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Shishkov A, Andrews MR, Alphonso SR, Deng Y, Moniruzzaman M, Cantor JH, Tamura K. County-Level Sociodemographic Characteristics and Availability of COVID-19 Therapeutic Drugs. JAMA Netw Open 2023; 6:e2334763. [PMID: 37728929 PMCID: PMC10512099 DOI: 10.1001/jamanetworkopen.2023.34763] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 08/14/2023] [Indexed: 09/22/2023] Open
Abstract
This cross-sectional study examines access to COVID-19 treatments in US counties by race and ethnicity, poverty rate, uninsured rate, and other population and community characteristics.
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Affiliation(s)
- Alyssa Shishkov
- Socio-Spatial Determinants of Health (SSDH) Laboratory, Population and Community Health Sciences Branch, Division of Intramural Research, the National Institute on Minority Health and Health Disparities, the National Institutes of Health, Bethesda, Maryland
| | - Marcus R. Andrews
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor
| | - Sophie R. Alphonso
- Socio-Spatial Determinants of Health (SSDH) Laboratory, Population and Community Health Sciences Branch, Division of Intramural Research, the National Institute on Minority Health and Health Disparities, the National Institutes of Health, Bethesda, Maryland
| | - Yangyang Deng
- Socio-Spatial Determinants of Health (SSDH) Laboratory, Population and Community Health Sciences Branch, Division of Intramural Research, the National Institute on Minority Health and Health Disparities, the National Institutes of Health, Bethesda, Maryland
| | - Mohammad Moniruzzaman
- Socio-Spatial Determinants of Health (SSDH) Laboratory, Population and Community Health Sciences Branch, Division of Intramural Research, the National Institute on Minority Health and Health Disparities, the National Institutes of Health, Bethesda, Maryland
| | | | - Kosuke Tamura
- Socio-Spatial Determinants of Health (SSDH) Laboratory, Population and Community Health Sciences Branch, Division of Intramural Research, the National Institute on Minority Health and Health Disparities, the National Institutes of Health, Bethesda, Maryland
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2
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Rubin EJ, Baden LR, Barocas JA, Morrissey S. Audio Interview: Addressing the Omicron Variant of SARS-CoV-2. N Engl J Med 2022; 386:e16. [PMID: 35081288 DOI: 10.1056/nejme2201214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Abstract
Health officials and scientists have warned that we face the threat of a potentially devastating influenza pandemic. Instead, we are now in the midst of a global coronavirus (COVID-19) pandemic. National and international pandemic preparedness plans have focused on developing vaccines and antiviral treatments. Another way to confront the COVID-19 pandemic (and future pandemics) might be to treat patients with inexpensive and widely available generic drugs that target the host response to infection, not the virus itself. The feasibility of this idea was tested during the Ebola outbreak in West Africa in 2014. This experience should inform our approach to treating COVID-19 patients. It could also save lives during outbreaks of other emerging infectious diseases and episodes of everyday acute critical illness. If this "bottom up" syndromic approach to treating acute critical illness were shown to be effective, it could have a dramatic impact on health, equity and security throughout the world. HIGHLIGHTS: Uncertainty about the outcome of COVID-19 is driving the social, economic and political distress associated with the pandemic. Treating the host response to COVID-19 with inexpensive and widely available generic drugs might save lives and mitigate this distress. Undertaking research on this idea will require political leadership.
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Rickert J. On Patient Safety: Mirroring the Strategies Used for Delivering COVID-19 Medications May Improve How Developing Countries Obtain Essential Medicines. Clin Orthop Relat Res 2021; 479:236-238. [PMID: 33273246 PMCID: PMC7899618 DOI: 10.1097/corr.0000000000001592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 11/05/2020] [Indexed: 01/31/2023]
Affiliation(s)
- James Rickert
- J. Rickert, President, The Society for Patient Centered Orthopedics, Bloomington, IN, USA
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6
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Tesfaye W, Abrha S, Sinnollareddy M, Arnold B, Brown A, Matthew C, Oguoma VM, Peterson GM, Thomas J. How Do We Combat Bogus Medicines in the Age of the COVID-19 Pandemic? Am J Trop Med Hyg 2020; 103:1360-1363. [PMID: 32815510 PMCID: PMC7543841 DOI: 10.4269/ajtmh.20-0903] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 08/08/2020] [Indexed: 12/15/2022] Open
Abstract
The COVID-19 pandemic has brought concurrent challenges. The increased incidence of fake and falsified product distribution is one of these problems with tremendous impact, especially in low- and middle-income countries. Up to a tenth of medicines including antibiotics and antimalarial drugs in the African market are considered falsified. Pandemics make this worse by creating an ecosystem of confusion, distraction, and vulnerability stemming from the pandemic as health systems become more stressed and the workload of individuals increased. These environments create opportunities for substandard and falsified medicines to be more easily introduced into the marketplace by unscrupulous operators. In this work we discuss some of the challenges with fake or falsified product distribution in the context of COVID-19 and proposed strategies to best manage this problem.
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Affiliation(s)
- Wubshet Tesfaye
- Health Research Institute, University of Canberra, Canberra, Australia
| | - Solomon Abrha
- University of Canberra, Canberra, Australia
- Mekelle University, Mek’ele, Ethiopia
| | | | - Bruce Arnold
- Canberra Law School, University of Canberra, Canberra, Australia
| | - Andrew Brown
- IntraHealth International, Durham, North Carolina
| | | | - Victor M. Oguoma
- Health Research Institute, University of Canberra, Canberra, Australia
| | - Gregory M. Peterson
- University of Canberra, Canberra, Australia
- University of Tasmania, Hobart, Australia
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Lim S, DeBruin DA, Leider JP, Sederstrom N, Lynfield R, Baker JV, Kline S, Kesler S, Rizza S, Wu J, Sharp RR, Wolf SM. Developing an Ethics Framework for Allocating Remdesivir in the COVID-19 Pandemic. Mayo Clin Proc 2020; 95:1946-1954. [PMID: 32861338 PMCID: PMC7305893 DOI: 10.1016/j.mayocp.2020.06.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 06/05/2020] [Accepted: 06/10/2020] [Indexed: 11/28/2022]
Abstract
On May 1, 2020, the US Food and Drug Administration (FDA) issued an Emergency Use Authorization (EUA) to allow use of the antiviral drug remdesivir to treat patients with severe coronavirus disease-2019 (COVID-19). Remdesivir is an investigational drug studied in clinical trials for COVID-19 and is available to children and pregnant women through compassionate-use access but is not yet FDA approved. In early May, the US Department of Health and Human Services began to distribute remdesivir, donated by Gilead Sciences, Inc., to hospitals and state health departments for emergency use; multiple shipments have since been distributed. This process has raised questions of how remdesivir should be allocated. The Minnesota Department of Health has collaborated with the Minnesota COVID Ethics Collaborative and multiple clinical experts to issue an Ethical Framework for May 2020 Allocation of Remdesivir in the COVID-19 Pandemic. The framework builds on extensive ethical guidance developed for public health emergencies in Minnesota before the COVID-19 crisis. The Minnesota remdesivir allocation framework specifies an ethical approach to distributing the drug to facilities across the state and then among COVID-19 patients within each facility. This article describes the process of developing the framework and adjustments in the framework over time with emergence of new data, analyzes key issues addressed, and suggests next steps. Sharing this framework and the development process can encourage transparency and may be useful to other states formulating and refining their approach to remdesivir EUA allocation.
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Key Words
- ecmo, extracorporeal membrane oxygenation
- ehr, electronic health record
- eua, emergency use authorization
- fda, food and drug administration
- hhs, department of health and human services
- mcec, minnesota covid ethics collaborative
- mdh, minnesota department of health
- niaid, national institute of allergy and infectious diseases
- sat, science advisory team
- shccc, state health care coordination center
- umn, university of minnesota
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Affiliation(s)
- Sarah Lim
- Minnesota Department of Health, St. Paul, MN
| | | | | | | | | | | | | | | | | | - Joel Wu
- University of Minnesota, Minneapolis
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Affiliation(s)
- Eli Weber
- Kaiser Permanente San Bernardino County Area Medical Centers
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9
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Affiliation(s)
- Ameet Sarpatwari
- Program On Regulation, Therapeutics, And Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Anna Kaltenboeck
- Drug Pricing Lab, Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Aaron S Kesselheim
- Program On Regulation, Therapeutics, And Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Affiliation(s)
- Douglas B White
- Program on Ethics and Decision Making in Critical Illness, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Derek C Angus
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Associate Editor
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Mazer-Amirshahi M, Fox ER, Farmer BM, Stolbach AI. ACMT Position Statement: Medication Shortages During Coronavirus Disease Pandemic. J Med Toxicol 2020; 16:346-348. [PMID: 32418120 PMCID: PMC7229882 DOI: 10.1007/s13181-020-00782-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 11/19/2022] Open
Affiliation(s)
- Maryann Mazer-Amirshahi
- Department of Emergency Medicine, MedStar Washington Hospital Center and Georgetown University School of Medicine, Washington, DC, USA
| | - Erin R Fox
- Drug Information and Support Services, University of Utah Health, Salt Lake City, UT, USA
- Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, UT, USA
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12
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Affiliation(s)
| | - Lawrence O Gostin
- O'Neill Institute for National and Global Health Law, Georgetown University, Washington, DC
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13
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Affiliation(s)
- Michael G Ison
- Divisions of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Cameron Wolfe
- Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina
| | - Helen W Boucher
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts
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14
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Alonso-Herreros JM, Berisa-Prado S, Cañete-Ramírez C, Dávila-Pousa C, Flox-Benítez MDP, Ladrón de Guevara-García M, López-Cabezas C, Martín de Rosales-Cabrera AM, Ramos-Martínez B. Hospital Pharmacy Compounding against COVID-19 pandemic. Farm Hosp 2020; 44:49-52. [PMID: 32533671 DOI: 10.7399/fh.11492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023] Open
Abstract
As in other areas of the health system, COVID-19 has had a dramatic impact on hospital compounding. This area has faced numerous challenges, including the shortage of frequent-use products (hydroalcoholic solutions, lopinavir/ritonavir suspension), the use of new preparations for SARS-CoV-2 (tocilizumab, remdesivir), or requests from overwhelmed wards unable to assume the safe preparation of a high volume of medications (intravenous solutions). The demand for all types of preparations (topic and oral medications, intravenous solutions) has increased dramatically. This increase has highlighted the shortage of resources allocated to this area, which has made it difficult to meet the high demand for preparations. In addition, the pandemic has revealed the scarcity of research on such basic aspects as agent stability and drug compatibility. One of the most relevant conclusions drawn from the COVID-19 pandemic is that the basic areas of hospital pharmacy, along with other, must be maintained and reinforced, as these are the areas that make us essential.
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Affiliation(s)
| | - Silvia Berisa-Prado
- Servicio de Farmacia Hospitalaria, Instituto Oftalmológico Fernández-Vega, Oviedo (Asturias). España.
| | | | - Carmen Dávila-Pousa
- Servicio de Farmacia, Complexo Hospitalario Universitario, Pontevedra. España.
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15
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Abstract
COVID crisis has abruptly broken into our hospitals, and many difficulties have emerged, including those related to supply logistics. A huge number of new patients, a fast internal reorganization process and many other changes were suddenly established. These circumstances revealed the need to increase stocks of drugs, both for basic treatment as well as for specific SARS-CoV-2 infection management. At the same time, other problems (shortages, new and complex purchasing procedures, etc.) surfaced, so they could risk safety along the pharmacotherapeutic process. The main objective was to develop and implement all the necessary measures within the logistics circuit in order to ensure the availability of medicines for patients, as safely and effectively as possible, during the Coronavirus crisis. Firstly, two pharmacists were appointed to coordinate the whole process, and a preliminary analysis of the following aspects was carried out an estimation of needs to make an initial drug provisioning, a storage feasibility study and a global analysis of the logistics process to detect critical points. Three different circuits for medicines supply were established as some drugs were operated by Agencia Española de Medicamentos y Productos Sanitarios (AEMPS) or Servicio Madrileño de Salud (SERMAS), and others were under no restrictions. For stocks control, inventory was frequently reviewed and monitoring of prescription trends was implemented. For all new medicinal products, compliance with security standards was reviewed and relabeling was carried out if necessary. Criteria were defined for the storage of overstocks and it was placed an isolated area for quarantined drugs. Shortages inevitably occurred but their effects were partly mitigated by AEMPS and SERMAS. After all, we consider that the implemented procedure for logistics management may be reproducible, and the key points we have identified are the following: to enhance our quality management system, to develop an Action Plan for Healthcare Emergencies and to ensure the adequate training for all pharmacy staff. Furthermore, we also should address other aspects: to establish storage optimization strategies, to focus on a more advanced logistics management model, as well as to take advantage of the extraordinary multidisciplinary network, which has been consolidated during this COVID pandemic.
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Affiliation(s)
| | - Ana Álvarez-Díaz
- Servicio de Farmacia, Hospital Universitario Ramón y Cajal, Madrid. España.
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Bermejo-Vicedo T, Queralt Gorgas M. COVID-19 Pandemic. New challenge for hospital pharmacy services. Farm Hosp 2020; 44:3-4. [PMID: 32533660 DOI: 10.7399/fh.11511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023] Open
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Abstract
The first case of novel coronavirus disease (COVID-19) in the Dominican Republic coincided with a period of political crisis. Distrust in governmental institutions shaped the critical phase of early response. Having a weak public health infrastructure and a lack of public trust, the Ministry of Health (MoH) began the fight against COVID-19 with a losing streak. Within 45 days of the first reported case, the political crisis and turmoil caused by "fake news" are limiting the capacity and success of the MoH response to the pandemic.
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Affiliation(s)
- Leandro Tapia
- Instituto de Medicina Tropical & Salud Global, Universidad Iberoamericana, Santo Domingo, Dominican Republic
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Vetter P, Kaiser L. [Ebola : an uncontrolled outbreak despite vaccines and new treatments]. Rev Med Suisse 2020; 16:739-743. [PMID: 32301308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The Ebola virus disease outbreak raging in the North-Kivu and Ituri provinces of Democratic Republic of the Congo already accounts for more than 3400 cases, from which 2200 died. Major progress have been achieved since the 2014-2016 West Africa outbreak. A vaccine is now approved by the European Medicine Agency and has been administered to more than 250 000 volunteers in the field. New specific antiviral treatments are now available. Ebola virus disease shifted from a deadly disease to a preventable, curable one. However, the long-lasting conflict and repeated attacks of civilians and health workers hampers the control of the outbreak.
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Affiliation(s)
- Pauline Vetter
- Centre des maladies virales émergentes et laboratoire de virologie, HUG, 2015 Genève
- Service des maladies infectieuses, Département des spécialités médicales, HUG, 2015 Genève
| | - Laurent Kaiser
- Centre des maladies virales émergentes et laboratoire de virologie, HUG, 2015 Genève
- Service des maladies infectieuses, Département des spécialités médicales, HUG, 2015 Genève
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Affiliation(s)
- Suerie Moon
- From the Graduate Institute of International and Development Studies, Geneva (S.M., E.E.); and the Harvard T.H. Chan School of Public Health, Boston (S.M.)
| | - Elise Erickson
- From the Graduate Institute of International and Development Studies, Geneva (S.M., E.E.); and the Harvard T.H. Chan School of Public Health, Boston (S.M.)
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Jester BJ, Uyeki TM, Patel A, Koonin L, Jernigan DB. 100 Years of Medical Countermeasures and Pandemic Influenza Preparedness. Am J Public Health 2018; 108:1469-1472. [PMID: 30252525 PMCID: PMC6187768 DOI: 10.2105/ajph.2018.304586] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2018] [Indexed: 11/04/2022]
Abstract
The 1918 influenza pandemic spread rapidly around the globe, leading to high mortality and social disruption. The countermeasures available to mitigate the pandemic were limited and relied on nonpharmaceutical interventions. Over the past 100 years, improvements in medical care, influenza vaccines, antiviral medications, community mitigation efforts, diagnosis, and communications have improved pandemic response. A number of gaps remain, including vaccines that are more rapidly manufactured, antiviral drugs that are more effective and available, and better respiratory protective devices.
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Affiliation(s)
- Barbara J Jester
- Barbara J. Jester is a Battelle contractor working for the Influenza Division at Centers for Disease Control and Prevention (CDC), Atlanta, GA. Timothy M. Uyeki is chief medical officer for the Influenza Division at CDC. Anita Patel is the medical care and countermeasures team lead for the Influenza Coordination Unit at CDC. Lisa Koonin is deputy director of the Influenza Coordination Unit at CDC. Daniel B. Jernigan is director of the Influenza Division at CDC
| | - Timothy M Uyeki
- Barbara J. Jester is a Battelle contractor working for the Influenza Division at Centers for Disease Control and Prevention (CDC), Atlanta, GA. Timothy M. Uyeki is chief medical officer for the Influenza Division at CDC. Anita Patel is the medical care and countermeasures team lead for the Influenza Coordination Unit at CDC. Lisa Koonin is deputy director of the Influenza Coordination Unit at CDC. Daniel B. Jernigan is director of the Influenza Division at CDC
| | - Anita Patel
- Barbara J. Jester is a Battelle contractor working for the Influenza Division at Centers for Disease Control and Prevention (CDC), Atlanta, GA. Timothy M. Uyeki is chief medical officer for the Influenza Division at CDC. Anita Patel is the medical care and countermeasures team lead for the Influenza Coordination Unit at CDC. Lisa Koonin is deputy director of the Influenza Coordination Unit at CDC. Daniel B. Jernigan is director of the Influenza Division at CDC
| | - Lisa Koonin
- Barbara J. Jester is a Battelle contractor working for the Influenza Division at Centers for Disease Control and Prevention (CDC), Atlanta, GA. Timothy M. Uyeki is chief medical officer for the Influenza Division at CDC. Anita Patel is the medical care and countermeasures team lead for the Influenza Coordination Unit at CDC. Lisa Koonin is deputy director of the Influenza Coordination Unit at CDC. Daniel B. Jernigan is director of the Influenza Division at CDC
| | - Daniel B Jernigan
- Barbara J. Jester is a Battelle contractor working for the Influenza Division at Centers for Disease Control and Prevention (CDC), Atlanta, GA. Timothy M. Uyeki is chief medical officer for the Influenza Division at CDC. Anita Patel is the medical care and countermeasures team lead for the Influenza Coordination Unit at CDC. Lisa Koonin is deputy director of the Influenza Coordination Unit at CDC. Daniel B. Jernigan is director of the Influenza Division at CDC
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22
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Vilhelmsson A, Mulinari S. Pharmaceutical lobbying and pandemic stockpiling of Tamiflu: a qualitative study of arguments and tactics. J Public Health (Oxf) 2018; 40:646-651. [PMID: 28977398 PMCID: PMC6166586 DOI: 10.1093/pubmed/fdx101] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 07/07/2017] [Accepted: 07/21/2017] [Indexed: 11/13/2022] Open
Abstract
Background Little is known about how pharmaceutical companies lobby authorities or experts regarding procurement or the use of vaccines and antivirals. This paper investigates how members of Denmark's pandemic planning committee experienced lobbying efforts by Roche, manufacturer of Tamiflu, the antiviral that was stockpiled before the 2009 A(H1N1) pandemic. Methods Analysis of interviews with six of seven members of the Danish core pandemic committee, supplemented with documentary analysis. We sought to identify (1) arguments and (2) tactics used in lobbying, and to characterize interviewees' views on the impact of (3) lobbying and (4) scientific evidence on the decision to stockpile Tamiflu. Results Roche lobbied directly (in its own name) and through a seemingly independent third party. Roche used two arguments: (1) the procurement agreement had to be signed quickly because the drug would be delivered on a first-come, first-served basis and (2) Denmark was especially vulnerable to an influenza crisis because it had smaller Tamiflu stocks than other countries. Most interviewees suspected that lobbying had an impact on Tamiflu procurement. Conclusions Our study highlights risks posed by pharmaceutical lobbying. Arguments and tactics deployed by Roche are likely to be repeated whenever many countries are negotiating drug procurements in a monopolistic market.
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Affiliation(s)
- Andreas Vilhelmsson
- Department of Sociology, Faculty of Social Sciences, Lund University, Box 117, Lund, Sweden
- Division of Social Medicine and Global Health, Department of Clinical Sciences Malmö, Faculty of Medicine, Lund University, CRC, House 28 Floor 12, Jan Waldenströms gata 35, Malmö, Sweden
| | - Shai Mulinari
- Department of Sociology, Faculty of Social Sciences, Lund University, Box 117, Lund, Sweden
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23
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Affiliation(s)
- Eric M. Espeland
- Biomedical Advanced Research and Development Authority (BARDA), Office of the Assistant Secretary for Preparedness and Response (ASPR), US Department of Health and Human Services (HHS), Washington, DC, United States of America
| | - Chia-Wei Tsai
- Biomedical Advanced Research and Development Authority (BARDA), Office of the Assistant Secretary for Preparedness and Response (ASPR), US Department of Health and Human Services (HHS), Washington, DC, United States of America
| | - Joseph Larsen
- Biomedical Advanced Research and Development Authority (BARDA), Office of the Assistant Secretary for Preparedness and Response (ASPR), US Department of Health and Human Services (HHS), Washington, DC, United States of America
- * E-mail:
| | - Gary L. Disbrow
- Biomedical Advanced Research and Development Authority (BARDA), Office of the Assistant Secretary for Preparedness and Response (ASPR), US Department of Health and Human Services (HHS), Washington, DC, United States of America
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SteelFisher GK, Benson JM, Caporello H, Koonin LM, Patel A, Ben-Porath E, Blendon RJ. Pharmacist Views on Alternative Methods for Antiviral Distribution and Dispensing During an Influenza Pandemic. Health Secur 2018; 16:108-118. [PMID: 29570363 DOI: 10.1089/hs.2017.0068] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Antiviral drugs are likely to be a frontline countermeasure needed to minimize disease impact during an influenza pandemic. As part of pandemic influenza preparedness efforts, the Centers for Disease Control and Prevention, in coordination with state health departments, has plans in place to distribute and dispense antiviral drugs from public stockpiles. These plans are currently under review and include evaluation of the benefits of commercial distribution and dispensing through community pharmacies. To ensure this alternative distribution and dispensing system is viable, it is critical to assess pharmacist acceptability and to understand the pharmacist perspective on dispensing these antivirals during a response. In this study, we examine community pharmacist reactions to the proposed alternative antiviral distribution and dispensing system using a nationally representative survey of pharmacists. Overall, pharmacists were highly receptive to this alternative system and voiced a willingness to participate personally, and most thought their own pharmacy would participate in such an effort. This was true across pharmacists with different personal and professional backgrounds, as well as those in different pharmacy settings. However, sizable shares of pharmacists said they were worried about facing shortages of the antivirals, the risk of exposure to disease for themselves and their families, managing their usual patients who need their prescriptions filled for medications other than antivirals, keeping order in the pharmacy, and potential liability concerns. These findings should be interpreted as an indication of acceptability of the concept, encouragement for the next steps in alternative distribution and dispensing system design, and a guide to potential barriers that may need to be addressed proactively.
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Delaune D, Iseni F, Ferrier-Rembert A, Peyrefitte CN, Ferraris O. The French Armed Forces Virology Unit: A Chronological Record of Ongoing Research on Orthopoxvirus. Viruses 2017; 10:E3. [PMID: 29295488 PMCID: PMC5795416 DOI: 10.3390/v10010003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 12/20/2017] [Accepted: 12/21/2017] [Indexed: 01/04/2023] Open
Abstract
Since the official declaration of smallpox eradication in 1980, the general population vaccination has ceased worldwide. Therefore, people under 40 year old are generally not vaccinated against smallpox and have no cross protection against orthopoxvirus infections. This naïve population may be exposed to natural or intentional orthopoxvirus emergences. The virology unit of the Institut de Recherche Biomédicale des Armées (France) has developed research programs on orthopoxviruses since 2000. Its missions were conceived to improve the diagnosis capabilities, to foster vaccine development, and to develop antivirals targeting specific viral proteins. The role of the virology unit was asserted in 2012 when the responsibility of the National Reference Center for the Orthopoxviruses was given to the unit. This article presents the evolution of the unit activity since 2000, and the past and current research focusing on orthopoxviruses.
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Affiliation(s)
- Déborah Delaune
- Unité de virologie, Centre National de Référence-Laboratoire Expert Orthopoxvirus, Institut de Recherche Biomédicale des Armées, 91220 Brétigny-sur-Orge, France.
| | - Frédéric Iseni
- Unité de virologie, Centre National de Référence-Laboratoire Expert Orthopoxvirus, Institut de Recherche Biomédicale des Armées, 91220 Brétigny-sur-Orge, France.
| | - Audrey Ferrier-Rembert
- Unité de virologie, Centre National de Référence-Laboratoire Expert Orthopoxvirus, Institut de Recherche Biomédicale des Armées, 91220 Brétigny-sur-Orge, France.
| | - Christophe N Peyrefitte
- Unité de virologie, Centre National de Référence-Laboratoire Expert Orthopoxvirus, Institut de Recherche Biomédicale des Armées, 91220 Brétigny-sur-Orge, France.
| | - Olivier Ferraris
- Unité de virologie, Centre National de Référence-Laboratoire Expert Orthopoxvirus, Institut de Recherche Biomédicale des Armées, 91220 Brétigny-sur-Orge, France.
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Pasquini-Descomps H, Brender N, Maradan D. Value for Money in H1N1 Influenza: A Systematic Review of the Cost-Effectiveness of Pandemic Interventions. Value Health 2017; 20:819-827. [PMID: 28577700 DOI: 10.1016/j.jval.2016.05.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 05/03/2016] [Accepted: 05/08/2016] [Indexed: 06/07/2023]
Abstract
BACKGROUND The 2009 A/H1N1 influenza pandemic generated additional data and triggered new studies that opened debate over the optimal strategy for handling a pandemic. The lessons-learned documents from the World Health Organization show the need for a cost estimation of the pandemic response during the risk-assessment phase. Several years after the crisis, what conclusions can we draw from this field of research? OBJECTIVE The main objective of this article was to provide an analysis of the studies that present cost-effectiveness or cost-benefit analyses for A/H1N1 pandemic interventions since 2009 and to identify which measures seem most cost-effective. METHODS We reviewed 18 academic articles that provide cost-effectiveness or cost-benefit analyses for A/H1N1 pandemic interventions since 2009. Our review converts the studies' results into a cost-utility measure (cost per disability-adjusted life-year or quality-adjusted life-year) and presents the contexts of severity and fatality. RESULTS The existing studies suggest that hospital quarantine, vaccination, and usage of the antiviral stockpile are highly cost-effective, even for mild pandemics. However, school closures, antiviral treatments, and social distancing may not qualify as efficient measures, for a virus like 2009's H1N1 and a willingness-to-pay threshold of $45,000 per disability-adjusted life-year. Such interventions may become cost-effective for severe crises. CONCLUSIONS This study helps to shed light on the cost-utility of various interventions, and may support decision making, among other criteria, for future pandemics. Nonetheless, one should consider these results carefully, considering these may not apply to a specific crisis or country, and a dedicated cost-effectiveness assessment should be conducted at the time.
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Affiliation(s)
- Hélène Pasquini-Descomps
- Haute École de Gestion Genève (Geneva School of Business Administration), HES-SO University of Applied Sciences Western Switzerland, Carouge, Switzerland; University of Geneva, Switzerland.
| | - Nathalie Brender
- Haute École de Gestion Genève (Geneva School of Business Administration), HES-SO University of Applied Sciences Western Switzerland, Carouge, Switzerland
| | - David Maradan
- Haute École de Gestion Genève (Geneva School of Business Administration), HES-SO University of Applied Sciences Western Switzerland, Carouge, Switzerland; University of Geneva, Switzerland
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Chabrol F, David PM, Krikorian G. Rationing hepatitis C treatment in the context of austerity policies in France and Cameroon: A transnational perspective on the pharmaceuticalization of healthcare systems. Soc Sci Med 2017; 187:243-250. [PMID: 28392011 DOI: 10.1016/j.socscimed.2017.03.059] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 03/24/2017] [Accepted: 03/27/2017] [Indexed: 01/18/2023]
Abstract
New powerful drugs against hepatitis C can cure the disease, but they are not widely distributed because their exorbitant prices are destabilizing healthcare systems in both African and European countries. This article takes access to hepatitis C treatments since 2013 in France and in Cameroon as a lens to analyze the rationing of pharmaceutical treatments in relation to recent transformations of health systems. Access to these treatments is analyzed thanks to ethnographic observation and interviews lead in Paris and Yaoundé, with patients, associations, health professionals and public health experts. In Cameroon, rationing takes place through various layers of socio-economic restrictions, and no patient organization advocates for hepatitis treatment. In France, access to hepatitis C treatments has become politicized, and collective mobilizations have denounced rationing as a threat to the promise of universal social security. In this study, we examine Africa's long experience with rationing in the context of structural adjustment, and we bring together experiences in France and Cameroon. This article analyses the phenomenon of the pharmaceuticalization of healthcare systems, that is to say the growing use of pharmaceuticals in healthcare systems, by documenting the social and political construction of scarcity. Indeed, whereas pharmaceuticalization is a concept that has often been used in situations of drugs abundance, a parallel analysis of rationing highlights a political economy of pharmaceuticals that shapes public health debates and policies according to an economy of scarcity, especially in times of austerity.
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Affiliation(s)
- Fanny Chabrol
- Sciences Economiques et Sociales de la Santé et Traitement de l'Information Médicale, SESSTIM, UMR 912 Inserm, IRD, Aix-Marseille Université, 27 boulevard Jean Moulin, 13385 Marseille, France; Centre de Recherche, Médecine, Sciences, Santé, Santé mentale, Société, CERMES 3, UMR 988 Inserm, CNRS, EHESS, Université Paris 5 Descartes, 7, rue Guy Môquet, 94801 Villejuif, France.
| | - Pierre-Marie David
- Laboratoire SPHERE, UMR 7219, Université Paris Diderot, bâtiment Condorcet, case 70935 rue Thomas Mann 75205 Paris cedex 13, France.
| | - Gaëlle Krikorian
- IRIS, Institut de Recherche Interdisciplinaire sur les enjeux Sociaux, UMR 8156 CNRS, U997 Inserm, EHESS, Université Paris 13, 190 avenue de France 75244 Paris cedex 13, France.
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Ghinea N, Lipworth W, Day R, Hill A, Dore GJ, Danta M. Importation of generic hepatitis C therapies: bridging the gap between price and access in high-income countries. Lancet 2017; 389:1268-1272. [PMID: 27832868 DOI: 10.1016/s0140-6736(16)32051-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 09/20/2016] [Accepted: 10/19/2016] [Indexed: 01/29/2023]
Affiliation(s)
- Narcyz Ghinea
- Centre for Values, Ethics and the Law in Medicine, University of Sydney, Sydney, NSW, Australia.
| | - Wendy Lipworth
- Centre for Values, Ethics and the Law in Medicine, University of Sydney, Sydney, NSW, Australia
| | - Richard Day
- Clinical Pharmacology & Toxicology, Therapeutics Centre, St Vincent's Hospital Clinical School, Darlinghurst, NSW, Australia
| | - Andrew Hill
- St Stephens AIDS Trust, Chelsea and Westminster Hospital, London, UK
| | - Gregory J Dore
- Viral Hepatitis Clinical Research Program, Kirby Institute, UNSW Australia, Sydney, NSW, Australia
| | - Mark Danta
- Faculty of Medicine, St Vincent's Hospital Clinical School, Darlinghurst, NSW, Australia
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Affiliation(s)
- Jessica Leston
- HIV/HCV Clinical Program, Northwest Portland Area Indian Health Board, Portland, Oregon
| | - Joe Finkbonner
- Northwest Portland Area Indian Health Board, Portland, Oregon
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Abstract
AbstractThe outbreak of H5N1 avian influenza in Asia has reignited concerns about an influenza pandemic. It is clear that influenza vaccine will be in short supply (or nonexistent) early in an influenza pandemic. Without vaccine, the role of antiviral agents, especially oseltamivir, in treatment and prophylaxis is of paramount importance. Unfortunately, the government cannot possibly stockpile enough oseltamivir to provide long-term prophylaxis or treatment for every healthcare worker in the United States. We think that hospitals should consider stockpiling oseltamivir, and we provide a strategy for doing so at a reasonable cost.
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Affiliation(s)
- Sandro Cinti
- Division of Infectious Diseases, University of Michigan Health System, Ann Arbor, Michigan, USA.
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Han QY, Liu ZW. Current treatment of chronic hepatitis C in China: Dilemma and potential problems. World J Gastroenterol 2016; 22:4615-4618. [PMID: 27217693 PMCID: PMC4870068 DOI: 10.3748/wjg.v22.i19.4615] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 04/03/2016] [Accepted: 04/20/2016] [Indexed: 02/06/2023] Open
Abstract
Major advances have been made in the treatment of chronic hepatitis C virus (HCV) infection with the advent of direct-acting antiviral agents (DAAs). China has the most cases of HCV infection worldwide, but none of the DAAs has been approved in mainland China so far, and interferon (IFN)-α-based treatment remains the standard of care. HCV patients without response or with contraindications to IFN-based therapy have no alternative options. However, many patients buy DAAs, especially the generic forms of sofosbuvir, from other countries or areas. Under these circumstances, the use of these drugs may cause many predictable and unpredictable problems in ethics, law and medical practice. Given the obstacles of legal accessibility to DAAs and the potential problems of obtaining and using DAAs in China, the early launching of the DAAs in China or the legalization of buying drugs from areas outside China and using these drugs in China is an urgent issue and needs to be dealt with as soon as possible, in the interest of the patients.
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Clary R. It's time to end insurance restrictions on life-saving hepatitis C treatments. Am J Manag Care 2016; 22:SP185-SP187. [PMID: 27266946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Ryan Clary
- National Viral Hepatitis Roundtable, 1424 K St, Washington, DC 20005. E-mail:
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Bhattacharya J. A way out of the dismal arithmetic of hepatitis C treatment. Am J Manag Care 2016; 22:SP183-SP184. [PMID: 27266945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Lakdawalla DN, Linthicum MT, Vanderpuye-Orgle J. Does patient cost sharing for HCV drugs make sense? Am J Manag Care 2016; 22:SP188-SP190. [PMID: 27266947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Darius N Lakdawalla
- USC Schaeffer Center, 635 Downey Way, Verna & Peter Dauterive Hall (VPD), Ste 210, Los Angeles, CA 90089-3333. E-mail:
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Hep C nurses face surge in drug demand. Nurs Times 2016; 112:6. [PMID: 27141714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Singh B, Huang HC, Morton DP, Johnson GP, Gutfraind A, Galvani AP, Clements B, Meyers LA. Optimizing distribution of pandemic influenza antiviral drugs. Emerg Infect Dis 2015; 21:251-8. [PMID: 25625858 PMCID: PMC4313645 DOI: 10.3201/eid2102.141024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
We provide a data-driven method for optimizing pharmacy-based distribution of antiviral drugs during an influenza pandemic in terms of overall access for a target population and apply it to the state of Texas, USA. We found that during the 2009 influenza pandemic, the Texas Department of State Health Services achieved an estimated statewide access of 88% (proportion of population willing to travel to the nearest dispensing point). However, access reached only 34.5% of US postal code (ZIP code) areas containing <1,000 underinsured persons. Optimized distribution networks increased expected access to 91% overall and 60% in hard-to-reach regions, and 2 or 3 major pharmacy chains achieved near maximal coverage in well-populated areas. Independent pharmacies were essential for reaching ZIP code areas containing <1,000 underinsured persons. This model was developed during a collaboration between academic researchers and public health officials and is available as a decision support tool for Texas Department of State Health Services at a Web-based interface.
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Graham CS, Swan T. A path to eradication of hepatitis C in low- and middle-income countries. Antiviral Res 2015; 119:89-96. [PMID: 25615583 DOI: 10.1016/j.antiviral.2015.01.004] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 01/08/2015] [Accepted: 01/12/2015] [Indexed: 12/11/2022]
Abstract
We are entering a new era in the treatment of hepatitis C virus (HCV) infection and almost all patient groups in high-income countries have the potential to be cured with all-oral, highly potent combinations of direct-acting antiviral drugs. Soon the main barrier to curing hepatitis C, even in wealthy countries, will be the high price of these all-oral regimens. The gulf between the advances in HCV drug development and access to treatment for individual patients will be even greater in low- and middle-income countries (LMIC) where 80% of the global burden of HCV infection and mortality exists. Ensuring that people in LMIC have access to regimens against HCV will require a similar level of advocacy and public-private partnerships as has transformed the control of other global diseases such as HIV. Numerous challenges will need to be overcome. These include improving low-cost diagnostic tests, especially in sub-Saharan Africa where the false-positive rate is unacceptably high, reducing iatrogenic spread of HCV, addressing transmission among people who inject drugs (PWID), and ensuring affordable access to antiviral treatment for all people living with HCV infection in LMIC. This article forms part of a symposium in Antiviral Research on "Hepatitis C: next steps toward global eradication."
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Affiliation(s)
- Camilla S Graham
- Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
| | - Tracy Swan
- Treatment Action Group, New York, NY, United States
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Abstract
Oseltamivir (Tamiflu), a neuraminidase inhibitor, was approved for seasonal flu by US Food and Drug Administration in 1999. A number of randomized controlled trials, systematic reviews, and meta-analysis emphasized a favorable efficacy and safety profile. Majority of them were funded by Roche, which also first marketed and promoted this drug. In 2005 and 2009, the looming fear of pandemic flu led to recommendation by prominent regulatory bodies such as World Health Organization (WHO), Centers for Disease Control and Prevention, European Medicines Agency and others for its use in treatment and prophylaxis of influenza, and it's stockpiling as a measure to tide over the crisis. Serious Adverse Events, especially neuropsychiatric events associated with Tamiflu started getting reported leading to a cascade of questions on clinical utility of this drug. A recent Cochrane review and related articles have questioned the risk-benefit ratio of the drug, besides raising doubts about the regulatory decision of approving it. The recommendations for stockpiling the said drug as given by various international organizations viz WHO have also been put to scrutiny. Although many reviewers have labeled the Tamiflu saga as a "costly mistake," the episode leaves us with some important lessons. This article takes a comprehensive relook on the subject, and we proceed to suggest some ways and means to avoid a similar situation in the future.
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Affiliation(s)
| | - Meenakshi Meenu
- Department of Pharmacology, AIIMS, Ansari Nagar, New Delhi, India
| | - Prafull Mohan
- Department of Pharmacology, AIIMS, Ansari Nagar, New Delhi, India
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Fain BA, Koonin LM, Stoto MA, Shah UA, Cooper SR, Piltch-Loeb RN, Kellermann AL. Facilitating access to antiviral medications and information during an influenza pandemic: engaging with the public on possible new strategies. Biosecur Bioterror 2014; 12:8-19. [PMID: 24552360 DOI: 10.1089/bsp.2013.0058] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Antiviral medications can decrease the severity and duration of influenza, but they are most effective if started within 48 hours of the onset of symptoms. In a severe influenza pandemic, normal channels of obtaining prescriptions and medications could become overwhelmed. To assess public perception of the acceptability and feasibility of alternative strategies for prescribing, distributing, and dispensing antivirals and disseminating information about influenza and its treatment, the Institute of Medicine, with technical assistance from the Centers for Disease Control and Prevention (CDC), convened public engagement events in 3 demographically and geographically diverse communities: Fort Benton, MT; Chattanooga, TN; and Los Angeles, CA. Participants were introduced to the issues associated with pandemic influenza and the challenges of ensuring timely public access to information and medications. They then discussed the advantages and disadvantages of 5 alternative strategies currently being considered by the CDC and its partners. Participants at all 3 venues expressed high levels of acceptance for each of the proposed strategies and contributed useful ideas to support their implementation. This article discusses the key findings from these sessions.
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Beresniak A. Public health. Be prepared: what work in fight against flu. Health Serv J 2014; 124:19-21. [PMID: 25029766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Starbuck ES, von Bernuth R, Bolles K, Koepsell J. Are we prepared to help low-resource communities cope with a severe influenza pandemic? Influenza Other Respir Viruses 2013; 7:909-13. [PMID: 23145978 PMCID: PMC4634293 DOI: 10.1111/irv.12040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Recent research involving lab-modified H5N1 influenza viruses with increased transmissibility and the ongoing evolution of the virus in nature should remind us of the continuing importance of preparedness for a severe influenza pandemic. Current vaccine technology and antiviral supply remain inadequate, and in a severe pandemic, most low-resource communities will fail to receive adequate medical supplies. However, with suitable guidance, these communities can take appropriate actions without substantial outside resources to reduce influenza transmission and care for the ill. Such guidance should be completed, and support provided to developing countries to adapt it for their settings and prepare for implementation.
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Affiliation(s)
- Eric S. Starbuck
- Department of Health and Nutrition, Save the Children, Westport, CT, USA
| | | | - Kathryn Bolles
- Department of Health and Nutrition, Save the Children, Westport, CT, USA
| | - Jeanne Koepsell
- Department of Health and Nutrition, Save the Children, Westport, CT, USA
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Mei L, Tang Q, Cui YM, Tobe RG, Selotlegeng L, Ali AH, Xu LZ. Changes in and shortcomings of drug stockpiling, vaccine development and related policies during outbreaks of avian influenza A H5N1, H1N1, and H7N9 among humans. Drug Discov Ther 2013; 7:95-100. [PMID: 23917856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The purpose of this paper is to provide a reference for the future stockpiling of drugs and developing vaccines for treatment of emerging infectious diseases by summarizing the status of drug stockpiling, vaccine development, and related policies during three major outbreaks of avian influenza among humans (H5N1 in 2003, H1N1 in 2009, and H7N9 in 2013). Documents regarding drug stockpiling and vaccine development during three influenza outbreaks have been reviewed. Results indicated that the response to pandemic influenza outbreaks has improved markedly in terms of stockpiles of antivirals and vaccine development. These improvements also suggest advances in related policy planning. These trends also foreshadow better prospects for prevention and control of emerging infectious diseases. However, the rationality of drug stockpiling and international cooperation still needs to be enhanced.
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Affiliation(s)
- L Mei
- Department of Health Care Management and Maternal and Child Health, Shandong University, Ji'nan, Shandong, China
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Miller PE, Rambachan A, Hubbard RJ, Li J, Meyer AE, Stephens P, Mounts AW, Rolfes MA, Penn CR. Supply of neuraminidase inhibitors related to reduced influenza A (H1N1) mortality during the 2009-2010 H1N1 pandemic: an ecological study. PLoS One 2012; 7:e43491. [PMID: 22984431 PMCID: PMC3439456 DOI: 10.1371/journal.pone.0043491] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Accepted: 07/23/2012] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The influenza A (H1N1) pandemic swept across the globe from April 2009 to August 2010 affecting millions. Many WHO Member States relied on antiviral drugs, specifically neuraminidase inhibitors (NAIs) oseltamivir and zanamivir, to treat influenza patients in critical condition. Such drugs have been found to be effective in reducing severity and duration of influenza illness, and likely reduced morbidity during the pandemic. However, it is less clear whether NAIs used during the pandemic reduced H1N1 mortality. METHODS Country-level data on supply of oseltamivir and zanamivir were used to predict H1N1 mortality (per 100,000 people) from July 2009 to August 2010 in forty-two WHO Member States. Poisson regression was used to model the association between NAI supply and H1N1 mortality, with adjustment for economic, demographic, and health-related confounders. RESULTS After adjustment for potential confounders, each 10% increase in kilograms of oseltamivir, per 100,000 people, was associated with a 1.6% reduction in H1N1 mortality over the pandemic period (relative rate (RR) = 0.84 per log increase in oseltamivir supply). While the supply of zanamivir was considerably less than that of oseltamivir in each Member State, each 10% increase in kilogram of active zanamivir, per 100,000, was associated with a 0.3% reduction in H1N1 mortality (RR = 0.97 per log increase). CONCLUSION While there are limitations to the ecologic nature of these data, this analysis offers evidence of a protective relationship between antiviral drug supply and influenza mortality and supports a role for influenza antiviral use in future pandemics.
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Affiliation(s)
- Paula E. Miller
- Department of Statistics, Saint Olaf College, Northfield, Minnesota, United States of America
| | - Aksharananda Rambachan
- Department of Statistics, Saint Olaf College, Northfield, Minnesota, United States of America
| | - Roderick J. Hubbard
- Department of Statistics, Saint Olaf College, Northfield, Minnesota, United States of America
| | - Jiabai Li
- Department of Statistics, Saint Olaf College, Northfield, Minnesota, United States of America
| | - Alison E. Meyer
- Department of Statistics, Saint Olaf College, Northfield, Minnesota, United States of America
| | | | | | - Melissa A. Rolfes
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, United States of America
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Abstract
CONTEXT The effect of global health initiatives on population health is uncertain. Between 2003 and 2008, the US President's Emergency Plan for AIDS Relief (PEPFAR), the largest initiative ever devoted to a single disease, operated intensively in 12 African focus countries. The initiative's effect on all-cause adult mortality is unknown. OBJECTIVE To determine whether PEPFAR was associated with relative changes in adult mortality in the countries and districts where it operated most intensively. DESIGN, SETTING, AND PARTICIPANTS Using person-level data from the Demographic and Health Surveys, we conducted cross-country and within-country analyses of adult mortality (annual probability of death per 1000 adults between 15 and 59 years old) and PEPFAR's activities. Across countries, we compared adult mortality in 9 African focus countries (Ethiopia, Kenya, Mozambique, Namibia, Nigeria, Rwanda, Tanzania, Uganda, and Zambia) with 18 African nonfocus countries from 1998 to 2008. We performed subnational analyses using information on PEPFAR's programmatic intensity in Tanzania and Rwanda. We employed difference-in-difference analyses with fixed effects for countries and years as well as personal and time-varying area characteristics. MAIN OUTCOME MEASURE Adult all-cause mortality. RESULTS We analyzed information on 1 538 612 adults, including 60 303 deaths, from 41 surveys in 27 countries, 9 of them focus countries. In 2003, age-adjusted adult mortality was 8.3 per 1000 adults in the focus countries (95% CI, 8.0-8.6) and 8.5 per 1000 adults (95% CI, 8.3-8.7) in the nonfocus countries. In 2008, mortality was 4.1 per 1000 (95% CI, 3.6-4.6) in the focus countries and 6.9 per 1000 (95% CI, 6.3-7.5) in the nonfocus countries. The adjusted odds ratio of mortality among adults living in focus countries compared with nonfocus countries between 2004 and 2008 was 0.84 (95% CI, 0.72-0.99; P = .03). Within Tanzania and Rwanda, the adjusted odds ratio of mortality for adults living in districts where PEPFAR operated more intensively was 0.83 (95% CI, 0.72-0.97; P = .02) and 0.75 (95% CI, 0.56-0.99; P = .04), respectively, compared with districts where it operated less intensively. CONCLUSIONS Between 2004 and 2008, all-cause adult mortality declined more in PEPFAR focus countries relative to nonfocus countries. It was not possible to determine whether PEPFAR was associated with mortality effects separate from reductions in HIV-specific deaths.
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Affiliation(s)
- Eran Bendavid
- Division of General Medical Disciplines, Center for Health Policy, Stanford University, Stanford, California 94305, USA.
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Hunter JC, Rodríguez DC, Aragón TJ. Public health management of antiviral drugs during the 2009 H1N1 influenza pandemic: a survey of local health departments in California. BMC Public Health 2012; 12:82. [PMID: 22276659 PMCID: PMC3323435 DOI: 10.1186/1471-2458-12-82] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Accepted: 01/25/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The large-scale deployment of antiviral drugs from the Strategic National Stockpile during the 2009 H1N1 influenza response provides a unique opportunity to study local public health implementation of the medical countermeasure dispensing capability in a prolonged event of national significance. This study aims to describe the range of methods used by local health departments (LHDs) in California to manage antiviral activities and to gain a better understanding of the related challenges experienced by health departments and their community partners. METHODS This research employed a mixed-methods approach. First, a multi-disciplinary focus group of pandemic influenza planners from key stakeholder groups in California was convened in order to generate ideas and identify critical themes related to the local implementation of antiviral activities during the H1N1 influenza response. These qualitative data informed the development of a web-based survey, which was distributed to all 61 LHDs in California for the purpose of assessing the experiences of a representative sample of local health agencies in a large region. RESULTS Forty-four LHDs participated in this study, representing 72% of the local public health agencies in California. While most communities dispensed a modest number of publicly purchased antivirals, LHDs nevertheless drew on their previous work and engaged in a number of antiviral activities, including: acquiring, allocating, distributing, dispensing, tracking, developing guidance, and communicating to the public and clinical community. LHDs also identified specific antiviral challenges presented by the H1N1 pandemic, including: reconciling multiple sources and versions of antiviral guidance, determining appropriate uses and recipients of publicly purchased antivirals, and staffing shortages. CONCLUSIONS The 2009 H1N1 influenza pandemic presented an unusual opportunity to learn about the role of local public health in the management of antiviral response activities during a real public health emergency. Results of this study offer an important descriptive account of LHD management of publicly purchased antivirals, and provide practitioners, policy makers, and academics with a practice-based assessment of these events. The issues raised and the challenges faced by LHDs should be leveraged to inform public health planning for future pandemics and other emergency events that require medical countermeasure dispensing activities.
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Affiliation(s)
- Jennifer C Hunter
- School of Public Health, University of California, Berkeley, CA, USA
| | | | - Tomás J Aragón
- School of Public Health, University of California, Berkeley, CA, USA
- San Francisco Department of Public Health, San Francisco, CA, USA
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