Swine flu pandemic: a year later

Last Friday, June 11th, marked one year from the declaration of the 2009 influenza pandemic.

Criticism of the World Health Organization’s handling of it, which began in January with claims of a ‘fake’ pandemic, was fuelled earlier this month by the publication of a feature article and editorial based on an investigation by the BMJ and The Bureau of Investigative Journalism. The feature goes back several years to when the world began to prepare for a pandemic and digs out information about the relationship of key flu experts to pharmaceutical companies that stood to gain from a strong response to the pandemic; it suggests that advice was given under that influence by pointing to a change in the definition of a pandemic and by revisiting the thorny issue of whether antivirals really do any good, which was the subject of a previous BMJ investigation; it criticises the WHO both for not disclosing who makes up the Emergency Committee formed to advise Margaret Chan and for not being transparent about how conflicts of interest were handled; and it briefly discusses how important decisions can remain independent of industry influence.

I don’t see that the investigation presents evidence of wrongdoing, by any advisers or by the WHO. That would take showing that members of the Committee who had links with industry gave advice that was tainted by that relationship, and that Chan’s decision making was unduly influenced by this advice. Clearly a difficult task. Until records of Emergency Committee meetings are released we won’t know what opinions were given, and even then I’m not sure we can know how influential they really were. In response to the investigation Chan released a statement last week denying that her decisions were influenced by commercial interests and responding to the allegations. Articles published in the New Scientist and Nature also dismiss the accusations made or implied by the feature.

But the questions over conflicts of interest will continue to be asked, and I see two reasons for that: the lack of transparency, and the fact that the ‘swine flu’ pandemic ended up being mild. As I said when the criticisms first surfaced it’s far too easy to scrutinize decisions with the benefit of hindsight – where were the critics months ago when the course of the pandemic was still very uncertain?

I do think the lack of transparency is a valid concern, and one that the BMJ/Bureau investigators are right to highlight. The concerns, conspiracies and speculation come down to this. To a great extent they are borne of the fact that we’re in the dark about who was involved in giving advice, and what mechanisms are in place to deal with conflicts of interest.

Truly independent decision making may be an elusive target – public health scientists don’t operate in a vacuum of institutional affiliations, points of view or ideologies. But transparency is key to a legitimate process.

To prevent undue influence by industry the idea of a “firewall” is put forward in the feature, based on the premise that conflicts should be held to a higher standard in certain circumstances: it may be enough to simply declare a conflict of interest when publishing a journal article, it is suggested, but when it comes to direct involvement in decision making the experts in question should be one step removed from the point of direct influence. In saying this the piece cites Professor Harvey Fineberg, president of the US Institute of Medicine, who is chairing a panel looking into how the WHO managed the pandemic.

If probing the WHO’s handling of the pandemic is an opportunity to look at the larger issue of managing commercial interests, and to get better insight into the basis of the response to the pandemic over the past few months, then it’s a welcome opportunity. It’ll be interesting to see if it can shed any light on the accusations too.