Few significant regional differences emerged across the community conversations. Individual participant commentary from all three sessions indicated widespread support for the overarching concept that public health authorities should develop alternative strategies to help people gain access to antiviral medications during an influenza pandemic. As noted above, many participants also expressed broad acceptance of all of the specific prescribing and dispensing strategies presented, as well as for the web site and text-messaging tools aimed at enhancing public access to information and advice about pandemic flu and treatment with antiviral medications.

Many participants also acknowledged the advantage of a “layered” approach to facilitating access to antivirals (i.e., the need to employ multiple strategies to reach different groups and respond to different circumstances). Qualitative information from several small-group discussions underlined the understanding that no single strategy could satisfy all needs at once; even when some participants voiced criticism of individual strategies on the basis of identified limitations, they still regarded them as generally acceptable. Several participants across the three sites did express reservations about the application of certain proposed strategies in the context of children (i.e., perceived safety issues), and when antivirals are in short supply (i.e., concerns about dishonesty and unpreventable “gaming” of the system). Alternative prescribing and delivery strategies will have to account for these concerns in order to receive the public’s trust and acceptance when implemented in a pandemic. Finally, public trust and acceptance also will depend on continued education to build public awareness and understanding of these or other alternative strategies.11



One observation, common throughout the community conversations, was the tendency of many participants to refer to antiviral medications and vaccines interchangeably. Whether misunderstandings relate to differences between medications and vaccines or differences among antivirals (i.e., to treat people with influenza or HIV), policy makers should not assume that everyone is knowledgeable about the distinctions.