Is Tamiflu the magic cure?

It is well known that influenza symptoms, caused by the influenza virus, are hard to treat and most of us simply go to bed and sweat it out when infected. One of the few medications to show consistent benefit for influenza sufferers is Tamiflu, an anti-viral medication developed by the Swiss company, Roche. Tamiflu acts by preventing the spread of the virus from one cell to another within the body.

To be effective it has to be started within 48 hours of the commencement of symptoms and the course should be taken for five days. Once the episode is over the patient will be immune to that particular influenza strain and will never develop it again.

The prospect of a human epidemic resulting from the current bird flu epidemic is causing governments around the world to stockpile Tamiflu. The problem is many countries are stockpiling the drug but only one facility in the world is making it. While Roche has agreed to allow other companies to manufacture Tamiflu under license there is likely to be a shortage for some time. If an epidemic does strike New Zealanders the question will inevitably arise as to who gets treated. The government has enough Tamiflu for 855,000 courses of treatment, which would cater for about 21% of the population. At the time of writing the Ministry of Health website states that it doesn't intend to source any more Tamiflu.

Anyone who wanted a private stock of Tamiflu could get it on prescription from a community pharmacy but they had to meet the cost themselves - around $75 for a five day course. However this morning Roche announced that there will be no more Tamiflu available commercially in New Zealand until May 2006.

The government has taken a lot of criticism this week about its priority list of recipients for Tamiflu. The Minister of Health, Pete Hodgson, denied there is such a list but the Ministry of Health has been working on an interim policy discussion document - a preliminary list which indicates preference could be given to groups such as "people who maintain essential health services, police, defence, key emergency decision-making bodies, border agencies, social support, critical infrastructure and selected non-health residential facilities staff." Dr Mark Jacobs, Director of Public Health at the Ministry, has pointed out there is no guarantee Tamiflu will work as it isn't effective against all influenza strains. If indeed any strain of bird flu that reaches New Zealand does not respond to Tamiflu most of the stockpile will never be used. The truth is we just don't know. If a worldwide bird flu develops that can be transferred from human to human - and right now that is not the case - the virus might have mutated to such an extent that Tamiflu may well be useless.

The best way to prevent a viral epidemic is by vaccination but influenza comes in many strains. A vaccine can't be prepared until the scientists know which strain is spreading through the human population.

New Zealand has been guaranteed supplies by an Australian company but it will take months to develop a vaccine. With international air travel our warning time is likely to be measured in days rather than months.

Of course, the feared epidemic may never strike. If it does, it may be able to be treated with Tamiflu but we can't rely on this as the sole safeguard. Even in the worst-case scenario influenza's most serious effects result from bacterial infections like pneumonia, which exploit the body's weakened state, and these can be treated with antibiotics. We do not need to see a repeat of the "Spanish" flu of 1918 when antibiotics had not been developed and most deaths were the result of pneumonia.

So what can people do to protect themselves in the event of bird flu? Despite the scoffing the Minister of Health received in Parliament this week from the National Party Health spokesman he was right when he emphasized the importance of hygiene - thorough hand washing and drying will help minimise spread as will limiting contact with others. Personal responsibility in the face of an epidemic is essential. The government for its part should consider stockpiling antibiotics.

Police or Police Staff?

One could have been forgiven for thinking the Labour government was getting serious about crime with the announcement in October, that a condition of Labour's Confidence and Supply agreement with New Zealand First was 1000 extra police. The announcement implied, and it is clear from comments made by New Zealand First MPs that they thought, the extra police promised over three budgets (i.e. three years) would be front line.

However Labour's new Police Minister Annette King, when questioned in parliament this week about the front line status of the extra police said there was no guarantee the extra police would operate anywhere near the front line. Careful reading of the Labour/New Zealand First agreement says "Budget for police numbers to be increased to provide another 1000 police staff over the three budgets …".

It will be difficult for Labour to deliver even this watered down promise. In the year to 2005 the attrition rate for sworn police was 4.7% and for non-sworn police was 12%. To add 1000 extra staff over the next three budgets the Police will actually have to recruit and train 2000 people.

Winston got the baubles while his MPs have been seriously duped.

ENDS

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