Some of Britain's top scientists yesterday accused the government of failing to listen to expert advice in its preparations for a flu pandemic and of stockpiling a single drug, which might not work, to treat the population. Over 14m doses of the drug, Tamiflu, have been delivered, but two leading scientific institutions, the Royal Society and the Academy of Medical Sciences, say the government should be buying similar quantities of a second drug, Relenza, as well.

Reports from south-east Asia suggest that in a few cases Tamiflu has not been effective because the H5N1 bird flu virus, which has proved lethal to humans, has developed resistance to the drug. The report is highly critical of the government's failure to act on scientific advice and proposes that an independent flu specialist should be appointed to advise the cabinet committee on influenza pandemic planning, alongside the chief medical officer and chief scientific adviser.

"We are concerned that decisions are being made, as the UK prepares for a possible pandemic, that fail to take account of expert advice," said Sir John Skehel, chairman of the report's working group and until last month director of the MRC National Institute for Medical Research, which is heavily involved in research into avian flu. The decision to continue to stockpile just one antiviral drug, he said, "is a major concern. This needs to be reconsidered. New evidence that H5N1 can develop resistance to Tamiflu indicates that a combination of antivirals should be stockpiled by the UK for the most effective management of a pandemic.

"The government was right to order Tamiflu in early 2005. However, we are concerned that it is not updating its plans as the landscape of what we know about influenza changes." The order of 14.6m courses of Tamiflu was completed in September and is intended to be enough to treat 25% of the population. But even if Tamiflu works against H5N1, it may need to be given in larger doses than originally intended and there will be no time to manufacture more between waves of the pandemic, so the stockpiles of both Tamiflu and Relenza may need to be larger than at present, the report says.

It also accuses the government of a lack of transparency. The scientific basis for its decisions - particularly concerning the purchase of Tamiflu and vaccines from pharmaceutical companies - "has not been made publicly available in full". It strongly urges greater openness over the government's pursuit of a vaccine. "Independent, high-level scientific advice should be sought in an open way before any decision is made to take a particular approach to vaccination that could affect the lives of millions," it says. "The working group found difficulty in penetrating the barrier of confidentiality that surrounds the industry and its relationship with the Department of Health."

The "flu tsar", Lindsey Davies, director of pandemic influenza preparedness at the Department of Health, said the government was already addressing many recommendations. "We do keep our pandemic preparedness planning under constant review with the advice and assistance of our scientific advisory group. "Our antiviral strategy is informed by international consensus and expert advice, and the current stockpile should be adequate to treat all those who fall ill in a pandemic," Professor Davies said.

Tamiflu attracted further controversy last week when it was linked to suicidal feelings among some young people. A 10-month review by the US drug regulation body, the food and drug administration, identified 103 incidents where young people on the drug had demonstrated disturbed behaviour, including a 17-year-old youth who jumped in front of a truck and a 14-year-old boy who died when he fell after climbing on a balcony railing. The European Medicines Agency said the manufacturer, Roche, would issue new information for doctors in a few months.

Yesterday Roche said it was theoretically possible for resistance to the drug to emerge, but that the World Health Organisation stated last December that resistance so far had been "negligible".

FAQ: Avian flu

Is there still reason to fear a flu pandemic?
Yes. Last year there were about as many cases of avian flu in humans as the year before, when it got more publicity, according to Sir John Skehel, chairman of the working group that produced yesterday's report.

Is it more likely to arrive in the UK?
No more and no less likely. Around 10% of the roughly 200 wild birds tested per day show infection with a form of avian flu, but not the lethal H5N1 strain which has passed to humans in Asia.

Are we safe in the UK?
No. Even if nobody is infected by contact with chickens here, we are likely to have serious problems if the virus begins to spread from human to human elsewhere in the world. Unless a pandemic were very quickly contained, people would inevitably arrive here from the infected area and some may carry the virus.
(By Sarah Boseley, The Guardian, 21/11/2006)
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