When Kelly Kimura came down with an ordinary case of the flu last Sunday, her husband, Darren, called the local pharmacy, hoping to fill her prescription for Tamiflu by the end of the day. He was surprised by the clerk's response: because of a flood of requests during the week, the pharmacy, a branch of Longs Drugs (owned by CVS) in Mililani, Hawaii, had none of the antiviral drug left in stock. They were also unable to find Tamiflu or Relenza, a similar medication taken with an inhaler, at other Longs and Walgreens locations nearby. By Monday afternoon, after driving a total of 60 miles around the island of Oahu with no success, the couple was frustrated and panicked.
"[The pharmacists] said they'd never seen anything like it," says Darren. Retailers on Oahu, Hawaii's most populous island, told Kimura that the shortage was caused by a surge of buyers likely hoping to stockpile drugs after reports of swine-flu cases in several mainland U.S. states. The Kimuras were lucky; by the time they returned to their local Longs store on Monday night, the pharmacist had found a single box of Tamiflu that hadn't shown up in his computer system. But as swarms of anxious patients ask their doctors for Tamiflu and Relenza prescriptions "just in case"—the government announced plans on Monday to release 12 million doses of oseltamivir phosphate (the generic name for Tamiflu) from its 50 million-dose reserve—some prescription holders are unable to find the drugs in pharmacies. Representatives for both Longs and Walgreens confirmed that their retail stores have been seeing increased demand and that some had "temporary stock outages" over the weekend. The scene in Hawaii, a state with no reported cases of swine flu so far, is repeating itself across the country. CVS reports increased demand in New York City, while Walgreens has seen interest spike in New York, California, Texas and Illinois.
Generally, people who seek prescription medications but can't find them at pharmacies may resort to one of three options, according to Jeffery Goad, an associate professor of clinical pharmacy at the University of Southern California. Buyers with a prescription may shop at online pharmacies based in the United States, many of which are certified by the National Association of Boards of Pharmacy. Those without prescriptions may try to buy online from companies based in Europe, Latin America and Asia, which claim to offer the same drugs (or their generic equivalents), but violate U.S. law by shipping products across the border without certification. Another, more immediate option is the informal black market: the same word-of-mouth network that traffics in illegal substances and prescription drugs like Vicodin.
Brad Walbrun is an old hand at stockpiling. The 35-year-old Illinois native buys antibiotics online without a prescription and keeps them on hand for his frequent ear and sinus infections. After hearing about swine flu last week, he checked his usual online sources and, aside from a few small doses of Relenza, found them wiped out. Walbrun considered talking to his underground contacts, but decided it wasn't worth the risk—or the cost. "Tamiflu is like gold right now," he says, adding that, in his experience, antiviral, antibacterial and other "useful" medications are difficult to find on the black market anyway.
With the World Health Organization warning countries to prepare for a possible swine-flu pandemic, that might change. When concerns about avian flu sent Tamiflu flying off the shelves in 2005, an illicit market for the drug quickly developed online—in one three-week span that year, Customs agents in San Francisco intercepted more than 50 packages of fake Tamiflu shipped by Asian suppliers to unsuspecting Internet buyers. U.S. Customs and Border Protection officials say they haven't seen any counterfeit flu medications in the past year, but said in a statement to NEWSWEEK that they are "monitoring enforcement statistics" in light of recent swine-flu developments. And spammers are already active as well. According to Dave Marcus, director of security research at McAfee Inc., e-mails with subject lines that included "swine flu" accounted for 4 to 5 percent of all spam on Wednesday morning, up from 2 percent on Monday. "Before this weekend," he says, "we never saw the words 'swine' and 'flu' together … The bad guys read the same news that you and I do."
Goad explains that the unique nature of flu medications makes the market particularly vulnerable in situations like this one. Tamiflu and Relenza "never took off as a commercial product," he says, because they are used by only a small percentage of the population for a few months each year. When panic strikes, "very few pharmacies have it [in stock]. They wouldn't usually have it." The U.S. government, which controls 25 percent of the country's supply of flu medication, isn't much help to would-be stockpilers: all the doses released by the Department of Homeland Security will go to public clinics and support teams, not private distributors. Faced with empty pharmacy shelves, Goad expects consumers to buy drugs wherever they can—and, once they find them, to buy as much as possible.
But while the idea of collecting a private antiviral stash might be reassuring to some, public health experts say hoarding consumers likely won't be better off than the rest of us and may, in fact, be doing more harm than good. Those who buy drugs from foreign sources run the risk of taking ineffective or possibly dangerous substances. Goad also warns that even those who get prescriptions ahead of time are likely to misdiagnose themselves later—mistaking a bad cold for the flu, for instance—and take drugs they don't need. That can help existing strains of the flu virus develop resistance to commonly prescribed medications, which makes them more difficult to treat in the future. In a press briefing on Thursday, acting Centers for Disease Control and Prevention Director Richard Besser acknowledged that the public is facing a "situation filled with uncertainty," but told reporters that individuals should focus on controlling the spread of the virus with preventive measures such as hand-washing and limiting nonessential travel to Mexico.
When it comes to drugs that are always in short supply, like Tamiflu and Relenza, Goad emphasizes that it's best to avoid alternative markets and to leave supplies available for those who, based on CDC guidelines, are most at risk for any type of flu: young children, the elderly, travelers and health-care personnel. Kelly Kimura, the flu sufferer in Hawaii who had an ordinary (non-swine) case, was able to take her prescription within the recommended 48-hour treatment period, but one swine-flu patient in New York City told NEWSWEEK she had to skip her dosage when she couldn't find it in drugstores. With pharmaceutical companies Roche (Tamiflu) and GlaxoSmithKline (Relenza) ramping up production, and Cipla, an Indian company, promising 1.5 million doses of a generic drug in the next four to six weeks, the global market should be able to handle the next wave of swine-flu sufferers. Everyone else should take basic health precautions and resist the urge to run to the doctor's office. For now, "just in case" just doesn't cut it.