The former secretary of state for health, Frank Dobson, has backed the National Institute for Clinical Excellence (NICE) in its ruling against the novel influenza drug zanamivir (Relenza).

The institute believes that the current evidence from clinical trials by the manufacturer, Glaxo-Wellcome, suggests only a moderate benefit of the drug to otherwise healthy individuals. The drug reduces flu symptoms by about one day, and the costs of achieving this benefit are uncertain. In the absence of clear evidence of its effectiveness in high risk patients (9 October, p 937), NICE has advised GPs not to prescribe zanamivir during the 1999-2000 flu season.

Frank Dobson said: “In their own literature the company have acknowledged that they have as yet not a great deal of evidence of the impact of the drug on high risk groups, but there is more research under way. I believe that this decision is in the long term interests of patients, the NHS, and research based pharmaceutical companies.”

Mr Dobson has asked NICE and Professor Sir John Pattison, the NHS director of research and development, to work with GlaxoWellcome to study the impact of zanamivir in high risk patients. It is hoped that NICE will be able to reconsider its guidance ahead of the flu season in the winter of 2000-1.

NICE has also advised that flu immunisation remains the most effective intervention in preventing complications. Rates of vaccine uptake remain low, and a Department of Health spokesperson commented, “We need to do better on uptake of vaccination in people most at risk” (11 September, p 659).

Professor Michael Pringle, chairman of council at the Royal College of General Practitioners, welcomed Frank Dobson’s decision. “We believe that GPs should encourage all vulnerable groups to be immunised against flu,” he said, “and we will join in encouraging GPs not to prescribe Relenza this year.”

But Dr John Chisholm, chairman of the BMA’s General Practitioners Committee, expressed serious concerns about the implementation of the ruling. “NICE’s decision should have been given legislative force,” he said.

“The secretary of state’s failure to blacklist the drug has done nothing to protect GPs from potentially colossal demand for Relenza. GPs have been left between a rock and a hard place. Relenza is still available on NHS prescription, and even if GPs follow NICE’s advice, as I hope they will, the prospect remains of enormous patient demand.

Photo caption:The international development secretary, Clare Short, releases 6000 balloons in Trafalgar Square, London, to publicise the fact that the world population has reached 6 billion.

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