In the past century the world has faced four influenza pandemics, the most recent being Swine Flu in 2009.
Around 2000 Australians die each year from the flu, but during a pandemic the potential death toll is far higher.
Vaccines may be effective during a normal flu season but if a pandemic strikes they’re unlikely to protect you.
Anti-viral drugs were thought to be an effective weapon against influenza. But it now turns out this was based on incomplete evidence. Nonetheless governments around the world have spent millions of dollars stockpiling these preparations in case of a pandemic.
Usually, patients take part in a trial, data is collected, but results are never published. In light of new evidence, experts are asking, are these drugs effective, and is it money well spent?
Until recently a viral medication was largly ineffective. But in the late 1900’s, new anti-virals hit the market. Relenza, a powder, and Tamiflu, a pill. Since 2002, the Australian government has spent $380m stockpiling these medications in the event of a pandemic.
Early on the consensus was, these medications could stop the spread of influenza and reduce the number of hospitalisations and complications. When Tamiflu first became available people thought it was like a new antibiotic that will kill viruses like the flu.
In 2009 during the Swine flu epidemic Tamiflu sales rose sharply. But some experts are questioning the drugs effectiveness and safety. It doesn’t appear to be working as well as they thought.
Roche, the drug company behind it, withheld vital information on its clinical trials for half a decade, but the Cochrane Collaboration, a global not-for-profit organisation of 14,000 academics, finally obtained all the information. Putting the evidence together, it has found that Tamiflu has little or no impact on complications of flu infection, such as pneumonia.
The results didn’t deliver on many of the claims, like preventing complications or hospital admissions. They equated anti-virals to simple pain relievers, but ten times as costly. It’s like an expensive aspirin, it makes you feel better but the virus carries on. It’s a health disaster because people will go wandering around spreading the virus, whereas they should be staying home.
Another concern was that the side effects had been under-estimated. They knew it increased nausea but not that it caused an increase in neuro-phychiatric side effects.
The FDA (Federal Drug Agency) in America maintain that Tamiflu has not been proven to have a positive impact on the potential consequenses such as hospitalisations, mortality, or economic impact) of seasonal, avian or pandemic influenza.
This reinforces the need for impartial researchers like Cochrane who can perform complex analyses on drug trials. Drug funding goes straight to the regulator, so if they discourage a drug from being used, their income drops.
In spite of the recent study by Cochrane, the Australian government will continue to stockpile the anti-viral drugs.
In science the most reliable evidence comes from randomised controlled trials. They are the gold standard. But they’ve never been done during a pandemic, so you can’t say for certain that these drugs reduce deaths in high-risk patients.
Cochrane say we’d be better spending our resources in masks and gloves, along with soap and water which is extremely effective in stopping the spread of viruses.
When asked if he thought the pros outweighed the cons when it came to prescribing Tamiflu for seasonal influenza, Prof Chris Del Mar, a Cochrane reviewer from Bond University said, “I personally do not. If I ever get influenza I won’t take it myself”.