Employers questioned on pandemic drug plan

Some employers preparing for a possible avian influenza pandemic have opted to stockpile antiviral drug Tamiflu, though that approach has raised questions about the effectiveness and appropriateness of that approach.

Basel, Switzerland-based drug company Roche Holding A.G., which manufactures Tamiflu, in July launched an online effort at http://pandemictoolkit.com to urge companies to buy the drug as part of their crisis planning. Governments worldwide, including the United States, have been stockpiling the drug for more than a year to make it available to clinics and hospitals.

In 2005, Virgin Atlantic Airways Ltd. said that it had ordered 10,000 treatments of Tamiflu to stockpile for a potential pandemic. The Crawley, England-based airline could not be reached for comment.

Since the summer, about 300 U.S. companies have ordered Tamiflu to set aside for a pandemic, according to an e-mail from a Roche spokesman. The drugmaker did not reply to requests to identify those companies.

Some observers, though, say employers should proceed cautiously when deciding to stockpile Tamiflu, noting that the drug can shorten the duration of seasonal flu but hasn't yet proven effective in preventing or treating avian flu.

"It is controversial and the reason is, we don't know to what extent (Tamiflu) is going to be effective against the (avian) viral strain," said Dr. William Craig, senior vp of the risk consulting practice with Marsh USA Inc. "We don't think there is enough evidence."

The World Health Organization and the U.S. Centers for Disease Control and Prevention have selected oseltamivir phosphate, the generic name for Tamiflu, as one of two antiviral drugs of choice—out of four such drugs on the market—that could work as a prophylactic or a treatment for avian flu.

A second, less popular antiviral drug, Relenza, also was selected. Unlike the Tamiflu pill, Relenza—made only by Research Triangle Park, N.C.-based GlaxoSmithKline Inc.—comes in a powder form which must be inhaled through the mouth using a special device. And unlike Roche, Relenza manufacturer GlaxoSmithKline P.L.C. hasn't widely marketed Relenza.

Meanwhile, the World Health Organization and the U.S. Centers for Disease Control have warned there is not enough clinical evidence that that Relenza or Tamiflu would be effective in a pandemic.

Tamiflu made headlines last month when British scientists reported that the medication was ineffective in fighting avian flu in some patients in Southeast Asia, where most of the infections from the H5N1 strain of the virus have occurred. In response, Roche has maintained that there was no proof that the strain is resistant to Tamiflu.

The avian flu has already caused more than 150 deaths in 20 countries, according to the WHO. All reported cases were the result of humans coming into contact with infected birds; there have been no reports of human-to-human transmission of the avian flu virus. However, health experts are bracing for such transmission, which many believe could spur a global outbreak weeks after first occurring.

For businesses worldwide, a pandemic could be catastrophic, and many companies have begun preparing for the worst.

Dr. Craig, who has helped guide companies in preparing for a pandemic, said that steps such as equipping employees to telecommute, setting up alternative offices and screening employees for illnesses before allowing them to work are among the most effective ways of preparing for a pandemic.

Unanswered questions

Stockpiling Tamiflu, he said, raises several issues.

"The first question is, who are (companies) going to give it to? Everybody?" Dr. Craig said. "How are you going to administer it? Does the company really want to be responsible for giving out medications?"

Because Tamiflu is a prescription drug, companies must have onsite doctors to prescribe it or have access to a clinic that will store and prescribe the drug to employees. Additionally, companies need to find secure storage for the drug, which has a shelf life of five years.

Gisele Norris, a San Francisco-based senior consultant with Aon Healthcare, said the administration of Tamiflu for companies that are stockpiling could cause additional problems.

"Would there be a hierarchy of who to give (the drug) to?" she asked. "Companies that give it to one employee and not the other could face legal issues because of it."

Ms. Norris said it is "hard to say" whether stockpiling is a good idea or not.

"Some companies that I know with multinational operations have stockpiles of Tamiflu, and they are facing major issues like security," she said. "If there's a pandemic, there's going to be widespread panic. With companies having stockpiles in some warehouse somewhere, people who need it may not get it."

Dr. Craig said companies also need to be concerned about potential side effects and the additional risks they present. Tamiflu, like many drugs, comes with a host of potential side effects that include dizziness, nausea and vomiting.

Incorporating the drug into a company's pandemic plan also might lead to lax adoption of other measures that are proven to prevent the spread of viruses, Dr. Craig said.

"Relying on the drug can lead to risky behavior," he said. "It may make you careless."

As for costs, a course of Tamiflu can cost between $25 and $64, according to Roche. "For a large corporation, that's a lot of money, particularly if they want to use it as a prophylactic," he said.

Dr. Craig added that he hasn't seen droves of companies line up to order Tamiflu, but said he believes companies may be "scared" into doing so.

New York-based Marsh & McLennan Cos. Inc., which has more than 60,000 employees, weighed the option during the past year and decided not to order the drug, he said.

Bradley R. Wood, senior vp-risk management for Bethesda, Md.-based Marriott International Inc., said the hotel chain considered Tamiflu as part of its pandemic plan, but opted against ordering after finding no evidence from credible sources that the drug would work against avian flu.

"We were looking toward the experts on this and they are saying not to stockpile," Mr. Wood said.

In addition, the Chicago-based American Medical Assn. and the Washington-based National Business Group on Health have warned against stockpiling Tamiflu for several reasons, including fears of misuse or mishandling of the drug.

Marriott, which has 143,000 employees worldwide, said it is taking other precautions, such as beefing up hygiene practices and setting up remote workspaces, to prepare for a pandemic.

Lance Ewing, vp-risk management for Memphis, Tenn.-based Harrah's Entertainment Inc., said his company also opted against stockpiling due to lack of evidence.

"I'm sure the company that makes Tamiflu would like to see their market share increase," he said.