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Significant progress has been made in public health and medical preparedness since September 11, 2001. State and local public health authorities are currently responsible for the majority of medication distribution and dispensing activities within their jurisdictions during public health emergencies. During both a pandemic and in routine seasonal influenza, antiviral medications are used to lessen the duration and severity of a patient’s symptoms, not to be confused with a vaccine, which is administered to the well to prevent them from getting sick. Vaccines take months to manufacture, in part because they must be specific to the influenza type. Antivirals, on the other hand, can work against many different strains of influenza. Because antivirals are more effective if taken within 48 hours of symptom presentation, many public health agencies have developed preparedness plans to facilitate the rapid dispensing of antiviral medications to large numbers of people during influenza pandemics.2 However, the feasibility and timeline of these plans remain significant concerns given projections that during a severe pandemic, approximately 30 percent of the population could become ill over a 12- to 18-month period.3 In such circumstances, the normal channels through which antiviral medications are prescribed, dispensed, and distributed could easily become overwhelmed. Indeed, the 2009 H1N1 influenza pandemic brought to light several related challenges that need to be addressed during future preparedness planning initiatives.

In response, the CDC is exploring alternate delivery systems for antiviral medications during severe influenza pandemics. Potential prescribing, dispensing, and distribution strategies include a variety of nontraditional mechanisms to ensure that people sick with flu receive antiviral medicines in a timely manner. These include

•  Nurse Triage Lines (NTLs): Phone hotlines that people with flu-like symptoms could call for advice, discuss whether an anti-


2For more information, see CDC, Antiviral agents for the treatment and chemoprophylaxis of influenza: Recommendations of the advisory committee on immunization practices (ACIP) (Atlanta, GA: CDC, 2011). Available at (accessed May 2, 2012).

3Department of Health and Human Services (HHS), HHS pandemic influenza plan (Washington, DC: HHS, 2005). Available at (accessed April 18, 2012). Further clarification provided by personal communication with Lisa Koonin, senior advisor, Influenza Pandemic Unit, CDC, February 14, 2012.

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