|The unspoken assumption made by those promoting this policy is that Tamiflu resistance evolves in a patient treated with Tamiflu, or in other words, that when you get the flu and your physician prescribes Tamiflu, that in some cases the virus develops resistance, and this strain may be passed on to others. In fact, this idea does not seem to agree with what actually happens:
First off, most transmission of flu occurs early in the cycle of infection, before the infected person shows symptoms, and before any Tamiflu is used.
Secondly, the evidence strongly suggests that flu strains 'trade genes' either by reassortment or recombination or both, in preference to individual mutation and evolution.
Thirdly, despite a relatively low level of Tamiflu use, Tamiflu resistant strains became dominant in seasonal flu in about 4 months time here in the USA last winter.
So, Tamiflu resistance is not primarily a result of overuse of Tamiflu, but an inevitable result of the existance of Tamiflu itself.
Another problem not addressed by those advocating restricting Tamiflu use is that there is no way to know who will get severe cases ahead of time. Since Tamiflu must be administered within 48 hours of symptom onset to be effective, and since most severe cases turn severe only after several days of mild illness, once a severe case manifests itself it is too late to treat such a case with antiviral drugs. People have died as a result of such mistaken thinking, and this will be a much bigger problem this fall.
Moreover, a recent study suggests that treatment with multiple different antiviral drugs, including amantadine, is synergistically more effective than the combined effects of individual antiviral drug treatment. This is one case where the "shotgun approach" appears to carry a significant benefit.
My thinking is that in order to maximize effectiveness of the present stockpile of antiviral drugs that they should be prescribed liberally, in accordance with the judgement of the responsible medical practitioner, and emphatically not rationed. If we ration antiviral drugs we will wind up with a useless stockpile of antiviral drugs and a lot of dead people who might have been saved.