Is Tamiflu policy driven by science or politics?

A team of Oxford healthcare researchers, some of whom are also practising primary care physicians, yesterday published a recommendation that the antiviral drug Tamiflu not be prescribed to children with mild cases of swine flu. You can see an interview with lead researcher Matthew Thompson in the BBC News report of the story.

Given the known side effects of the drug whose generic name is oseltamivir phosphate, which include vomiting and associated dehydration, the advice given by Thompson would seem wise. After all, with respiratory illnesses in children it is important to control their temperature. But this is made difficult when the poor mites cannot keep down the syrupy paracetamol preparations they are fed by anxious parents.

The conclusions of the Oxford study run counter to official policy in the UK, where the government is busy buying up stocks of Tamiflu with the intention of offering the drug to anyone infected, or suspected to be infected, with the H1N1 virus that causes swine flu.

As an aside, it’s perhaps worth noting that the UK strategy appears to be antagonising other EU member states, some of which are struggling to build up stocks of Tamiflu sufficient for their own populations. A cynic might call the British stance an example of healthcare nationalism.

So what of the British policy of offering Tamiflu to all who ask for it? Can it be justified? As the pharmacologist-blogger Anthony Cox notes, the government is taking a safety first approach, and to a degree one can understand this. The Labour administration is in a deep hole right now, and could surely do without the political fallout resulting from even a single child dying from swine flu after being denied oseltamivir. But at the same time it reveals that swine flu policy is being driven in part by political considerations rather than sound science.

Planning for a severe outbreak of swine flu is perfectly justifiable, given what we know about the H1N1 virus. However, we may be in danger of going over the top in our reaction to it.

Further reading

Shun-Sin et al., “Neuraminidase inhibitors for treatment and prophylaxis of influenza in children: systematic review and meta-analysis of randomised controlled trials”, BMJ (2009)