So Roche Pharmaceuticals now has sufficient productive capacity to make their influenza antiviral Tamiflu (oseltamivir) meet demand. More than enough, it appears, since they now have come up with a new scheme to unload some of their inventory before its 3 year shelf life expires and to keep turning over the inventory year after year, whether or not there is a demand in any particular year:
With an endorsement from US health officials, Roche, maker of the antiviral drug oseltamivir (Tamiflu), today unveiled a program to encourage more businesses to stockpile the drug to protect employees in case of an influenza pandemic.Roche officials, speaking at a press conference, said the program is designed to remove some of the obstacles that have made many businesses hesitate to stockpile the drug, which is recommended as first-line treatment in a pandemic. For an annual fee, companies can secure a supply of Tamiflu, which will be stored, secured, rotated, and kept current by Roche. If and when the company requests its supply, Roche will guarantee delivery within 48 hours in most instances. (Lisa Schnirring, CIDRAP News)
This isn't such a bad idea for corporations -- on its face, at least. It amounts to buying an insurance policy for sufficient doses of this oral antiviral if the time comes it is indicated. Whether the drug will be effective we don't know but right now it and the inhalable antiviral Relenza are the only therapeutic drugs available should a bird flu pandemic materialize. The welfare of employees and their ability to keep working is in the interests of these corporations. The federal government is encouraging this and other preparations to ensure continuity of operations should influenza cause extensive morbidity and mortality with accompanying high rates of absenteeism.
What's wrong with this? Again -- on its face -- nothing. It is being portrayed as an innovative way to pursue what will have to be a "shared responsibility" should a catastrophic pandemic come our way. What causes me some unease, however, is the extent to which "shared responsibility" has become a new phrase to describe something quite different, the continued privatization of public health. If it is true that access to antivirals -- or a vaccine -- is an effective way to help the community protect itself from a devastating virus, should the main burden be placed on the community members buying access? Isn't this the classic example of a "public good"? If companies want to do this I have no problem with it, but for the Department of Health and Human Services to have a major press conference touting Roche's scheme makes me and other public health professionals more than a little uneasy. No one knows if this is at all an effective strategy but it is most certainly a strategy that has private efforts at its center.
Why don't we leave the private efforts private and spend tax payer time and effort on strategies that strengthen the combined and collaborative efforts of the community, most notably strengthening public health and social services? As one highly regarded public health expert said to me about the way the feds were pimping Roche's scheme, "In classic 1984 fashion 'shared responsibility' means doing it yourself, for yourself. Public goods anyone?"
I think evoking 1984 Newspeak was exactly right. What seems so unobjectionable on the surface -- shared responsibility -- is hiding something just the opposite. Abrogation of responsibility by our government.
- Log in to post comments
what has it do do with 1984 ?
private stockpiling reduces the amount which HHS has to stockpile,
so they should have an interest. I think, they should encourage
and even support it financially.
Remember the earlier discussion about why they discouraged/forbidded
private stockpiling of drugs ?
anon: 1984 is the name of a novel by George Orwell.
Interesting that the States have been forbidden to rotate the stocks they bought. We get to store them for 5 years; they can only be used for treatment during a pandemic; and if there's no pandemic in that time, when they expire, we get to flush them.
I wonder if there is enough information in the public domain for an investigative piece by one of the reveres on why Tamiflu is such a success and Relenza has failed. Starting with the speed with which the FTA approved Tamiflu, compared to the delays and attempted blocking of Relenza approval; through to GSK's abandonment of Relenza and wilful attempts to prevent further investigation of zanamivir as a weapon against bird flu e.g. withdrawal of support for injectable trials in S.E Asia.
Perhaps some of the politics behind GSK's decisions (they certainly weren't based on the science) will be exposed during the trial GSK v Biota later this year. Let's hope there isn't an out of court settlement.
FTA = FDA
1984 dealt with Big Brother and total government control of the people via socialist methods. The hive mind. On one hand Revere backs away from it, then steps into it by suggesting more social programs and control. With few exceptions, H5N1 has confounded the best efforts of nations to control in any form. Extra ventilators when the power might be off is my point. What good are they? What would extra beds do if they were available? Only a place to die in because a pandemic of the nature of 5% would completely flatten the system w/wo socialized medicine. Then, those bills for the remaining people would shatter what was left and return it barter or some other type of exchange. This would happen if it was capitalism too but it would return more quickly in some form afterwards for care.
.
Roche is either stupid or ill informed that the people will buy into this and thats where this will diverge into the realities. Very likely their stuff wont work anyway now, or the amount of damage will eventually outweigh the benefits (Vioxx). For a while it was the only BB in the gun and it did work in some minimal way. But no one could point to Tamiflu and say I survived because of it. There are other things are coming on line. Government should tell people to stockpile just about everything and to try everything if it happens though. In particular and in light of current events this should especially include food for what may come, but thats a personal decision. Corps buying into this are likely going to find that Tamiflu wont work after about a week into it but thats an uncertainty. If they do and it does work they are heroes, else they are the village idiots and Roche might control the world afterwards either way.
I really do think the undercurrent of Revere's concerns -- and use of Orwellian metaphor -- aint altogether different from Randy's comments -- ie. monopolization of public health choice. UHC is a paradigm -- not necessarily socialist -- attempting to ensure the health and well being of everybody living within a nation state (irrespective of wage levels). Revere appears concerned about the monopolization of U.S. taxpayer money expended within one corporations avian flu treatment product. But. And this IS the point. There certainly are -- as Randy would agree -- other options ie. early prepandemic vaccination...
So, will these other treatment options receive an equal or significant level of U.S. taxpayer funded investment!?!
Reveres:
I think you've missed the boat on this one. I share your concern about "privatization" of public health. But coming up with a way to get enough flu antivirals stockpiled in advance of a pandemic is tricky.
It's a strange situation and a hard sell: expensive, short shelf life (actually 5 years for Tamiflu), and--the kicker--it may not even work. At all. So most people won't buy it in advance.
But if it does work in the next pandemic, demand will immediately go through the roof, and so will the price--we already saw a little of what that might be like in 2005. And for it to work, people have to have it in their hands, ready to take right when symptoms appear--even a 24 hour delay will (likely) reduce its effectiveness. The only way to have enough drug, fast enough, is for it to be manufactured and stockpiled in advance.
The US government and the States have already stocked enough to provide one treatment course to all who will (likely) get sick--about 1/3 the population. Most of those doses probably will not reach sick people in a timely way, alas, but it's better than nothing (if the drug works).
Given all that, I think the solution Roche came up with is about the best you could expect from a multi-national corporation. It solves many problems: the more companies buy in advance, the more will be available for people to take when the crunch comes. The offer is for an annual fee that pays for a "right" to take possession of the drug at wholesale cost when the pandemic begins. And in that crunch, many companies will take possession and hand it out to their workers, (hopefully) with clear enough instructions on how best to use it.
It doesn't seem so bad to me that HHS came out and said that they support the approach. Business needs guidance on how they should prepare, including on whether they should stockpile drugs. Your beating up on the government and on Roche for their approach doesn't really isn't helpful--they need encouragement as well as thrashing.
If anybody starts mumbling about this for vaccines, I'll join you at the barricades. But do you have a better way to get the drugs stockpiled?
Rob: I agree with you about the stockpiling effort by companies, which I hope I was careful to say I thought netted out positive. I also phrased it gingerly that it made us uneasy, not that we rejected it. The part that made me most uneasy was not what either Roche or the companies were doing but the ostentatious endorsement by DHHS combined with their lack of enthusiasm and effort to strengthening public health infrastructure. The truth is that the raison d'etre of this Administration is to privatize public services and this is part of that larger picture.
Perhaps it didn't come through that you thought it netted positive--although on re-reading, I can see that's what you meant.
But I don't think this instance quite deserves the 1984 treatment. In point of fact, the govt. won't be able to do enough. People, and businesses, do have to take some responsibility on their own shoulders. In this case, I think the Govt. had to play a role in making it happen: Roche wouldn't have made this offer on its own, nor would it have invested as much in the extra production capacity for Tamiflu, without some arm twisting from HHS. And business wouldn't buy in without an endorsement. Remember, there's a strong current in the public health community and medical profession against trusting people do much of anything on their own, including stockpiling drugs.
I don't buy that one: I see no other way to get antivirals to people in a timely way in a flu pandemic than to let them have the drugs in advance of need. If people have to go to the doctor's office, get a scrip, then fill it somehow, too often the rather short time window will close.
I've had a minor view into how this policy was made. It definitely could have been worse. I'm convinced the people at HHS, even (some) political appointees, are trying to do the right thing. (I didn't actually watch their press conference, so I'm not sure how over the top it was. I hope Leavitt wasn't there--he is insincerity personified.)
Two things we agree on. Don't do this with vaccines. And January 2009 can't come soon enough.
Revere: Is it demonstrated fact that Tamiflu has only the five year shelflife? Sometimes those ratings are conservative to err on the safe side.
Another rather silly question: how many people still work for corporations that could stockpile? Will Jiffy-Lube Corporate deliver to every last shop across America? Seven-Eleven? The banks, airlines and auto manufacturing corps are shedding employees faster than a poor soul newly-infected with H5N1 sheds virus.
Give the Tamiflu stocks to soup kitchens.
wenchacha: Shelf life is almost certainly conservative (the incentives are in that direction). I don't know what it really is. If it doesnt work, it's zero.
Yes, of course some companies won't really distribute to everyone. They aren't democracies. Some people will be expendable. It will depend on the company.
Howdy, I'd like to correct my crappy grammar -- this open sentence should read, "eg. early prepandemic vaccination..."
I will reiterate the main point of yesterday's posting -- investing on more than one transgenic pathogen treatment horse: eg. vaccines constructed with the correct clades...
Recombinomics Commentary -- Mismatched H5N1 Vaccines Stockpiled By WHO? (June 30, 2008)
http://www.recombinomics.com/News/06300802/H5N1_Vaccine_WHO.html
Jonny-Email me please. I have some internals to share with you.
Michael Smith knows Newspeak
"The last decade has also seen new treatments for the virus that causes hepatitis and the first ever drug indicated to treat the common flu, Tamiflu (oseltamivir)."
http://www.norwichbulletin.com/lifestyles/x379983886/Healthy-Living-Gre…
Rommie Amaro, knows Newspeak:
"If those resistant strains begin to propagate, then thats when were going to be in trouble, because we dont have any antivirals active against them, said Rommie Amaro, a postdoctoral fellow in chemistry at UC San Diego."
http://www.newswise.com/articles/view/542298/
If you believe their statements to be true,...welcome to 1984.