Canadian Forum on Implementation of the Antiviral Strategy for Pandemic Influenza: Proceedings Report
October 25-26, 2007 Montreal, Quebec
Table of Contents
- Executive Summary
- October 25, 2007 - Day One
- Day One. Key Findings/ Outstanding Issues and Recommendations
- October 26, 2007 - Day Two
- Day Two. Key Findings/Outstanding Issues and Recommendations
- Conclusion
Executive Summary
On October 25 and 26, 2007 the Public Health Agency of Canada (PHAC) hosted a Canadian Forum on Implementation of the Antiviral Strategy for Pandemic Influenza. The Forum brought together key stakeholders to seek their agreement on the national elements of an antiviral early treatment strategy, and to review challenges, best practices and models to advance the development and coordination of national antivirals stockpile implementation plans. There were over 120 delegates in attendance.
The Forum was planned with a multi-stakeholder Planning Committee chaired by Patricia Huston (representing both the federal perspective and the Pandemic Influenza Committee (PIC) and Corinne Rowswell (representing both the provincial/territorial perspective and the Pandemic Preparedness Health Operations Coordination Working Group (PPHOC). There were also two Task Groups that assisted with development of Day One and Day Two of the Forum.
Delegates included the Chief Medical Officers of Health (or their delegate), Public Health Network Council (PHNC) appointed provincial/territorial (p/t) health planners, members of PIC, members of PPHOC, local public health officials, federal officials, and representatives of various stakeholder groups (College of Family Physicians of Canada, Canadian Nurses Association etc). First Nations Inuit Health Branch (FNIHB) and representatives from First Nations and Inuit communities were well represented at the Forum. International guests attended from Australia, the United Kingdom, the European Union, Japan and the United States.
October 25, 2007 - Day One
Day One of the Forum focused on the “who”, identifying who should receive antivirals and the surveillance, laboratory, regulatory and communications strategies needed to support this.
It began with a historical overview of Canada's evolving preparedness to deploy antiviral drugs in the event of a pandemic. The overview focused on the creation and ongoing enhancement of the national antivirals stockpile, steps leading up to the adoption of an early treatment strategy and the process underway to complete a national policy on antiviral prophylaxis.
The presentation on “who to treat” featured a proposal developed by the Day One Task Group. Critical gaps were identified in areas such as research and professional education, and included strategies for substantive collaborative action to address the gaps in anticipation of a pandemic. While there was little dissent around the proposal itself, participants raised a number of important considerations that should guide next steps, including the need to clarify definitions and other key dimensions of the early treatment strategy, build pandemic capacity and develop tools and resources to support implementation.
Participants received a summary of the status of influenza surveillance in Canada, an overview of the proposal for pandemic surveillance and recommendations and next steps to advance the pandemic surveillance strategy. The need to establish infrastructure, including modeling capacity in anticipation of a pandemic was stressed by participants.
The current laboratory strategy for influenza and the proposed national approach to guide lab testing during a pandemic was presented. There was strong recognition of the indispensability of laboratory capacity and procedures to guide testing and triage, as well as for a “real-time feedback loop” from surveillance and laboratory data to inform decision making at all levels.
There were presentations on a number of other national issues, including potential steps to address antiviral stockpile expiry; the use of medical directives to facilitate access to antiviral drugs in the event of a pandemic; the regulations that govern prescription status, the regulatory process behind switching a drug from prescription to non-prescription status and an explanation and exploration of the potential of the Health Canada Special Access Program's “block release” mechanism. Plans for a passive, stimulated adverse reaction reporting system were presented, and how it might be maintained and enhanced in the event of a pandemic.
Day One concluded with a presentation on the potential of the risk communications model for ensuring stakeholder and citizen buy-in for an early treatment antiviral implementation plan. Participants expressed collective appreciation for the importance of effective communications during a pandemic, and offered suggestions for translating communication challenges into effective action at all levels.
Day One. Key Findings/ Outstanding Issues and Recommendations
Findings/ Outstanding Issues | Recommendations |
Who should receive antivirals for treatment during a pandemic?
Issues
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Consistent with the FPT Ministry of Health policy decision in May 2006:
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National surveillance strategy to support AV implementation Surveillance and the national laboratory network are critical to the AV implementation strategy as release of the AV stockpile depends on documenting that “pandemic virus is known to be circulating in the community”. Surveillance will build on FluWatch, the seasonal influenza surveillance program, and will include Severe Respiratory Illness (SRI) reporting and PHAC Alerts. Regional areas in FluWatch are currently based on census-tracts. Issue
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National laboratory strategy to support AV implementation
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October 26, 2007 - Day Two
On Day Two, the objectives of the Forum were to review a range of early antiviral treatment models and emerging plans towards addressing issues such as storage and handling, delivery and dispensing of antivirals, monitoring uptake, legal and ethical considerations. Participants were invited to move from national issues to the operational implications of an antiviral early treatment strategy from the provincial-territorial level to the front line.
A comparative analysis of international implementation planning for antiviral use during a pandemic was presented. The analysis focused on developed countries, most of which have antivirals policies and are further developing their implementation plans. It included a range of issues from stockpiling and distribution to patient assessment and dispensing.
Next, participants received a briefing on the results of a 2006 survey which was subsequently updated in the summer of 2007 of provincial and territorial Emergency Health Planners. The focus of the survey was to determine whether there are logistical plans in place for the delivery of antivirals during an influenza pandemic. The results indicate that the majority of provinces and territories have plans and are continuing to develop their respective logistical plans.
Presentations from some of the Forum's international guests offered a variety of considerations and approaches to help inform domestic planning efforts. There was considerable interest in the range of practical approaches that are being adopted in Australia, the United States and England, and their potential applicability in the Canadian context, for example as they pertain to patient triage and special populations.
Participants were also presented planning and preparedness efforts in some key Canadian jurisdictions. They engaged in a frank discussion of challenges to effective planning and implementation at the provincial, regional and local level.
There were presentations and discussions regarding the legal and ethical questions and considerations related to an antiviral early treatment strategy, and general acknowledgment that these considerations must inform planning efforts and underpin decision-making at all levels.
Day Two. Key Findings/Outstanding Issues and Recommendations
Key Findings/Outstanding Issues | Recommendations |
Operational strategies to support AV implementation
Issues
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Conclusion
There are a number of areas that need to be further developed to ensure effective implementation of the early treatment strategy. Some issues can be addressed through existing F/P/T mechanisms and for other issues new mechanisms are needed. As delineated in the key findings/outstanding issues and recommendations, some areas will benefit from national coordination; in other instances no “one size fits all” will be possible, and each jurisdiction will need to develop and advance their own plans.
Participants were advised that national issues that would benefit from a coordinated approach would be brought forward to the F/P/T Public Health Network Council for their consideration.