Public health officials across Canada are grappling with the medical and ethical issues of giving front-line health-care workers preventive antiviral drugs if a flu pandemic strikes.

The federal and provincial governments have stockpiled more than 50 million doses of antiviral drugs to prepare for a pandemic. 

'We have to be there to look after the ill population, and if we're not there because we're sick, people are going to die.' —Dr. Michael Gardam

Under the current federal plan, the drugs may only be used to treat people once they are ill, a reversal of an original decision two years ago to stockpile antivirals as a preventive treatment or prophylaxis for front-line health-care workers as well.

Antiviral drugs such as Tamiflu offer the best hope of protecting health-care workers in the event of a pandemic and keeping them on the job to treat patients, said Dr. Michael Gardam, an infectious disease expert at Toronto's University Health Network.

Following the outbreak of SARS in 2003 that killed 44 people in Toronto, most large hospitals in Ontario decided not to take chances and have stockpiled Tamiflu for their employees.

If there is a shortage of Tamiflu, Gardam said, hospitals have been told the Ontario government has the right to confiscate the drugs bought for preventive purposes, but he disagrees with that approach. 

"It's a bit like we're going to say we're going to war, but not provide our soldiers with the right stuff necessary to actually make them safe in that setting," Gardam said.

"We have to be there to look after the ill population, and if we're not there because we're sick, people are going to die."

As jury remains out, countries vary approaches

But the antiviral drugs may not work against a new and deadly flu virus, and the preventive treatment could build up resistance to the drug, said Dr. Eric Young, head of pandemic planning in British Columbia.

"We're looking at hundreds of millions of dollars in potential costs, and those are hundreds of millions that will basically be kept out of the health-care system for other things such as MRIs, dialysis, hiring of other health-care workers," Young said.

The scientific jury is out on the practice, agreed Dr. Arlene King, head of pandemic planning at the Public Health Agency of Canada, saying there are no "instantaneous answers" to the issues. 

Australia and European countries have set aside some of their antiviral stockpiles for preventive treatment.

The U.S. and United Kingdom are taking a different approach by buying vaccine for the H5N1 bird flu virus, betting that the strain will cause the next pandemic.

After holding public hearings on the value of using antivirals for preventive purposes, public health experts in Canada are reviewing the federal antiviral decision. Their recommendations won't be made public for months, but it could lead to the policy changing once again for the federal and provincial governments.