Oseltamivir storage, distribution and dispensing following the 2009 H1N1 influenza outbreak in Mexico
Luis Meave Gutiérrez-Mendoza, Brian Schwartz, José de Jesús Méndez de Lira & Veronika J Wirtz
Volume 90, Number 10, October 2012, 782-787
Table 1. Compliance with the national pandemic preparedness plan for influenza in Mexico between April and May 2009, according to key informants interviewed
| Antiviral stockpile supply stage | Information provided or not provided | Compliance/non-compliance during first month of the influenza outbreak | Positive implications of compliance/non-compliance | Negative implications of compliance/non-compliance |
|---|---|---|---|---|
| Purchase and storage | No information on the type of preparation to be purchased | Stockpiled oseltamivir only as bulk | Compared with capsules, bulk powder is cheaper, requires less storage space and has a longer shelf-life while not reconstituted | Lack of required infrastructure and financial and human resources during outbreak |
| No information on the quantities of antivirals needed | Oseltamivir in bulk covered 1.28% of Mexico’s population. Criteria for quantity purchased unknown to key informants | Less expense if population coverage low | Uncertainty about priority groups requiring antivirals first | |
| Recommended purchasing a mix of antiviral drugs | Contrary to the national pandemic preparedness plan, only one antiviral (oseltamivir phosphate in bulk) was purchased for stockpile. | Less expense than if two or more alternative drugs are stored | No alternative treatment available for cases with resistance to oseltamivir | |
| Recommended decentralized storage | Contrary to the national pandemic preparedness plan, the strategic stockpile was only centrally stored | Less expense if stockpile centrally stored | 11-day delay in drug distribution during outbreak | |
| Distribution from the central level to the states | Recommended delivery of the bulk product to each state | Contrary to the national pandemic preparedness plan, bulk powder was not delivered to the states | Central control over the production of oral suspension from bulk powder | Loss of vital time in distributing strategic stockpile |
| Reconstitution of bulk powder not explained | An appropriate site for reconstituting the bulk powder had to be found and the reconstitution process had to be developed | Support from Roche and the National Medicines Regulatory Authority in developing the reconstitution process | Loss of vital time in distributing strategic stockpile | |
| Distribution criteria not defined | Priority given to health-care professionals, military personnel, patients hospitalized at the National Reference Centre for Respiratory Diseases and members of the National Congress and Ministry of Health | No public outcry over distribution criteria | No clear prioritization criteria and ad hoc decisions without prior stakeholder agreement | |
| Distribution within San Luis Potosí | Not described | The Ministry of Health designed the distribution ad hoc during the first 4 weeks of the outbreak. Two outlets at the primary care level dispensed oseltamivir to anyone with a medical prescription | No need for coordination with the private sector, which was perceived as difficult by key informants | Complete reliance on the public sector and delays in distribution in this sector affected both private and public sector patients |
| Prescription within San Luis Potosí | Not described | The health ministry in San Luis Potosí designed its own guidelines and adapted them according to the availability of antivirals | State control over the use of antivirals | Impossible to cover everyone with influenza-like illness from the start of the outbreak; prescription guidelines changed in conformity with drug availability |
| Dispensing within San Luis Potosí | Not described | The health ministry in San Luis Potosí decided to set up two dispensing outlets at the primary care level for patients with influenza-like illness in the public or private sector | State control over the dispensing of antivirals | Supply bottlenecks in the public sector affected both private and public sector patients |