National reserve supplies

National reserve supplies have been developed to ensure that as far as is possible, DHBs and the wider health sector have continued access to specific critical supplies during a severe pandemic which would generate unusual demands on normal health service stocks or supply chains

The Ministry’s approach to establishing and maintaining an appropriate strategic national reserve is supported by World Health Organization guidance.[1]

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Background

National reserve supplies were developed between 2006 and 2009 using existing Vote: Health funding re-appropriated by Cabinet. Their purchase was to ensure ready health service access to supplies of critical clinical items that need to be immediately on hand in case of certain emergencies, or are likely to be in exceptionally high worldwide demand during a pandemic or other health emergency.

The supplies support the phased response options described in the New Zealand Influenza Pandemic Action Plan (NZIPAP). The National Health Emergency Plan: National Reserve Supplies Management and Usage Policies and the National Health Emergency Plan: H5N1 Pre-Pandemic Vaccine Usage Policy provide further details.

What is the purpose of having a national reserve supply stockpile?

The national reserve supplies stockpile was originally established for a possible influenza pandemic, but some elements, such as masks, could be used for any health emergency (eg, after a natural disaster). It comprises a specific range of consumables and drugs which modelling, and experience during events such as SARS, has shown may very quickly become unavailable from global supply chains.

How are the supplies managed?

The national reserve supplies are managed by the Ministry of Health and are monitored and maintained to ensure readiness for an emergency. This includes a management programme for replacement of expiring supplies. Because the volume of supplies needed for a severe pandemic are so large they cannot be effectively rotated through normal use.

Maintenance of the national reserve supplies is a continuing process. The supply comprises a range of stock with varying purchase dates, shelf life, storage requirements and expiry dates.

How often are the national reserve supplies reviewed?

The composition of the national reserve supplies stockpile is continually reviewed as part of an ongoing programme of work which considers the ongoing risk of an influenza pandemic - which includes the need for, and suitability of, components of the stockpile. The last full review occurred in 2011, when it was decided that the national reserve supplies would be maintained, although the volume of some items were altered in line with revised recommendations about expected use.

The national reserve supplies stockpile is operated in accordance with a usage policy which includes objectives, responsibilities of government and logistics for moving supplies from bulk stores.

What is the antiviral Tamiflu replacement programme?

The Ministry current maintains a national reserve supply of the anti-viral Oseltamivir (Tamiflu). The current stockpile will start to reach the end of its shelf life from 2019–20 and a decision on replacement, based on ongoing efficacy and the risk of an influenza pandemic, will be made as part of the ongoing programme of work described above.

Why do we hold a national reserve supply of antivirals?

Current evidence shows that early use of antiviral medication) may shorten the duration of illness from seasonal or pandemic influenza, and may reduce the risk of complications. It is especially recommended for critically ill hospitalized influenza patients. Evidence of the effectiveness of antiviral medication against influenza continues to be monitored. The Ministry is aware of the World Health Organization’s downgrading of Oseltamivir (Tamiflu) from a ‘core’ essential medicine to a ‘complementary’ essential medicine. Evidence of the effectiveness of all antiviral medications against influenza continues to be monitored and will be taken into account as part of the ongoing review of the national strategic reserve.

The national reserve supply of antivirals is held in case of a severe pandemic resulting from the appearance of a novel influenza virus, where population immunity is lower and rates of serious illness may be higher. Specific guidance on the use of antivirals in the event of a pandemic will be developed by a New Zealand pandemic influenza technical advisory group, taking into account the known efficacy of the antivirals against the pandemic influenza strain. If required, the antivirals will be released to hospitals and public health units for use. These measures are further described in the New Zealand Influenza Pandemic Plan.

What is the composition of the national reserve supply?

See Composition of the national reserve supply.

How much does it cost to purchase national reserve supplies?

Overall, the current national reserve supplies stock holding (as of 31 May 2014) is valued at $28.62 million. Tamiflu and Relenza form a significant proportion of this value. The Ministry is allowed to hold a stock of up to $48 million. The exact value of any component is complicated by staggered purchase dates spanning several years, stock write down and variation in exchange rates for items purchased offshore.

What is the cost for storage and insurance?

Annual storage and insurance costs for the national reserve supplies managed by the Ministry are approximately $0.57 million. 

What is the process for destruction of national reserve supplies?

All national reserve supplies that expire are destroyed as they are no longer fit for use, and cannot be donated because of this. This is in line with World Health Organization guidelines. Costs related to destruction vary based on weight, volume and type. Cost of destruction is built into maintenance funding.

How much funding does the Ministry receive to maintain the national reserve supply?

The Ministry is funded $8 million per annum for the maintenance of the national reserve supplies. An additional $10 million of funding was received in the 2013/14 year to write down the bulk expiries in the national reserve supplies. 

The stockpile is managed through a suite of contracts with a number of suppliers for purchase, storage and maintenance. The supplies were purchased at different times and each has their own expiry timeframe, therefore the timing for repurchase differs for each supply.

How much of the supply is held by individual district health boards?

Each district health board (DHB) is provided with 440 courses of ‘national reserve’ oseltamivir (Tamiflu). The 440 courses equates to a standard packed shipping box, avoiding the requirement to further break down stock. These courses are intended for use by the DHB if deemed clinically relevant f in the event of a newly emerging viral respiratory disease.

DHBs are also funded to maintain a range of DHB held national reserves including; antibiotics for treatment of secondary infections, intravenous giving sets and infection prevention supplies such as gloves and gowns.

Where is the stockpile located?

The Ministry’s national stockpile is stored in various locations across New Zealand – split over multiple sites to reduce risk and increase efficiency in distribution.

Should I stockpile my own tamiflu?

The current threat of an influenza pandemic remains unchanged and the Ministry of Health continues to receive surveillance data on infectious influenza and is constantly monitoring the situation. The Ministry of Health does not believe it is necessary for individuals or organisations to maintain their own stockpiles of Oseltamivir (Tamiflu) or other antiviral agents, as the Ministry of Health continues to maintain a national reserve supply of antivirals specifically for release to DHB’s in a pandemic influenza response.

If an individual or staff member believes they may have been exposed to pandemic influenza in the workplace they should first seek advice from their health and safety advisors and/or their local public health unit who will be able to provide advice and treatment if necessary.

Antivirals such as Oseltamivir are restricted (Pharmacist) only medication and as with any medication it is essential that antivirals are taken with clinical indication and oversight, in order to avoid misdiagnosis and due to the significant side effects that antivirals may cause in some people.

Taking Oseltamivir or other antivirals pre- or post- exposure does not guarantee that a person will not develop influenza.  The Ministry does not recommend the use of Oseltamivir for pre-exposure prophylaxis as Oseltamivir may only be taken prophylactically for a maximum of six weeks and it is likely that any influenza pandemic will last for a significantly longer length of time. The unnecessary use of antivirals may also contribute to the development of antiviral resistant influenza.

The Ministry encourages organisations to promote annual influenza vaccination for all staff, and strongly promotes the effective use of infection prevention and control procedures as central to any effective pandemic influenza response.

More information

Read more about influenza infection prevention and control:

Read more about the annual influenza immunisation programme:

If organisations do have out of date antiviral stocks, they should contact their local DHB Pharmacist to arrange for appropriate disposal.

Information not available publicly

Not all information can be made publicly available. Due to commercial sensitivities, the Ministry does not release individual costs associated with the national reserve supplies. This is allowed under the following sections of the Official Information Act:

Section (9)(2)(b)

(to) protect information where the making available of the information—

  • (i) would disclose a trade secret; or
  • (ii) would be likely unreasonably to prejudice the commercial position of the person who supplied or who is the subject of the information;

Section (9)(j)

(to) enable a Minister of the Crown or any department or organisation holding the information to carry on, without prejudice or disadvantage, negotiations (including commercial and industrial negotiations);

[1] The WHO 2009 guidance document Pandemic Influenza Preparedness and Response which recommends national actions to ‘estimate and prioritise antiviral requirements for treatment and prophylaxis’.

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