Tough choices on Tamiflu

The government's decision to make antiviral drugs to treat swine flu widely available goes against latest scientific advice. Is this a mistake, asks Vaishali Bhardwaj

To accept or reject the opinion of scientists? That is the question. Well that was the question facing the British government this week when ministers were warned by advisers, appointed by the Department of Health, that the mass prescription of the swine flu antiviral Tamiflu could speed up the virus' resistance to the drug.

The government seemingly fears what the public's reaction will be should Tamiflu stocks be withheld and as suggested by scientific advisers, only prescribed to people in high-risk categories, such as people with underlying health conditions.

No doubt the government is trying to show the public that it is actively trying to reduce the spread of the influenza A (H1N1) [swine flu] virus with such a move, but is this really the solution? Shouldn't the government instead aim to educate the public on the potential long-term risks of overuse of Tamiflu before the mass distribution of the drug to the wider public? Perhaps this should be the government's stance instead of taking one that so flatly rejects scientific advice, which history itself supports.

Indeed, scientists are not new to the phenomenon of drug-resistant microbes developing as a result of the overuse of antimicrobial drugs. The resistance of the bacterium Staphylococcus aureus to penicillin in the 1950s is a classic example of how the overuse of an effective drug led to widespread penicillin resistance in the bacterial population by the late 1980s.

Understandably the government needs to be seen to be providing a solution to the swine flu pandemic. And it seems on this occasion it has made a perhaps more politically driven decision rather than a medical one based on potential public reaction.

To reject the advice of expert advisers on such an issue as the swine flu pandemic is risky business. The widespread use of a single drug such as Tamiflu will speed up the selection of resistant mutant strains. Should one of these mutant, more virulent flu strains emerge in the future (one which has the risk of spreading on a pandemic level) the drug will be prove to be ineffective.

Of course this has not yet occurred. But if scientists have learned anything from the past 100 years of scientific discovery it is that microbes can and will develop resistance to drugs over time. So the government seems to have two options: treat all suspected cases of swine flu with Tamiflu and risk the rapid emergence of resistant viral strains (and please the uninformed public) or choose to heed the opinion of scientists and only prescribe the drug to high-risk category cases. Tough choice.

Vaishali Bhardwaj is a microbiology graduate from Imperial College London.