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Half of England's Tamiflu Prescriptions Were Wasted in the 2009 Swine Flu Pandemic

By receiving and then not using prescriptions, people are drawing away limited resources from people who potentially need it more.
Photo: Andrew Wales/Flickr

This is pretty crazy, both in conclusion and methodology: New research, published in PLoS ONE, has determined that during the 2009-2010 swine flu pandemic, roughly half of all the prescriptions filled for Tamiflu in England were never taken. That's 600,000 courses of the drug, costing the British public £7.8 million ($11.9 million).

To determine this, scientists for the first time examined sewage water, recovering the active component in Tamiflu to find out how much of the drug was consumed by patients and how much was just flushed away. This can be done in the case of this drug, report lead author Dr Andrew Singer explains, because "Tamiflu gets transformed into the active antiviral only after being consumed, and is released into the sewage with every visit to the toilet."

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So by recording how much of that metabolite showed up in sewage and comparing it to how much would have been expected to be excreted based on the number of prescriptions, the research team was able to calculate a general compliance rate for the populace at large. Their results suggest that somewhere between 45 and 60 percent of prescriptions were actually used.

Singer goes on to say, "There is a clear need to improve public health messages so that less antiviral is wasted and that the duration and severity of infection is reduced. Furthermore, we feel the waste water epidemiology approach undertaken can potentially help shape future public health messages, making them more timely, targeted, and population sensitive, while potentially leading to the less mis- and unused antiviral, less wastage, and ultimately a more robust and efficacious pandemic preparedness strategy."

In the paper itself, Singer and colleagues note that their procedure could be used for "near real-time understanding of drug compliance" at a water treatment facility, covering anywhere from hundreds to millions of people.

Why does this matter? The report rightly notes that by receiving and then not using prescriptions, people are drawing away limited resources from people who potentially need it more. This is of course in addition to the cost to the nation of the wasted medications.

There's one more factor that brings this out from the background of influenza. The study cites other research showing that in flu cases where secondary bacterial infections arise, the need for antibiotics decreases by roughly 50% when antivirals are provided.

The 2009-2010 swine flu pandemic was originally thought to have killed just 18,500 people, but research published two years later in The Lancet found that at least 284,000 people died from the H1N1 influenza virus—and perhaps as many as 579,000. Roughly half of the deaths occurred in Africa. Official reports have the total number of people in the world infected by the virus to be a bit over 1.63 million, but these are the same reports that list the number of dead at under 20,000. In the UK, it's thought that some 28,500 people became infected with swine flu, which ultimately killed under 500 people.

In the summer of 2009, fears of shortages of Tamiflu led to some people in Britain attempting to lie their way into getting a prescription. Apparently a great many of them then just flushed it all away.