Global Governance of Pandemics Requires WHO Transparency
CORPORATE CITIZENSHIP, ENVIRONMENT & HEALTH
Wednesday, June 9, 2010
With June 11, 2010 being the first anniversary of the World Health Organization ("WHO") declaring the H1N1 influenza a pandemic, two recently-released European reports raise serious questions about the WHO's failure to operate transparently in regards to its decision-making processes relating to the pandemic. In particular, the reports explain that, even as the pandemic officially continues, the WHO has failed to adequately disclose the degree to which the scientific experts upon whom the WHO relied to declare and manage the pandemic had financial ties to the pharmaceutical companies that manufactured the vaccines and anti-flu medications used to combat the outbreak and effects of the H1N1 influenza.
According to its Constitution, the objective of the WHO is the attainment of the highest possible level of health of all peoples. The WHO coordinates and directs international health work, provides technical assistance and aid in emergencies, and seeks to eradicate epidemic, endemic, and other diseases. The WHO is the international authority on public health recommendations for its 193 member states.
The World Health Assembly is the supreme decision-making body of WHO. It generally meets in Geneva and is attended by delegations from all member states. The Health Assembly appoints the WHO Director-General, supervises the financial policies of the WHO, and reviews and approves the proposed program budget.
One of the main WHO bodies involved in situations relating to pandemic diseases is the Strategic Advisory Group of Experts ("SAGE"), which serves as the principle advisory group for the development of policy related to vaccines and immunization. There are 15 members of SAGE who are appointed for an initial term of three years (to be renewed only once) and who serve in their personal capacity. Before being appointed, all members must sign a declaration of interest with the purpose of excluding conflicts of interest between any of their professional activities and their advisory function within WHO.
Under the provisions of the International Health Regulations ("IHR") of 2005, the WHO Director-General may also appoint an Emergency Committee for special advice on matters related to acute public health events and emergencies of international concern. In response to cases of swine influenza H1N1, reported in Mexico and the United States, on April 25, 2009, WHO Director-General Dr. Margaret Chan convened a first Emergency Committee meeting to assess the situation and advise her on appropriate responses. Despite repeated requests, the WHO has refused to disclose the members of the Emergency Committee to the public. It was on the basis of advice from this Committee that the WHO declared the H1N1 influenza a pandemic.
One year after the declaration, two groups have published reports that critically examine the processes and decisions of the WHO and the Emergency Committee.
First, on June 4, 2010, Paul Flynn, the Rapporteur for the Social Health and Family Affairs Committee of the Parliamentary Assembly of the Council of Europe, delivered his report titled "The handling of the H1N1 pandemic: more transparency needed" (the "Flynn Report"). The Flynn Report consists of a Draft Resolution, a Draft Recommendation, and an Explanatory Memorandum. In the Explanatory Memorandum, Mr. Flynn expresses his concerns about:
1. The manner in which the WHO communicated about the pandemic to member states' governments and to the European public at large (i.e., calling for an overwhelming response to a medical emergency the severity and ultimate impact of which was still uncertain).
2. The dramatic outcomes of the pandemic, including the distortion of priorities of public health services all over Europe; waste of huge sums of public money; provocation of unjustified fear amongst Europeans; and creation of health risks through vaccines and medications which might not have been sufficiently tested before being authorized in fast-track procedures.
3. The inappropriate timing and method of changing essential definitions relating to what constitutes a pandemic so that the former criteria of "impact and severity" of an epidemic in terms of the number of infections and deaths was no longer considered relevant.
4. The financial ties between WHO pandemic advisers and pharmaceutical companies who had a vested commercial interest in the declaration of a pandemic and subsequent vaccination campaigns.
5. The "real danger" that the WHO has cried "wolf" so often with regard to this and previous public health scares (i.e., avian flu, SARS) that the public will not take appropriate notice anymore when the next infectious disease occurs.
In the Explanatory Memorandum, Mr. Flynn recommends that:
1. The Council of Europe Parliamentary Assembly request that the WHO and applicable European institutions share essential information, notably by publishing the names and declarations of interest of experts present on relevant WHO advisory bodies who have a direct influence on public health recommendations taken.
2. The Parliamentary Assembly should request that the WHO, European Union bodies dealing with health matters, and also national governments review their structures in the public health sector; agree on common definitions relating to public health (such as pandemics); revise existing guidelines for working with the private sector (or prepare such guidelines where they do not exist); entirely revise their communications strategies relating to sensitive public health issues; and exercise maximum transparency in all work undertaken.
3. The Parliamentary Assembly should call upon the pharmaceutical industry to be aware of their corporate social responsibility with regard to major public health matters and to act in the most transparent manner possible.
For the most part, the findings of the second recently released report mirror those contained in the Flynn Report. In the report published on June 3, 2010 by BMJ and the Bureau of Investigative Journalism titled "Conflicts of Interest: WHO and the flu ‘conspiracies'," authors Deborah Cohen and Philip Carter focus on the undisclosed conflicts of interest arising from the fact that "key scientists advising the World Health Organization on planning for an influenza pandemic had done paid work for pharmaceutical firms that stood to gain from guidance they were preparing."
Of particular concern to Cohen and Carter is the fact that several of the influenza experts involved from 2002 through 2004 in developing the WHO's guidelines for the use of vaccines and antivirals during an influenza pandemic had received honorariums, consultancy fees, or research support from pharmaceutical companies who had a vested interest in the outcomes from the development of the guidelines. According to the BMJ/Bureau report, the "WHO itself did not publicly disclose any of these conflicts of interest when it published the 2004 guidance" and the WHO has refused to provide copies of the conflict of interest declarations submitted by the influenza experts involved in the development of the guidelines.
In response to the scrutiny that is being paid to the WHO's handling of the H1N1 pandemic and calls for greater transparency, Harvey Feinberg, President of the U.S. Institute of Medicine, is conducting a review of the WHO's handling of the pandemic on behalf of the WHO. Hopefully, this review will be an objective one. Otherwise, as expressed in the BMJ/Bureau report: "H1N1 may yet claim its biggest victim⎯the credibility of the WHO and the trust in the global public health system."
Jim Kelly is the President of Solidarity Center for Law and Justice, P.C., a public interest civil and human rights law firm based in Atlanta, Georgia. The opinions expressed herein are his own.
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