Swine flu backlash

Back in October I began to suspect that pandemic response measures would come to be criticised if a severe winter ‘wave’ of swine flu never materialised as feared, and as predicted by many, in the northern hemisphere. I shared this on picking up early signs of a milder epidemic in parts of the US and the UK.

Going by news reports this past week, the backlash has begun. The political organisation Council of Europe reportedly claimed this was a ‘false’ pandemic for which drugs and vaccines were stockpiled under undue influence by pharmaceutical companies on the World Health Organization’s response to the emergency. The WHO said independent experts will review how well the pandemic was handled when the emergency is over — but as case numbers are still high in some parts of the world, it’s not over yet.

In the meantime, with the number of cases on the decline in many countries, some are cancelling their orders for swine flu vaccine and others are planning to donate or sell their stocks. And there’s been plenty of debate about the risk of side effects [PDF] and apparently modest benefit [PDF] of the antiviral drug Tamiflu, the latest twist coming from the publication last December of a Cochrane review with an account of difficulties accessing necessary data.

So, was the response by the WHO and national governments out of proportion? In October, when we knew very little about how this would pan out, I wrote that it makes sense to prepare for the worst-case scenario under the circumstances — and I still believe that. It’s way too easy to look back now and talk about what should’ve been. In a sense, the time lapse makes it irrelevant: if there was a difference of opinion about the response it should have been voiced months ago, when decisions were taken under uncertainty.

This doesn’t mean the response and the evidence that underpins it should not be examined critically. Several key questions were raised during the past few months — from elements of the response to how a pandemic should be defined [PDF], when it starts [PDF], how it progresses [PDF].

Having said all this, I think the role of pharmaceutical companies is a separate question. I imagine this should become clearer in the course of the planned investigation.