Tamiflu – Medicine or Vaccine

To anticipate the containment of Swine Flu the MoHA of Indonesia issued a circular on April 28, 2009, advising governors, district administrators and mayors to take the following strategic step: “To secure the Tamiflu drug and its distribution to the public.” A circular from the Directorate General of Disease Control & Environmental Health, MoH, of 29 April 2009, affirmed that Swine Flu/Mexican Flu can be treated with Oseltamivir (Tamiflu). The 28 April 2009 circular of the MoH to all governors in Indonesia did not mention any directive to conduct a Swine Flu vaccination campaign.

On the other hand, during the same period, other countries planned to conduct a Swine Flu campaign (active immunization). This plan faced two obstacles: (1) the H1N1 specific vaccine was not yet available/has not yet been certified by the authorities, because more testing was required to prove its efficacy and safety; and, (2) the slow production of the H1N1 specific vaccine, because the production capacity of Swine Flu viruses is half as much that of common flu viruses. Because no specific vaccine was available these countries were going to use Tamiflu for mass vaccination. (WHO: No licensed swine flu vaccine until end of year. Accessed 16 July 2009 at http://www.usatoday.com/news/health/2009-07-13-swine-flu-vaccine_N.htm?csp=34).

The use of Tamiflu as medicine or vaccine has obviously different logistical implications. As a drug Tamiflu is only prescribed for persons with ILI symptoms (approximately 20% of the population) 2 X 75mg/day for 5 days (administered within 48 hours of onset). As a vaccine Tamiflu must be administered to all persons, without contraindications, above 1 year of age 1 X 75mg/day for 10 days. Politically prevention seems better than treatment, but when resources are limited treatment appears to be more cost saving. Both approaches are mere speculations, because both may not be efficacious and both may not be safe. The Influenza viruses that were circulating at that time have already undergone changes (antigenic drift) caused by preceding vaccinations; and, the Swine Flu virus was probably already resistant to Oseltamivir. Both strategies can boomerang the respective governments – face public criticism when it turns out that many still get the Swine Flu and many suffer grave side effects (e.g., Guillain-Barre syndrome in 1976) or waste resources because case management of Swine Flu and control of Tamiflu utilization (i.e., to be used only for treatment) are not cheap. (Moscona, A. Global transmission of Oseltamivir-resistant influenza. The New England Journal of Medicine, Vol 360:953-956,March 5, 2009. Accessed 17 Juli 2009 at http://content.nejm.org/cgi/content/full/NEJMp0900648)


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