Abstract Decisions regarding the regulation of individual medicines differ from country to country. In the case of Relenza, Mulinari and Davis (Health Res Policy Syst 15:93, 2017) have suggested that these inconsistencies are primarily due to processes, statistical methodologies and technical capacity varying between regulatory agencies. They go on to name specific individuals involved in the evaluation of this anti-influenza medicine and imply that differences in the judgements of these individuals has affected public policy concerning the market access of this medicine. This Commentary argues that what may appear as inconsistent decision-making may in fact be due to differences in the applicability of the evidence base to the local population and health system for which each regulator has responsibility. If health technology assessors are providing nuanced judgements on the effectiveness of a medicine for the local population, differences in regulation and reimbursement decisions are to be expected.