Stockpiling antiviral medications for pandemic influenza

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An antiviral stockpile is a reserve supply of essential antiviral medications in case of shortage. Many countries have chosen to stockpile antiviral medications against pandemic influenza. [1] Because of the time required to prepare and distribute an influenza vaccine, these stockpiles are the only medical defense against widespread infection for the first six months. [2] The stockpiles may be in the form of capsules or simply as the active pharmaceutical ingredient, which is stored in sealed drums and, when needed, dissolved in water to make a bitter-tasting, clear liquid. [3]

There are no evidence-based guidelines to guide the use of these stockpiled drugs, [1] and plans are based on assumed similarities to seasonal influenza. The most common antivirals are neuraminidase inhibitors, which, if begun during the first 48 hours after symptoms appear, will reduce the duration of seasonal influenza by about one day. Taken before symptoms appear, it may prevent disease in about three-quarters of people treated prophylactically. [4] Currently, this is recommended in institutionalized elderly people and other high-risk groups as a form of post-exposure prophylaxis during seasonal influenza outbreaks. [2] However, since pandemic influenza differs somewhat from normal seasonal influenza, it is not clear that these drugs will prove either safe or effective for their intended purpose. [4]

For a person who has very recently been exposed to seasonal influenza, effective post-exposure prophylaxis generally requires taking a drug like oseltamivir for seven to ten days, at half the daily dose needed for treatment. A person that is repeatedly exposed, such as hospital staff members, may require continuous treatment throughout the duration of the outbreak in a community. Based on experience with seasonal influenza in nursing homes, control of influenza requires full treatment of any ill persons and prophylactic treatment of all their contacts. In a pandemic situation, before a vaccine becomes available, this level of treatment and medical prevention may require providing drugs to 80% of the people in an affected community. [3] Consequently, very large supplies of the drugs must be made available — much larger supplies than could be produced on demand. Stockpiles are generally arranged in advance by government health authorities, due to fear of shortages and an awareness of manufacturing limitations during an outbreak. [3]

Supplies in each country

List of available treatments of antiviral per country.

RankCountry / TerritoryPopulationTreatmentsDate Last UpdatedSource
1Flag of the People's Republic of China.svg  China 1,337,722,000
2Flag of India.svg  India 1,396,450,000
3Flag of the United States.svg  United States 336,628,00050,000,000April 27, 2009Bloomberg.com
Report of antiviral stockpile sales
4Flag of Indonesia.svg  Indonesia 230,014,115
5Flag of Brazil.svg  Brazil 229,070,572
6Flag of Pakistan.svg  Pakistan 166,146,000
7Flag of Bangladesh.svg  Bangladesh 162,221,000
8Flag of Nigeria.svg  Nigeria 154,729,000
9Flag of Russia.svg  Russia 141,833,393
10Flag of Japan.svg  Japan 127,630,00047,700,000November 27, 2017Ministry of Health, Labour and Welfare
11Flag of Mexico.svg  Mexico 109,610,000
12Flag of the Philippines.svg  Philippines 92,226,600
13Flag of Vietnam.svg  Vietnam 88,069,000
14Flag of Germany.svg  Germany 82,062,200
15Flag of Ethiopia.svg  Ethiopia 79,221,000
16Flag of Egypt.svg  Egypt 76,030,000
17Flag of Turkey.svg  Turkey 71,517,100
18Flag of Iran.svg  Iran 70,495,782
19Flag of the Democratic Republic of the Congo.svg  Dem. Rep. of Congo 66,020,000
20Flag of France.svg  France 65,073,482
21Flag of Thailand.svg  Thailand 63,389,730
22Flag of the United Kingdom.svg  United Kingdom 61,612,30030,000,000April 28, 2009BBC News
Swine flu: How serious a threat?
23Flag of Italy.svg  Italy 60,090,400
24Flag of Myanmar.svg  Myanmar 50,020,000
25Flag of South Africa.svg  South Africa 48,697,000
26Flag of South Korea.svg  South Korea 48,333,00021,100,000August 21, 2009The Korea Times
More Flu Virus Vaccines to Be Stockpiled
27Flag of Ukraine.svg  Ukraine 46,143,700
28Flag of Spain.svg  Spain 45,853,000
29Flag of Colombia.svg  Colombia 44,830,423
30Flag of Tanzania.svg  Tanzania 43,739,000
31Flag of Sudan.svg  Sudan 42,272,000
32Flag of Kenya.svg  Kenya 39,802,000
33Flag of Argentina.svg  Argentina 39,745,613
34Flag of Poland.svg  Poland 38,130,300
35Flag of Algeria.svg  Algeria 34,895,000
36Flag of Canada (Pantone).svg  Canada 33,476,6881,400,000April 27, 2009Bloomberg.com
Report of Antiviral Stockpile Sales
37Flag of Uganda.svg  Uganda 32,710,000
38Flag of Morocco.svg  Morocco 31,394,044
39Flag of Iraq.svg  Iraq 30,747,000
40Flag of Nepal.svg    Nepal 29,331,000
41Flag of Peru.svg  Peru 29,165,000
42Flag of Venezuela.svg  Venezuela 28,685,400
43Flag of Malaysia.svg  Malaysia 28,200,000
44Flag of the Taliban.svg  Afghanistan 28,150,000
45Flag of Uzbekistan.svg  Uzbekistan 27,488,000
46Flag of Saudi Arabia.svg  Saudi Arabia 25,721,000
47Flag of North Korea.svg  North Korea 23,906,000
48Flag of Ghana.svg  Ghana 23,837,000
49Flag of Yemen.svg  Yemen 23,580,000
50Flag of the Republic of China.svg  Taiwan 23,027,672
51Flag of Mozambique.svg  Mozambique 22,894,000
52Flag of Syria.svg  Syria 21,906,000
53Flag of Australia (converted).svg  Australia 21,745,000
54Flag of Romania.svg  Romania 21,496,700
55Flag of Cote d'Ivoire.svg  Côte d'Ivoire 21,075,000
56Flag of Sri Lanka.svg  Sri Lanka 20,238,000
57Flag of Madagascar.svg  Madagascar 19,625,000
58Flag of Cameroon.svg  Cameroon 19,522,000
59Flag of Angola.svg  Angola 18,498,000
60Flag of Chile.svg  Chile 19,413,000950,000June 6, 2009Ministerio de Salud de Chile
Nueva Influenza Humana A (H1N1)
61Flag of the Netherlands.svg  Netherlands 16,508,734
62Flag of Burkina Faso.svg  Burkina Faso 15,757,000
63Flag of Kazakhstan.svg  Kazakhstan 15,571,506
64Flag of Niger.svg  Niger 15,290,000
65Flag of Malawi.svg  Malawi 15,263,000
66Flag of Guatemala.svg  Guatemala 14,027,000
67Flag of Ecuador.svg  Ecuador 13,938,115
68Flag of Cambodia.svg  Cambodia 13,388,910
69Flag of Mali.svg  Mali 13,010,000
70Flag of Zambia.svg  Zambia 12,935,000
71Flag of Senegal.svg  Senegal 12,534,000
72Flag of Zimbabwe.svg  Zimbabwe 12,523,000
73Flag of Greece.svg  Greece 11,262,500
74Flag of Chad.svg  Chad 11,206,000
75Flag of Cuba.svg  Cuba 11,204,000
76Flag of Belgium (civil).svg  Belgium 10,741,0003,000,0001 Jan. 2007Influenza
77Flag of Portugal.svg  Portugal 10,631,800
78Flag of the Czech Republic.svg  Czech Republic 10,474,600
79Flag of Tunisia.svg  Tunisia 10,327,800
80Flag of the Dominican Republic.svg  Dominican Republic 10,090,000
81Flag of Guinea.svg  Guinea 10,069,000
82Flag of Haiti.svg  Haiti 10,033,000
83Flag of Hungary.svg  Hungary 10,029,900
84Flag of Rwanda.svg  Rwanda 9,998,000
85Bandera de Bolivia (Estado).svg  Bolivia 9,863,000
86Flag of Serbia.svg  Serbia 9,850,000
87Flag of Belarus.svg  Belarus 9,690,000
88Flag of Sweden.svg  Sweden 9,264,000
89Flag of Somalia.svg  Somalia 9,133,000
90Flag of Benin.svg  Benin 8,935,000
91Flag of Azerbaijan.svg  Azerbaijan 8,629,900
92Flag of Austria.svg  Austria 8,356,700
93Flag of Burundi.svg  Burundi 8,303,000
94Flag of Switzerland (Pantone).svg   Switzerland 7,705,800
95Flag of Bulgaria.svg  Bulgaria 7,602,100
96Flag of Honduras.svg  Honduras 7,466,000
97Flag of Israel.svg  Israel 7,411,000
98Flag of Tajikistan.svg  Tajikistan 6,952,000
99Flag of Papua New Guinea.svg  Papua New Guinea 6,732,000
100Flag of Togo.svg  Togo 6,619,000
101Flag of Libya.svg  Libya 6,420,000
102Flag of Paraguay.svg  Paraguay 6,349,000
103Flag of Laos.svg  Laos 6,320,000
104Flag of Jordan.svg  Jordan 6,316,000
105Flag of El Salvador.svg  El Salvador 6,163,000
106Flag of Nicaragua.svg  Nicaragua 5,743,000
107Flag of Sierra Leone.svg  Sierra Leone 5,696,000
108Flag of Denmark.svg  Denmark 5,511,451
109Flag of Kyrgyzstan (2023).svg  Kyrgyzstan 5,482,000
110Flag of Slovakia.svg  Slovakia 5,411,100
111Flag of Finland.svg  Finland 5,333,089
112Flag of Turkmenistan.svg  Turkmenistan 5,110,000
113Flag of Eritrea.svg  Eritrea 5,073,000
114Flag of Singapore.svg  Singapore 4,839,400500,000April 28, 2009 Referenced. Confirmation expected.
115Flag of Norway.svg  Norway 4,814,0751,400,000April 28, 2009
116Flag of the United Arab Emirates.svg  United Arab Emirates 4,599,000
117Flag of Costa Rica.svg  Costa Rica 4,579,0003,000April 28, 2009 Nacion.com (Spanish)
118Flag of Ireland.svg  Ireland 4,517,800
119Flag of Croatia.svg  Croatia 4,432,000
120Flag of the Central African Republic.svg  Central African Republic 4,422,000
121Flag of Georgia.svg  Georgia 4,382,100
122Flag of New Zealand.svg  New Zealand 4,306,500
123Flag of Lebanon.svg  Lebanon 4,224,000
124Flag of Puerto Rico.svg  Puerto Rico (US)3,982,000
125Flag of Liberia.svg  Liberia 3,955,000
126Flag of Bosnia and Herzegovina.svg  Bosnia and Herzegovina 3,767,000
127Flag of Palestine.svg  Palestine 3,761,646
128Flag of the Republic of the Congo.svg  Republic of the Congo 3,683,000
129Flag of Moldova.svg  Moldova 3,572,700
130Flag of Panama.svg  Panama 3,454,000
131Flag of Uruguay.svg  Uruguay 3,361,000
132Flag of Lithuania.svg  Lithuania 3,350,400
133Flag of Mauritania.svg  Mauritania 3,291,000
134Flag of Armenia.svg  Armenia 3,230,100
135Flag of Albania.svg  Albania 3,170,000
136Flag of Kuwait.svg  Kuwait 2,985,000
137Flag of Oman.svg  Oman 2,845,000
138Flag of Jamaica.svg  Jamaica 2,719,000
139Flag of Mongolia.svg  Mongolia 2,671,000
140Flag of Latvia.svg  Latvia 2,259,400
141Flag of Namibia.svg  Namibia 2,171,000
142Flag of Lesotho.svg  Lesotho 2,067,000
143Flag of Slovenia.svg  Slovenia 2,053,355
144Flag of North Macedonia.svg  North Macedonia 2,048,900
145Flag of Botswana.svg  Botswana 1,950,000
146Flag of The Gambia.svg  Gambia 1,705,000
147Flag of Guinea-Bissau.svg  Guinea-Bissau 1,611,000
148Flag of Gabon.svg  Gabon 1,475,000
149Flag of Qatar.svg  Qatar 1,409,000
150Flag of Estonia.svg  Estonia 1,340,341
151Flag of Trinidad and Tobago.svg  Trinidad and Tobago 1,339,000
152Flag of Mauritius.svg  Mauritius 1,288,000
153Flag of Eswatini.svg  Eswatini (Swaziland) 1,185,000
154Flag of East Timor.svg  East Timor 1,134,000
155Flag of Djibouti.svg  Djibouti 864,000
156Flag of Fiji.svg  Fiji 849,000
157Flag of Cyprus.svg  Cyprus 801,600
158Flag of Bahrain.svg  Bahrain 791,000
159Flag of Guyana.svg  Guyana 762,000
160Flag of Bhutan.svg  Bhutan 697,000
161Flag of the Comoros.svg  Comoros 676,000
162Flag of Equatorial Guinea.svg  Equatorial Guinea 676,000
163Flag of Montenegro.svg  Montenegro 624,000
164Flag of the Solomon Islands.svg  Solomon Islands 523,000
165Flag of Suriname.svg  Suriname 520,000
166Flag of the Sahrawi Arab Democratic Republic.svg  Western Sahara 513,000
167Flag of Cape Verde.svg  Cape Verde 506,000
168Flag of Luxembourg.svg  Luxembourg 491,700
169Flag of Malta.svg  Malta 412,600
170Flag of Brunei.svg  Brunei 400,000
171Flag of the Bahamas.svg  Bahamas 342,000
172Flag of Iceland.svg  Iceland 319,326
173Flag of Maldives.svg  Maldives 309,000
174Flag of Belize.svg  Belize 307,000
175Flag of Barbados.svg  Barbados 256,000
176Flag of Vanuatu.svg  Vanuatu 240,000
177Flag of the Netherlands Antilles (1986-2010).svg  Netherlands Antilles (Netherlands)198,000
178Flag of Samoa.svg  Samoa 179,000
179Flag of Guam.svg  Guam (US)178,000
180Flag of Saint Lucia.svg  Saint Lucia 172,000
181Flag of Sao Tome and Principe.svg  São Tomé and Príncipe 163,000
182Flag of the Federated States of Micronesia.svg  Federated States of Micronesia 111,000
183Flag of the United States Virgin Islands.svg  U.S. Virgin Islands (US)110,000
184Flag of Saint Vincent and the Grenadines.svg  Saint Vincent and the Grenadines 109,000
185Flag of Aruba.svg  Aruba (Netherlands)107,000
186Flag of Grenada.svg  Grenada 104,000
187Flag of Tonga.svg  Tonga 104,000
188Flag of Kiribati.svg  Kiribati 98,000
189Flag of Jersey.svg  Jersey (US)89,300
190Flag of Antigua and Barbuda.svg  Antigua and Barbuda 88,000
191Flag of the Northern Mariana Islands.svg  Northern Mariana Islands (US)87,000
192Flag of Andorra.svg  Andorra 86,000
193Flag of Seychelles.svg  Seychelles 84,000
194Flag of the Isle of Man.svg  Isle of Man (UK)80,000
195Flag of Dominica.svg  Dominica 67,000
196Flag of American Samoa.svg  American Samoa (US)67,000
197Flag of Bermuda.svg  Bermuda (UK)65,000
198Flag of the Marshall Islands.svg  Marshall Islands 62,000
199Flag of Guernsey.svg  Guernsey (UK)61,811
200Flag of Greenland.svg  Greenland (Denmark)57,000
201Flag of the Cayman Islands.svg  Cayman Islands (UK)56,000
202Flag of Saint Kitts and Nevis.svg  Saint Kitts and Nevis 52,000
203Flag of the Faroe Islands.svg  Faroe Islands (Denmark)48,797
204Flag of Liechtenstein.svg  Liechtenstein 35,700
205Flag of Monaco.svg  Monaco 33,000
206Flag of the Turks and Caicos Islands.svg  Turks and Caicos Islands (UK)33,000
207Flag of San Marino.svg  San Marino 30,800
208Flag of Gibraltar.svg  Gibraltar (UK)31,000
209Flag of the British Virgin Islands.svg  British Virgin Islands (UK)23,000
210Flag of the Cook Islands.svg  Cook Islands (New Zealand)20,000
211Flag of Palau.svg  Palau 20,000
212Flag of Anguilla.svg  Anguilla (UK)15,000
213Flag of Tuvalu.svg  Tuvalu 10,000
214Flag of Nauru.svg  Nauru 10,000
215Flag of Saint Helena.svg  Saint Helena (UK)6,600
216Flag of Montserrat.svg  Montserrat (UK)5,900
217Flag of the Falkland Islands.svg  Falkland Islands (UK)3,000
218Flag of Niue.svg  Niue (New Zealand)1,500
219Flag of Tokelau.svg  Tokelau (New Zealand)1,400
220Flag of the Vatican City (2023-present).svg  Vatican City 800
221Flag of the Pitcairn Islands.svg  Pitcairn Islands (UK)50

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References

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