Healthy Skepticism Library item: 18487

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Publication type: Journal Article

WHO failing in duty of transparency
Lancet Infectious Diseases 2010 Aug; 10:(8):505
http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(10)70147-X/fulltext?elsca1=TLID-260710&elsca2=email&elsca3=segment

Abstract:

“I have conferred with leading infl uenza experts,
virologists, and public health offi cials…I have sought
guidance and advice from an Emergency Committee
established for this purpose”, WHO Director General
Margaret Chan announced on June 11 last year. “On the
basis of available evidence, and these expert assessments
of the evidence, the scientifi c criteria for an infl uenza
pandemic have been met…The world is now at the start
of the 2009 infl uenza pandemic.”
Since WHO gave infl uenza A H1N1 pandemic status,
the world has watched an unprecedented sequence of
events unfold. Initial worst-case scenarios predicted that
up to 4 million people might die as a result of pandemic
infl uenza, and those governments that had resources
sent pharmaceutical companies into overdrive as they
stockpiled antiviral medication and sought to develop a
vaccine for mass immunisation campaigns. According
to J P Morgan sale of H1N1 vaccines in 2009 produced
revenues of more than US$7 billion. However, two reports
published on June 4 this year criticise WHO’s handling of
the pandemic, suggesting that the rush to buy vaccines
and antiviral drugs was substantially infl uenced by people
with ties to pharmaceutical companies.
Paul Flynn, UK Labour MP and rapporteur for the
Parliamentry Assembly of the Council of Europe, has
called into question the transparency of WHO’s decisionmaking
process relating to the “pandemic that never
was”. And an investigation by the BMJ and the Bureau
of Investigative Journalism reports that some of the
experts who advised WHO, most of whose identities
are still unknown, had fi nancial ties to Roche and
GSK, manufacturers of the antiviral drugs oseltamivir
(Tamifl u) and zanamivir (Relenza), respectively. The
reports raise important questions. Why did WHO seek
guidance from scientists who had received payments
from antiviral manufacturers? Why were the names of
people on the Emergency Committee not made public?
And did WHO ignore the confl icts of interests between
the drug fi rms and the advisors, or did it simply not
know about them?
WHO spokesperson Gregory Härtl responded by
saying that WHO knows that some experts that come
to its committees have contact with industry, but WHO
must gather advice from such experts to deliver the best
service for public health. Other agencies have voiced their
support for this view. According to Bill Hall and Michael
Osterholm, public health agencies such as WHO cannot
easily avoid the problem of confl ict of interest because
scientifi c experts often have ties to industry.
Is this, however, an adequate response? As stated by
the BMJ report, the 2004 WHO pandemic-preparedness
document detailed new rules on managing confl icts
of interest and these rules seem not to have been
followed in this case. In a interview with the BMJ,
Härtl was asked whether or not WHO knew if the three
contributing scientist used signed a confl ict of interest
statement, to which he replied, “I think they did it but I
am not 100% sure”. As pointed out by the BMJ, it is very
odd that WHO might not have known about possible
confl icts of interests.
This lack of transparency is a key shortcoming of the
WHO process. As Flynn notes, some WHO advisors have
made no secret of consulting work-for example, Karl
Nicholson declared his receipt of speaker’s fees from
several pharmaceutical companies in a 2003 Lancet
seminar on infl uenza, but as pointed out by the BMJ and
the Bureau of Investigative Journalism report he seems
not having enclosed a confl ict of interest form for the
annex he wrote for WHO’s 2004 pandemic-preparedness
document. The two above reports have prompted a
statement from Chan confi rming that the identity of the
16 members of the Emergency Committee formed last
year will be revealed as soon as the experts fi nish their
work. Chan added that the lack of disclosure to date is to
protect the committee. However, the BMJ report names
Arnold Monto, John Wood, and Masato Tashiro as three
of the 16 members of the Emergency Committee and
identifi es potential confl icts of interest for one of them.
Rather than the 4 million deaths predicted in the
worst case scenarios, 15 000 people are estimated to
have died from pandemic infl uenza so far. WHO is right
to have sought advice from a range of experts, some
of whom will inevitably have ties with pharmaceutical
companies. However, the lack of transparency raises
concerns that WHO did not take into account possible
confl icts during its decision-making process and points
to a system struggling to balance a relationship between
drug companies and global health. WHO must address the
failings of transparency in this event to recover public trust
and restore its credibility.