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 2

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) 3

4. 4 Ethical Framework for Decision Making  Decision making processes need to be:  Open and transparent  Reasonable  Inclusive  Responsive  Accountable 4 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. 5 Ethical Framework (2)  Core ethical values:  Individual liberty  Protection of the Public from harm  Proportionality  Privacy  Equity  Duty to provide care  Reciprocity  Trust  Solidarity  Stewardship

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 6

7. 7 Ontario Priority Groups

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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 12

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 13

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 14

15. 15 Algorithm for Antiviral Medication Prophylaxis Influenza-like Illness > 48 hours Continue isolation x 5 days – adults x 7 days - children oseltamivir b.i.d x 5 days Provide Information oseltamivir o.d. x 75 mg - adults Treatment No Ye s Meets Criteria 1.front line health care providers & key health decision makers 2.remaining health care providers 3.emergency/ essential service providers 4.high risk residents of institutions (for outbreak control) 5.high risk hospitalized 6.high risk community members Assessment Criteria Review Suspicion of Influenza Individual Presents Meets Criteria 1.persons hospitalized for influenza 2.ill health care providers & first responders/ emergency service providers 3.ill high risk persons in the community 4.high risk residents of institutions (for outbreak control) Influenza-like Illness < 48 hours No Ye s

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 16

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 17