WHO Flu Misconduct Debate Polarising As Independent Review Advances

“Exactly a year ago, a very bad decision was taken” by the World Health Organization that now seems “unscientific and irrational,” said Council of Europe parliamentarian Paul Flynn in a late June presentation of a new report on the WHO’s actions during the 2009 influenza pandemic.

But opinions heard at an ongoing review of the WHO’s pandemic response were mixed, with some praising the organisation’s work to protect public health and others critiquing what they say is suspicious secrecy.

Flynn’s report is heavily critical of the WHO’s response to the influenza outbreak, particularly its lack of transparency about its decision making process. This, coupled with a pandemic “milder than seasonal flu,” risks alienating the trust of the public in WHO pronouncements said Flynn during a 24 June hearing on the report, which could prove problematic if a serious disease arrives.

“We need a WHO in which we have absolute confidence; without transparency that is not possible,” he said. Flynn, the report’s author, is a British Member of Parliament acting as rapporteur for the Social Health and Family Affairs Committee within the Parliamentary Assembly of the Council of Europe (PACE).

The report received almost universal approval from assembled delegates at the PACE hearing, with the vast majority emphasising both the WHO’s importance and the equal importance of it becoming more open. A report of the British Medical Journal (BMJ) also released in June was similarly critical of the WHO. A resolution calling for more transparency in the handling of the pandemic and passed the Parliamentary Assembly with an overwhelming majority: of 62 votes cast, 60 were for it, with one against and one abstention.

“The WHO is an excellent organisation that deserves to exist,” Valery Parfenov of Russia, a member of the European Democrat Group, said during the PACE hearing. But “why is it that emergency efforts seem to lead to scandalous results?” The “problems with WHO as an organisation is that it is very closed,” he said, adding “transparency is the best way out.”

“Have we all been victims of a series of deceptions?” asked Arcadio Díaz Tejera of Spain’s Socialist Party at the PACE hearing, adding part of the harm that had been done was that the money spent on vaccines that were not used could have been used to fight other diseases.

Michael Hancock, a British Liberal Democrat, congratulated the committee for keeping the issue alive, saying “if it had not been for this assembly this issue might have been quite easily swept under the carpet,” and criticised the WHO for not having shown up to the hearing.

Karmela Caparin of Croatia and the European People’s Party defended WHO, saying “no definition of pandemic is needed … for epidemiologists to know how to act or start acting” and adding that the number of hospitalised patients in her country was much higher than under seasonal flu.

Meanwhile, a review committee under the WHO International Health Regulations is continuing its task of evaluating the WHO’s response to H1N1.

The review committee met for the second time 30 June to 2 July, holding a series of interviews with different stakeholders from ministries of health, pharmaceutical companies, public health organisations and journalists, including the authors of the PACE report and the BMJ report. The committee plans to meet again from 27-29 September, where representatives from developing countries, from public health organisations, and additional journalists will be interviewed, committee chair Harvey Fineberg told a 2 July press conference. The group is meant to deliver a completed report to the WHO’s annual decision-making World Health Assembly in May 2011.

Most interviewees in June fell to one extreme or another in evaluating WHO’s response – either thanking the agency for leadership and praising its actions as completely appropriate, or lashing out at its lack of transparency and asking tough questions about its motivations.

“I think all the actions were taken in an appropriate way,” said Suresh Jadhav of the Developing Country Vaccine Manufacturers Network (DCVMN), though he said it is critical to continue developing the capacity of the developing world to make vaccines.

Norbert Hehme from the International Federation of Pharmaceutical Manufactures and Associations (IFPMA) called it the “most robust and complete pandemic response ever” and praised the “high level of preparedness” borne out of previous work, though said it could be improved in the future with more advanced supply agreements, technical improvements to make vaccines faster, mutual recognition of regulatory approvals to reduce bureaucracy, and strengthened public communication.

Fiona Godlee of the British Medical Journal, who wrote an editorial criticising the WHO’s response, said the degree of anonymity around its H1N1 decisions was “unprecedented” and “egregious.” She also said that some of the calculations cited in her editorial (IPW, Public Health, 7 June 2010) about the amount of money made by manufacturers on the H1N1 vaccines were overestimated though she added “no one doubts we are talking about a large amount of money.”

Among the committee interviewees were the chairs of a related working group on pandemic influenza preparedness, which was tasked by the World Health Assembly with finalising outstanding aspects of a comprehensive WHO plan for handling future pandemic threats (IPW, WHO, 14 May 2010).

The most difficult to resolve issues of this WHO plan are a Standard Material Transfer Agreement for the exchange of viruses and related benefits (including resulting vaccines) and intellectual property aspects of such exchanges. The co-chairs are ambassadors Bente Angell-Hansen of Norway and Juan José Gómez Camacho of Mexico.

“In our view, the [current] system is very opaque, it’s not very transparent and it’s not very clear,” Camacho told the committee. “But it’s not like that because it was devised as such. In our view it is like that because it is a system that has been growing over time,” with pieces added here and there. He said it was clear the system’s efficiency needed improvement for it to have the strength and clarity needed to handle a pandemic threat.

“We were very lucky with H1N1,” said Angell-Hansen, adding “we can now look at where this system works and where it needs improving.” Some of the shortcomings included the fact that even those with money to pay did not get vaccines, said Camacho, and that Mexico shared its viruses without receiving many benefits, said Angell-Hansen.

While still too early in the process to begin predicting the committee’s conclusions, Fineberg said, what has been most striking so far have been the amount of controversy over whether WHO altered the definition of a pandemic. “Some are adamant that it did,” he said, while others are equally adamant it did not. Also questions were swirling over whether or not the severity of the virus (as well as its geographical spread) should have been taken into account.

There were some questions about the independence of this committee during the PACE meeting, as two of its members (John MacKenzie and Tony Evans) withdrew from the committee “due to their concerns that their close association with the work of WHO during the H1N1 pandemic could be perceived as inconsistent with the committee’s role in providing an independent evaluation of this work,” according to the WHO.