New Developments in Alberta Pandemic Influenza Planning

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• New Developments in Alberta Pandemic Influenza
  Planning

Tarrant Annual Meeting
Agnes Honish Alberta Health and Wellness February
24 2005
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Milestones for Pandemic

• March 2000 Plan begins
• September 2002 Alberta Pandemic
• Influenza Contingency Plan
• September 2002 Stakeholder Meeting
• September 2003 Three Subcommittees Reports
  (Infection control., antivirals, clinical
  guidelines)

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Over-Arching Plan
SARS
Chapters
Pandemic flu
Smallpox
?
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Milestones for Pandemic (cont.)

• April 2004 AHW internal exercise of plan

Current Year

• Stockpile of supplies
• Self care
• Web site
• RHA Visits

• Exercise
• Antivirals
• Workforce

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Current Areas Of Work

• Command and Control (Emergency Response)
• Self-Care Strategy
• Coordination with regional plans
• Funding for antiviral drugs

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Self-Care Strategy

• Foundation for health services response
• Rely on Albertans to care for themselves and
  their families as long as possible
• Self-care forms the base of the medical care
  pyramid during pandemic
• Challenge to implement need for a Self-Care
  Strategy

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Communication and Coordination with RHA Plans

• 17 regions submitted plans in 2002
• Based on checklists supplied provincially
• Coordinate AHW plan with regional plans
• synchronization points
• Now 9 regions (April 2003)
• ICS system provincially

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AHW-RHAs How do we work Together

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Role of Antiviral Drugs

• Prior to the availability of vaccine, antiviral
  drugs will be the only intervention available
• Used both to treat influenza and prevent illness
• Can be stockpiled in preparation for pandemic
• Global shortage
• Requires 18-24 months manufacturing lead time
• No Canadian manufacturer

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Background H5N1

• Deadly strain that is sweeping through Asia,
  recent activity in Vietnam with poultry outbreaks
  and human cases
• Widespread distribution, not controllable
• A small number of human cases, majority of cases
  have been fatal
• 1 cluster with suspected human-to-human spread
• Heightened level of concern
• Potential to ignite the next pandemic

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Antivirals and H5N1

• H5N1 resistant to Amantadine
• Oseltamivir protective efficacy in the 70-90
  range
• Reduced duration of illness 1-2 days
• Lack of published data on complications and death
  but CDC expert group estimates that NI will
  reduce mortality, LRI and hospitalization by 1/3

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PIC Priority Groups (1)

• Based on natl goals of pandemic preparedness
• Reduced overall morbidity and mortality
• Minimize societal disruption
• Three main purposes of antivirals
• Rx of cases that present within 48 hr
• Prophylaxis for the duration of the wave
• Outbreak control (Rx and Px)

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PIC Priority Groups (2)

• Rx of persons hospitalized with flu
• Rx of ill HCWs and ESWs
• Px of front-line HCWs
• Rx of high risk in the community
• Px of remaining essential HCWs
• Control of outbreaks in institutions (Rx and Px)
• Px of essential ESWs
• Px of high risk persons in hospital (non-flu)
• Px of high risks persons in the community

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Purchase Antiviral Drugs

• Purchase a national stockpile of 16 million doses
  of oseltamivir (Tamiflu)
• Enough for 2 million Canadians
• Alberta has moved forward to purchase an initial
  provincial stockpile of 1.6 M doses

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Ability to Mount/Sustain Response

• Human Resources Health Workforce Mobilization
• Health professionals providing services outside
  of existing scope of practice
• Mobilizing the non-active workforce e.g. retired
  nurses/physicians
• Issues liability redeployment licensure
• compensation training/skill conscription
• AHW lead Health Workforce Division
• Working through the Federation of Regulated
  Health Professions (-30 members)

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Influenza-Specific Medical Supplies Policy

• 2001 Health Services Subcommittee medical
  supply list (prevent, control and care for
  population)
• General Assumptions
• Population-based volume projections with 25
  attack rate
• Three levels of care acute, triage and community
• Treatment and immunization supplies
• excludes equipment (e.g. ventilators), support
  services, antivirals

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New National Initiatives

• Change of Pandemic Planning Phases from 6 to 3
• Equitable method to calculate antiviral drugs for
  priority groups