28
Securing antiviral drugs, however, is not simply a matter of funding because there are
currently shortages of them. The demand for Tamiflu from governments and private
entities exceeds Roche’s production capacity, and the firm temporarily suspended
shipments of the drug to the United States in late October to prevent hoarding and
ensure adequate supplies to treat seasonal flu cases this winter. In the event of an influ-
enza pandemic in the immediate future, sufficient quantities would not be available to
treat the sick. That situation may improve, however, since Roche will soon begin to
manufacture Tamiflu in the United States (in six new FDA-approved facilities) and
claims that the firm will increase 10-fold over 2003 levels.
41
Even if the supply of antiviral drugs were adequate, questions would remain about re-
lying too heavily on them for protection. Many of those who died from H5N1 influ-
enza were given Tamiflu, although the drug may have been administered too late or in
too small a dose to be effective.
42
(Tamiflu needs to be taken within two days of the
initial flu symptoms, when many people may not yet be aware that they have the flu.)
Some research in mice has suggested that Tamiflu is less effective against recent strains
of H5N1 than it was against the 1997 strain.
43
Additionally, the nature of the treat-
ment (10 pills over five days) might make it difficult for overburdened medical facili-
ties to provide Tamiflu and for patients to comply with the dosage regimen.
An additional concern about antiviral drugs is the location of stockpiles and the distri-
bution of drugs, should an outbreak occur. That concern overlaps with concerns
about health care system readiness, discussed below. Without an adequate plan that
accounts for limited supplies and the predominantly local character of health care de-
livery, a national stockpiling plan will not be effective. Federal, state, and local efforts
to devise such a plan are ongoing.
Health Care System Readiness. If a pandemic occurred in the next several months, the
United States would have to rely primarily on the existing public and private health
system (and its current capacity for hospitalization, antibiotics, and ventilators) to
treat infected people. The effectiveness of that response would depend not only on the
federal government but also on the state and local health authorities and the private
sector, which traditionally play large roles in immunization, laboratory services, and
deciding on and implementing public health actions. Health system response, while
relatively more important than other options were an outbreak to occur in the near
term, would also remain critical for the foreseeable future, in that the effectiveness of
antiviral drugs is uncertain and vaccines, even if produced in mass quantities in the
future, would not be available for at least six months after an outbreak. Limiting the
41. “Roche Plans Big Increase in Tamiflu Production,” New York Times, November 10, 2005; and
“Run on Drug for Avian Flu Has Physicians Worried,” Washington Post, October 22, 2005.
42. Garrett, “The Next Pandemic?”
43. “Mouse Studies of Oseltamivir Show Promise Against H5N1 Influenza Virus,” NIH News, Mon-
day, July 18, 2005, available at www.nih.gov/news/pr/jul2005/niaid-18.htm.