Relenza or Tamiflu where to buy?

[self-taught-mba]

Any ideas?

[Scoobyqueen]

I dont know about these products. However, chlorophenyle over 3 % kills the virus. I have already bought my bottle of Dettol!

[peekay]

Large pharmacies might have them under their generic names oseltamivir (Tamiflu) and zanamivir (Relenza). They're both made here in China, along with tons of counterfeits, unfortunately.

[nickbartman]

Hi Peekay, I was interested to read what you had to say about fake Tamiflu. I'm doing research on this problem. Would you mind communicating with me direct by email? If not then of course we can by this forum. Thanks ~ Nick.

[peekay]

Nick I don't have much information except that counterfeit flu medication have been mass-produced in China for a number of years.

E.g., from China Daily, August 30, 2006:

"Shanghai police have uncovered more than 400 kilograms of fake Tamiflu pills, Shanghai Municipal Public Security Bureau announced yesterday. Thirteen people have been arrested.

The investigation showed that the gang made more than 1.6 million yuan (US$200,000) by selling the drugs on the Internet and through other channels to Heilongjiang, Liaoning, Jiangsu, Guangdong provinces and countries in Southeast Asia. Relevant departments are still trying to retrieve the fake pills. "

Counterfeit Tamiflu were being shipped from China to numerous countries, including the US and UK:

"As worldwide fears of a bird flu pandamic escalates, US border control are fighting an influx of fake Tamiflu products being imported into the country. Such products have been surfacing across the country as the global Tamiflu shortage has led to a scramble of consumers purchasing the drug from unreliable sources."

There are laboratory tests which can be conducted to determine the presence of oseltamivir phosphate (the active ingredient in Tamiflu) but as always the best bet is to buy them from reliable sources.

Unfortunately even governments can be duped into buying counterfeit drugs from time to time (most notoriously when Nigeria purchased then donated 88,000 doses of fake meningitis vaccine, resulting in thousands of deaths.)

[Madot]

Sorry I don't have the correct URL but I have seen on the web from a legitimate site material on how to tell the difference between the counterfeit Tamiflu and the real one. Try googling to find this. It had very specific instructions and even pictures.

Mado

[nickbartman]

Peekay, that's great and really helpful. Many thanks. You seem to understand this in great detail. Are you simply interested in the subject, or are you somehow involved in watching the problem? And are you based in Beijing, perhaps? I'm from the Uk just outside London toward Oxford city. I have some other questions for you. Thanks for your kind reply ~ Nick.

[peekay]

Nick I'm not at all involved with monitoring, and not having a medical background, I only know as much as any layperson.

I might follow the issue more closely than some since: 1) I lived in Toronto during the SARS outbreak; and 2) Part of my work / consultancy involves "risk management" (mostly on the IT side) where "Epidemic Preparedness" is our "new" industry buzzword.

For example, various "Business Continuity Plans" now lists items like Tamiflu & H1N1, in addition to items like Norton Antivirus & Win32/Conficker. I.e., I get to ask questions like, "if there's an H1N1 outbreak, do you have enough Remote Access licenses so your key employees can work from home?"

Also, some companies are considering stocking Tamiflu / Relenza for their employees, but there are numerous issues with that... so I tend to think about them before any potential client asks me.

[nickbartman]

...thanks for this Peekay, I suppose your answer might be that it varies country by country and circumstance, but given the drug is for the most part prescription only, then would it be only companies with their owe Dr that would be able to stock Tamiflu or Relenza? And what would be the issue you refer to anyway, as they alone sound a problem? Kindest ~ Nick.

[peekay]

Yes, basically each "identified" employee must receive an individual prescription from a doctor. Most large companies either have internal clinics or have contracts with outside health organizations which can assist with writing prescriptions for a (possibly) large number of key employees. Basically the company plans "mass consultations" where each identified employee gets to see a doctor to get an advance prescription (i.e., before anyone is actually sick.)

Having a prescription doesn't mean an employee gets access to medication immediately, but only that each identified person has a prescription "on file", or one can be issued without delay. Usually these are done for Tamiflu but not Relenza, because Tamiflu can be used for prevention while (I believe) Relenza can only be used for treatment. However companies might buy stockpiles of both Tamiflu and Relenza.

This illustrates why advanced planning is essential. If a large, geographically-distributed company waits until a severe pandemic is already underway, then it might be too late to get all those prescriptions ready and distribute them in time.

There are many (many!) issues associated with stockpiling. How to identify "key" employees and processes at risk? How to handle prolonged pandemics (with multiple "waves" of infection)? Where to buy the doses from? Can the company safely & securely store them or must storage be contracted-out as well? When and how to distribute doses? How to educate employees on the subject without creating workplace anxiety?

There are also many non-logistical issues... such as legal and ethical problems of not making anti-virals available to all employees, liabilities if the stockpiles are inadequate for any reason, etc. There are even issues if a company decides not to stockpile medicine if it has the ability to do so.

Furthermore, corporations today don't work in isolation. A company in the US might depend on a supplier in China and use a Korean-based shipper. How do you protect this "value chain" and to what extent do you do so?

[nickbartman]

Ok, so I'm with you, but a few more questions, if I may, and for the sake of simplicity I'll stick with Tamiflu, and not Relenza:

Can, say, a USA company source Tamiflu from China? I understand there is a Roche licence to a Chinese company, but can that Chinese company supply into the USA, I wonder?

You refer to companies stockpilling Tamiflu but given this is a prescription drug is it lawful for "Anycompany Corp" in the USA to stock it? If I follow you properly Anycompany Corp gets it's staff checked out and given prescriptions, but who then activates the drug to the individuals as and when required sometime later?

[peekay]

No, an American company cannot legally source Tamiflu from China.

While numerous Chinese companies claim to make generic oseltamivir, only one (Shanghai Pharmaceutical) is actually licensed by Roche, and that license restricts production to the domestic Chinese market for pandemic use. As far as I know, Shanghai Pharmaceutical has never sought FDA approval for manufacturing oseltamivir, so its version of the drug cannot be commercially imported into the US.

As mentioned before, usually companies have contracts with an outside healthcare provider and would buy medicine through them. Some larger companies have their own clinics licensed to dispense medicine, and presumably they'd purchase Tamiflu through their usual distributors.

As far as who "activates" the drug once the prescription is approved... that depends on the stockpiling strategy and need. Some companies dispense the drugs to their employees immediately (to keep at home or with them while travelling), while others might choose to store the drugs in a central or regional storage facility.

Technically once the prescription is written, the drug may be used by the employee at any time, since it can be used as prophylaxis. This is where employee education becomes important. Anti-virals are much like antibiotics, so misuse could lead to resistant strains of viruses.

Having said all that, no one even knows if either Tamiflu or Relenza would be effective in preventing or easing pandemic flu. I suspect much of the stockpiling at the corporate level are driven from a liability perspective rather than real medical needs.