Vaccines & Antivirals: Provincial Stockpile & Distribution Plans

1. Vaccines & Antivirals: Provincial Stockpile & Distribution Plans Pandemic Planning Education Day for Community Laboratories Joanne Rey, Vaccine and Antiviral Working Group Chair Joanne.Rey@moh.gov.on.ca

2. 2 Vaccine and Antiviral Working Group Objectives • Revising the OHPIP vaccine & antiviral sections • Expanding objectives & assumptions • Harmonizing vaccine & antiviral sections of OHPIP with Canadian Pandemic Influenza plan • Incorporating an ethical framework • Development of Ontario Priority Groups • Development of tools to assist with vaccine and antiviral planning at the local level

3. 3 Planning Assumptions • Individuals who recover from the Pandemic strain will be immune from further infection from that strain • The antivirals will be used for treatment and prophylaxis of priority groups • Priority groups could change based on the epidemiology of the pandemic strain (i.e., the nature of the virus, the people most affected)

4. 4 Ethical Framework for Decision Making • Decision making processes need to be: • Open and transparent • Reasonable • Inclusive • Responsive • Accountable Adapted from: Ethics in a Pandemic Influenza Crisis. Framework for Decision Making, by Dr. Jennifer Gibson, of the Joint Centre for Bioethics, University of Toronto.

5. Core ethical values: Individual liberty Protection of the Public from harm Proportionality Privacy Equity Duty to provide care Reciprocity Trust Solidarity Stewardship Ethical Framework (2)

6. 6 Ontario Priority Groups • National priority groups have been adopted • Categories and examples of roles that fall into the various priority groups continue to be expanded and clarified • Guidelines to assist in the recognition and interpretation of Ontario priority groups are being developed

7. Ontario Priority Groups

12. 12 Tools • Enumeration: • Development of enumeration tool to assist stakeholders to identify who the essential workers are in their organizations • Enumeration tool is being piloted in York Region • Tracking tool developed, to assist health units in tracking numbers of essential workers in their jurisdictions

13. 13 Tools (2) • Emergency Mass Prophylaxis Plan • Collaboration with the Emergency Management Unit • Vaccine and Antiviral Distribution Framework • Incorporated into the Emergency Mass Prophylaxis Plan • Training Manual for Vaccinators

14. 14 Tools (3) • Antiviral Algorithm: • Adapted from the Alberta Pandemic Plan • Provides guidance to determine the course of action to take with treatment and prophylaxis using antivirals • Ensure that treatment of persons with influenza-like illness (>48 hrs) are in line with public health measures working group recommendations

15. Suspicion of Influenza Individual Presents Assessment Criteria Review Treatment Prophylaxis Meets Criteria front line health care providers & key health decision makers remaining health care providers emergency/ essential service providers high risk residents of institutions (for outbreak control) high risk hospitalized high risk community members Influenza-like Illness < 48 hours Influenza-like Illness > 48 hours • Meets Criteria • persons hospitalized for influenza • ill health care providers & first responders/ • emergency service providers • ill high risk persons in the community • high risk residents of institutions (for outbreak control) No Yes No Yes oseltamivir o.d. x 75 mg - adults Provide Information Continue isolation x 5 days – adults x 7 days - children oseltamivir b.i.d x 5 days Algorithm for Antiviral Medication

16. 16 Identified Gaps: • Identification of “unique populations” • Linking with other working groups • Communications Strategy • Education and communication messages • Enhancement of current IT systems • Surveillance system is needed to track adverse events

17. 17 Next Steps • Working group to continue meeting via teleconference every 2 weeks • Comprehensive distribution system (Distribution Protocol) • Consent forms • Fact Sheets • Face-to-face meeting with Health Unit representatives to finalize distribution details