Pharmacies Need to Prepare for Bird Flu Pandemic

DAN ALAIMO

NEW YORK — While the possibility of an avian flu pandemic has dropped from the headlines, North American governments issued a plan to deal with such an event late last month.

The U.S., Canada and Mexico together announced “The North American Plan for Avian and Pandemic Influenza.”

This reflects continued planning for such an occurrence, and pharmacies need to be a part of the process, or they might find themselves subject to undesirable mandates, said Stuart Weiss, partner, MedPrep Consulting Group here. For example, pharmacists and medicines could be requisitioned by local health departments at a time when both are urgently needed by retail pharmacy, he said.

“You need to be at the table with your local emergency planning folks, and know what they are writing into their plans,” he said. A physician, Weiss is an expert in emergency preparedness.

“Almost every state has very powerful health emergency laws on the books that can basically commandeer goods and services, and force businesses to do things. So you really need to be at the table, and you need to decide which of these roles you are willing to play in the response,” he said.

He noted that bird flu — the H5N1 avian influenza virus — is not presently in North America, so it is not getting very much media attention. However, since 2003 it has spread across Europe, Asia and parts of the Middle East. It will likely spread through the mixing of bird flocks over the Bering Strait in Alaska, and start appearing in North America either in fall 2007 or fall 2008, Weiss said.

“We expect there to be bird flu in North America, and you know that as soon as that happens, it will be in the newspaper again. But until that happens, it is probably going to be pretty quiet,” Weiss told the recent Pharmacy & Technology Conference held in Boston by the National Association of Chain Drug Stores, Alexandria, Va.

“I can't tell you exactly when a pandemic is going to happen. I can show you the numbers. I can tell you that we have a history. We have a virus that comes about every 40 years, and 2008 will be the 40th year. We have a virus that is out of control in birds, and sooner or later we are going to have a pandemic,” Weiss said.

“What I can tell you is you need to start planning. You need to start thinking about how you are going to maintain your business during this six- to eight-week wave of a pandemic,” he said.

While the pharmacy business learned much about emergency preparedness from its experience with Hurricane Katrina, that was a regional event. A pandemic, by definition, will be everywhere, probably occurring in three waves of six to eight weeks each, spreading across the country in three to four months, and lasting 18 months, he said. A 60% mortality rate can be expected, and 30% of the population might get sick, resulting in 40% to 50% cumulative workforce absenteeism for a number of reasons, Weiss said.

Two medications that will likely be effective are Tamiflu and Relenza. “The big question is pharmaceutical distribution: how to get these medications to people who are sick within 48 hours. That's where pharmacies play a big role. People are used to coming to pharmacies to pick up their medications, and that's where they are going to turn,” he said.

For pharmacies, staffing issues will be a big concern, especially if absenteeism reaches 50%. Retail pharmacies may need to plan to centralize their locations and to recruit workers from other businesses, Weiss said.