influenza pandemic". J. Antimicrob. Chemother. 55 (Suppl 1): i5–i21. doi:10.1093/jac/dki018. PMID 15709056.
  4. Harrod ME, Emery S, Dwyer DE (November 2006). "Antivirals in the management of an influenza pandemic". Med. J. Aust. 185 (10 Suppl): S58–61. PMID 17115954.
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