The party line and the flu-line
It has emerged over the weekend that the UK government ignored the advice of a key panel of scientific advisors in the formulation of its pandemic response. The panel advised against the mass prescription of antivirals (Tamiflu) because of the fear that this would accelerate resistance of the virus (see also this previous post in the pandemic ethics series). An expert in influenza, Hugh Pennington, has even called for the national flu hotline to be shut down. It appears that the government may have been influenced in its pandemic response by political sensitivities.
Part of the problem is that this pandemic influenza strain appears to be relatively mild. There has been speculation about, and preparation for, a new influenza pandemic for some years. The stockpiling of anti-virals and the development of distribution systems that would reduce the burden on the health service (for example the flu hotline) were designed to deal with a pandemic with high mortality. But, although this new strain of influenza has caused serious illness and death in a small number of individuals, thankfully it is nowhere near as bad as feared.
The Committee on Ethical Aspects of Pandemic Influenza recommended that anti-virals be given only to those at higher risk, for example pregnant women or those with pre-existing illnesses. But this approach was rejected, at least in part because of a feeling that the public would not accept rationing of antivirals when there was an existing large stockpile. In the first fortnight of the national flu hotline more than 500,000 courses of anti-virals were prescribed.
The hotline has some definite advantages. It takes the pressure off GPs and emergency departments as well as streamlining access to antivirals for those who genuinely have influenza and would benefit from treatment. It potentially serves to reduce spread of the virus by preventing patients from attending clinics and hospitals. But there are also risks. As I discovered myself this morning, (I have a mild flu-like illness at present), the criteria for ‘diagnosis’ of influenza are so broad that they include almost any patient with a febrile illness. There have been a number of stories in the media in the last week of patients with other serious illnesses (see here, here, or here) who have received a telephone diagnosis of influenza and as a consequence have delayed presentation to hospital. There have also been large numbers of patients developing (mostly mild) complications from the anti-virals. The biggest concern is that using up the stockpile of antivirals on patients who may or may not have influenza, and who have a very low chance of benefit, risks the drugs not being available, or not being effective come winter.
There is, of course, a balance to be achieved in public health policy between optimal community benefit, and public acceptability. But short term political expediency may come at long term political cost. The current pandemic response needs to be reconsidered.
Experts warned dispersal of Tamiflu would do more harm than good Guardian 16/8/9
Ministers ignored advice on mass issue of Tamiflu Telegraph 17/8/9