National Policy Recommendations on the Use of Antivirals for Prevention during an Influenza Pandemic
The Government of Manitoba, in conjunction with the federal government and other provincial and territorial governments, has released a report from the Pan-Canadian Public Health Network Council (PHNC) concerning the use of antiviral medications for prophylaxis (prevention) during an influenza pandemic.
The PHNC is an expert advisory body created by the federal, provincial and territorial governments to facilitate inter-governmental dialogue and collaboration on public health issues. The PHNC appointed a Task Group on Antivirals for Prophylaxis (TGAP) with relevant expertise (i.e. communicable diseases, public health, emergency management, ethics, legal, First Nations and Inuit and communications) to review the public policy merit of using antivirals for prevention during an influenza pandemic. After 18 months of careful analysis and consultation, TGAP concluded that, based on current knowledge, the use of antiviral medications for prophylaxis during an influenza pandemic could be recommended to governments to:
- prevent illness among individuals who had been in close contact with an infected person in the period immediately preceding the declaration of a pandemic, and
- control outbreaks in closed, high-risk facilities during the pandemic period.
TGAP also proposed a number of corollary recommendations to strengthen pan-Canadian pandemic preparedness and response capacity.
TGAP’s conclusion that the widespread use of antivirals for prophylaxis during a pandemic is not justifiable at this time is based on a number of factors. They include, among others: the limited availability of data on the efficacy of antivirals when used for prophylaxis; the unknown health and safety risks of administering a drug with known side effects to a large number of healthy people for a prolonged period (as well as the difficulties of ensuring compliance with the course of treatment); and, the risk of resistant strains of the virus developing. It is also premised on the adoption of TGAP’s corollary recommendations, which emphasize the need for a comprehensive communications strategy on the pan-Canadian pandemic influenza plan, strengthened occupational health and safety measures, including infection control in healthcare delivery settings, and additional research.
Provincial and territorial governments and the Government of Canada will use the policy recommendations on the use of antivirals for prophylaxis as a guide for approaching pandemic preparedness in the event of a pandemic outbreak. The recommendations reflect current public health advice, given the scientific evidence available. Governments also recognize the importance of ensuring that policies and practices will not risk antiviral resistance within the population.
The recommendations provide critical guidance for all jurisdictions in developing their pandemic plans. Governments have agreed to develop their respective antiviral for prophylaxis policies and preparations based on the following principles:
1. Antiviral policies and practices will be developed on the basis of the best public health advice given the state of science, balancing risks and benefits.
2. Antiviral policies and practices will be drafted on the basis of ensuring that they minimize the risk of antiviral resistance developing among health care providers and the population.
3. Governments commit to continued collaboration in the development of their antiviral for prophylaxis policies to ensure that they align with each other in the protection of the public.
4. Government policy will be guided by the recommendations of the Task Group on Antivirals for Prevention as jurisdictions continue ongoing, comprehensive pandemic planning.
All jurisdictions will continue to work together to protect the health and safety of Canadians during an influenza pandemic and to bridge the knowledge gaps identified by TGAP. Within the context of these efforts, F/P/T governments will be assessing the adequacy of the current stockpile of antiviral medications and related distribution plans and protocols. They will also expedite their work on N95 masks and their effectiveness in protecting frontline health care workers from infection. The PHNC policy recommendation will be reviewed periodically to take account of new research, evidence and scientific knowledge.
Learn more about the Government of Manitoba's pandemic preparedness strategy.
