Too much Tamiflu

The case of a Danish woman developing a drug-resistant strain of swine flu after being given low doses of the Tamiflu vaccine is raising questions about how and when to hand out the vaccine.

On 29 June, Denmark's National Board of Health announced the first known case of H1N1 swine flu resistant to the most popular antiviral drug. The woman was in contact with an infected person and was put on low-dose Tamiflu as a precaution, but she developed flu anyway.

She has now recovered after taking the antiviral Relenza, and the drug-resistant strain appears not to have spread. The State Serum Institute in Copenhagen assumes resistance emerged during treatment with Tamiflu, as low doses can favour the emergence of resistant strains.

It appears to be an isolated case, so on one is ringing alarm bells at the moment, but the case is is causing some questioning of the standard policy to treat those close to swine flu patients as a preventive measure. Doing so, after all, could lead to the development of a more dangerous strain of the flu than the current one -- which could be disastrous. 

British Medical Journal blogger Iain Brassington, a bioethics lecturer at the Centre for Social Ethics and Policy at the Law school at Manchester, points out that this puts governments and medical officials in a bind. Do they risk making things worse down the road by treating people now, or not?

There seems to be an interesting dilemma generated: while governments presumably ought to take steps to ensure the availability of prophylaxis, this also generates a risk that they’re creating a much bigger problem further down the line. I don’t think that this is an argument against prophylaxis per se - of course governments should deal with the threat as it stands at the moment (and anything else would be a counsel of despair), and the threat of resistant H1N1may never be realised - but the point would stand that, in doing what they ought to do now, they may be making things worse in the long run. And that means that meeting the present danger isn’t nearly as morally straightforward as it would seem at first.

I'll be keeping an eye out for more drug-resistant strains.