Science Blog

Make antivirals available to everyone before the next flu season
Dr Graeme Laver - former professor of biochemistry & molecular biology at the Australian National University
14 March 2007

Dr Graeme Laver is a former professor of biochemistry and molecular biology at the Australian National University in Canberra and was awarded the Australia Prize for excellence in the field of pharmaceutical design in 1996. Dr Laver proved the avian origin of human influenza, together with New Zealand’s Rob Webster, and his work led to the development of the antiviral drug Tamiflu. He has been a long time critic of the Federal Government’s plans to use the antiviral in the event of a bird flu pandemic.

The Government has stockpiled millions of doses of Tamiflu for use in a bird flu pandemic, but they have no effective strategy in place to get it quickly to people who need it.

I believe the Health Department should be doing all it can to make this safe and effective treatment easily accessible so that people can get it as soon as possible after flu symptoms first appear because antivirals are most effective if taken within the first 6-12 hours.

About 3,000 people die from flu each year in Australia, and Tamiflu might save at least some lives if it was used properly. Yet, the Health Department is going out of its way to make it impossible for the drug to be used correctly. Why?? I would really like to know and that’s why I’m emailing some senior people in government to ask them.

Here are extracts from some recent emails:

From: Graeme Laver
To: Professor John Horvath, Chief Medical Officer, Dept of Health,
Cc: Tony Abbott, Minister for Health and Ageing, John Howard
Sent: Wednesday, February 28, 2007
Subject: Tamiflu OTC (Over-The-Counter) in pharmacies

Dear John,

There are only about three months to go before the winter flu season starts and I would like to ask again whether there are plans to make Tamiflu available OTC in pharmacies to flu victims without the time-wasting need to first get a doctor's prescription.
If I wake in the night with a high fever, headache, muscle aches and pains and a dry cough coming on, I know I have probably caught the flu. I also know that there is an anti-viral drug, Tamiflu, out there, which, if I take it immediately, will abort the infection and I will recover fairly soon.

But can I go to the chemist in the morning (or send someone) and get a course of Tamiflu pills that I can start taking straight away? Of course I can't, because of the completely stupid, unnecessary and potentially dangerous policy of the Commonwealth Department of Health.

This requires me to first get a prescription from a doctor, which might take me a couple of days, by which time Tamiflu will no longer be effective. Furthermore, if the replicating virus (which Tamiflu could have clobbered) has provoked my immune system into unleashing a "cytokine storm", I may well die, even though the virus has long gone from my body. That is not something I would like to happen.

There is no reason to need a prescription to obtain Tamiflu OTC from the pharmacy. If you think there is, please tell me what it is? Unlike some of your previous assertions, inappropriate use of Tamiflu (to treat a common cold for example) will not lead to Tamiflu-resistant influenza. So what is the problem?

Inappropriate use of Tamiflu should be avoided, of course, because it would mean the drug is wasted and the patient will lose money. As I have said many times before, but it seems nothing has been done about it, there should be a rapid, sensitive, accurate and inexpensive point-of-care flu diagnostic test in the pharmacy so that people who think they have caught the flu can be tested on the spot and if positive be given a course of Tamiflu tablets they can start taking straight away.

I think you have pointed out that these tests are not perfect. That is indeed true. It seems they are accurate, but lacking in sensitivlty. That means false positives will be rare, but false negatives may be common. I am puzzled why this means the tests should not be used at all! Please explain this quaint notion!

And, in any case, as you should know, there is a big effort being made in the USA and elsewhere to develop better flu diagnostics and these will be available one day. In the meantime a less-than-perfect test would be extremely useful.

So my assertion that the Commonwealth Department of Health is putting the lives of Australians at risk from influenza, for no good reason, still stands.

Arrangements should be made now, before it is too late, to have every pharmacy in Australia stocked with as much Tamiflu as Roche can supply, together with a point-of-care flu diagnostic.

Also, and this is very important, there should be a public education campaign to tell people about Tamiflu, what it is, what it does and how it should be used. If you go into any pharmacy in Australia or into a doctor's waiting room, you will see a stack of small brochures describing things like diabetes, hypertension, coronary disease, various allergies and so on.

There is even one entitled "What to do about the flJanuary 9, 2008LL about the CSL vaccine. Nothing to tell you what to do if you did not take the vaccine, or if you had vaccine failure and you end up suffering from the flu anyway.
I would have thought that to describe and make easily available the new anti-viral flu drugs would have been just the sort of thing the Department should be doing.

But far be it for me to tell you what you need to do. It is not my job to look after the health of the Australian people.

Best wishes,
Graeme Laver

Professor Horvath phoned me almost immediately after that email and after we talked I sent this email to Health Minister Tony Abbott.

From: Graeme Laver
To: Tony Abbott
Sent: Wednesday, February 28, 2007
Subject: John Horvath's reply

Dear Mr Abbott,

Following the email I sent to John Horvath and yourself, I had an immediate phone call from John Horvath to say he was totally opposed to the idea of having Tamiflu available OTC in pharmacies for flu victims to get quickly.

I asked him what alternative procedure was he proposing in the event of a flu epidemic. His reply; "They can go to the Emergency Department of a hospital or to a GP". How would that work, particularly in rural Australia?

Please think about this for a bit and tell me, is this advice sound? If not, do you think maybe steps should be taken to replace Professor Horvath as Australia's CMO?

Best wishes,
Graeme Laver

The Prime Minister’s Department also responded quickly with a phone call from Sue Cox. We talked for a while and then I sent her an email. Here’s an extract:

From: Graeme Laver
To: Sue Cox, Department of the Prime Minister and Cabinet
Sent: Friday, March 02, 2007
Subject: Tamiflu OTC in pharmacies.

Dear Sue,
Thanks for your phone call.

The Commonwealth Department of Health, which is Mr Tony Abbott's responsibility, I am sorry to say, is putting the lives of Australians at risk from influenza and I would like to have this situation corrected. A word in Mr Abbott's ear might help.

Tamiflu (oseltamivir) depended for its creation on basic medical research done by Australians in Australia and funded by the Australian taxpayer through the Australian Government.

The Australian Government is now going out of its way to deny the results of this research to the people who funded it and who could benefit from it if they fall ill.
What possible sense can you make of this?

Best wishes,
Professor Graeme Laver

-------------

Comment

Return to main Science Blog page

If you are a scientist and wish to contribute to this Science Blog, please contact the AusSMC.
Comments received are moderated by the AusSMC and placement cannot be guaranteed.

The opinions expressed in this Science Blog are those of the authors, and do not necessarily represent the views of the Australian Science Media Centre.