What did we learn from Tamiflu?
BMJ 2020; 368 doi: https://doi.org/10.1136/bmj.m626 (Published 19 February 2020) Cite this as: BMJ 2020;368:m626- Owen Dyer, freelance journalist
- Montreal
- owen_dyer{at}hotmail.com
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.
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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