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What did we learn from Tamiflu?

BMJ 2020; 368 doi: (Published 19 February 2020) Cite this as: BMJ 2020;368:m626
  1. Owen Dyer, freelance journalist
  1. Montreal
  1. owen_dyer{at}

Ten years after questions were first raised over its effectiveness, Owen Dyer charts the fortunes of this blockbuster pill and finds that lack of evidence has not dented its success

Governments cannot calm earthquakes, bottle up volcanoes, or hold back tsunamis—they may not even be able to put out wildfires—but one disaster they do claim to have power over is a flu epidemic. Since the first pandemic scare of this century, H5N1 avian influenza in 2004 (see timeline, box 1), governments have been stockpiling the neuraminidase inhibitors zanamivir (Relenza) and especially oseltamivir (Tamiflu), in vast quantities.

Box 1

Oseltamivir and pandemic flu preparedness—key events

  • 2003—US adds oseltamivir to its strategic national stockpile

  • 2004—First outbreak of H5N1 avian flu in humans

  • 2005—UK announces it will stockpile 14 million doses of oseltamivir

  • 2006—Cochrane review concludes that oseltamivir reduces complications and symptoms in seasonal flu

  • 2009—H1N1 swine flu pandemic declared by WHO

  • 2009—The BMJ publishes critical Cochrane update review of oseltamivir

  • 2011—FOI request results in European Medicines Agency releasing 20 000 pages of oseltamivir data

  • 2013—GSK and Roche release trial data on zanamivir and oseltamivir

  • 2014—Cochrane review finds insufficient evidence that oseltamivir reduces lower respiratory complications or impedes transmission

  • 2016—Generic formulations of oseltamivir become available

  • 2017—WHO downgrades status of oseltamivir

  • 2020—Cochrane team member Thomas Jefferson sues Roche in US for wrongfully billing public health authorities for oseltamivir as a pandemic response drug


The UK, the US, and many other countries hold enough stocks of these antivirals to offer courses of treatment to a quarter of their population. The practice is almost ubiquitous in rich countries. Of 28 European states that have published a pandemic response plan, all but one (Poland) make oseltamivir the mainstay of their response until a vaccine can be developed.

In the public mind, and the minds of politicians, the flu pandemic problem is one that has …

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