What happens when a prosperous industrial nation decides to give out antivirals to the masses?  Well, we will see!  This is an experiment unfolding before our eyes.

Drug Resistance is the Main Concern

The Uk Has Given Out Thousands Of Doses Of Tamiflu
The UK has given out thousands of doses of Tamiflu

The UK government rejected advice from its expert advisers on influenza pandemic H1N1, who said there was no need for the widespread use of Tamiflu and suggested that the public should simply be told to take paracetamol. An independent panel set up by the Department of Health warned health ministers that plan to make the stockpiled drug widely available could do more harm than good, by helping the flu virus to develop resistance to the drug.   However, those health ministers pressed ahead with a policy of mass prescription, fearing the public would not tolerate being told that the millions of doses of Tamiflu held by the state could not be used during a pandemic, one of the committee members has told the Guardian [newspaper]. “It was felt … it would simply be unacceptable to the UK population to tell them we had a huge stockpile of drugs but they were not going to be made available,” Professor Robert Dingwall, a member of the Committee on Ethical Aspects of Pandemic Influenza, said. On August 16, one of the country’s foremost flu experts called for the national helpline to be shut down to stop hundreds of thousands of doses of Tamiflu going out in an unregulated way, which could render it useless when a more dominant strain returns in the autumn.

Antivirals Should Be Given to High Risk Groups

As it became clear that the current outbreak only had mild symptoms, the committee recommended that antivirals should only be given to those in high-risk categories, like pregnant women or people with existing respiratory illnesses. It suggested the government explain to people that they would not be given medicine they did not need and should use off-the-shelf flu treatments.

No Magic Bullet

Oxford University researchers have warned that antivirals are not a “magic bullet” against flu and that resistance to the drug could develop, making it useless to fight any future and potentially more serious pandemic flu strain. Flu expert Hugh Pennington, emeritus professor at Aberdeen University, who called for the national flu line to be shut down, seconded the concern. “I am concerned about the vast amount of Tamiflu that is going out almost unregulated,” he told the Guardian. “We are increasing the possibility that the flu will become resistant sooner or later. At the moment, there is no desperate need for Tamiflu. We should be reconsidering its issue rather than encouraging its use. I think we should stop the national pandemic flu service. It was put there for an outbreak of far higher mortality than we have. If you get a resistant strain that becomes dominant in the autumn, Tamiflu will then be useless.”

The ProMed Editor went on to say…. The danger inherent in the uncontrolled dispensation of the anti-neuraminidase antiviral Tamiflu is already evident in the sporadic appearance of Tamiflu-resistant viruses. In all cases so far, resistance has been conferred by the same H275Y mutation in the NA gene. The spread of Tamiflu-resistant viruses may not be long delayed if there is restriction in the use of this drug. Fortunately, so far, all the Tamiflu-resistant viruses have remained sensitive to the alternate anti-neuraminidase drug Relenza (zanamivir).

PRO> ProMED Digest V2009 #386 – www.promedmail.org

The Guardian – http://www.guardian.co.uk/society/2009/aug/17/society-email-briefing

The Guardian – http://www.guardian.co.uk/commentisfree/2009/aug/17/swine-flu-tamiflu