Ethical issues should be discussed at the highest level of government...

If a bird flu pandemic was to hit the UK and it became a full on crisis with people struggling to get their hands on Tamiflu or Relenza it is likely that the health authorities would be overrun and under a large amount of pressure. The problems would not be purely logistical and involving lots of work and time but would be of a very ethical and moral dimension too.

The WHO says that to be fully prepared for the H5N1 virus governments should have enough Tamiflu for around 25% if its population. How they came to this percentage is not known but it is at best a calculated guess as well as an estimate bearing in mind the practicalities of the problem that there is not an unlimited amount of Tamiflu available in the world.

If the WHO had said that it was advisable for governments to have a 50% threshold for Tamiflu then as well as the demand not being met by Roche it would have impacted on poorer countries far more than on the richer countries. The poorer nations are the ones that need Tamiflu more as they tend to have people who exist in close proximity to each other and to poultry and who also have less efficient structures in place for controlling spread of the disease by using quarantining and disinfectants.

If a bird flu virus really hits it may be necessary to limit the supplies of Tamiflu and Relenza to sick patients and this could mean that doctors may have to make life and death decisions. Who would be excluded first? The elderly, the weak or should Tamiflu be administered on a first come first served basis. Maybe those who are in charge like doctors and nurses and other health officials should get the first Tamiflu, what about the Prime Ministry and his cabinet or the head of the army?

Ethical issues should be discussed at the highest level of government (maybe they have been already?) so that clear guidelines can be in place when and if the H5N1 virus strikes.