Wednesday, April 14, 2010

H1N1 - The Pandemic that wasn't; flawed response.

Apr 13, 2010
The pandemic that wasn't
By Henry I. Miller

LAST June, the World Health Organisation (WHO), responding to an outbreak of the H1N1 virus, or swine flu, boosted the pandemic alert to the highest level, Phase 6, meaning that a pandemic was under way - the first time in 41 years that the organisation had taken that declared step.

But the outbreak appears to have ended less like the rogue wild boar that WHO bureaucrats predicted and more like a roasted pork tenderloin with apples and sage.

In fact, the WHO repeatedly violated Sherlock Holmes' warning: 'It is a capital mistake to theorise before you have all the evidence.' And the pandemic alert was doubly strange, given that ordinary seasonal flu sweeps the world annually, is invariably far more lethal than the currently circulating low-virulent H1N1, and certainly meets the WHO's definition of a pandemic: infections over a wide geographical area and affecting a large proportion of the population.

Ironically, the appearance of the H1N1 flu during the past nine months might be thought of as a net public-health benefit, because it appears to have suppressed, or at least supplanted, the far more virulent and lethal seasonal flu strains.

During the second week of January, for instance, 3.7 per cent of Americans tested positive for the seasonal flu, compared with 11.5 per cent during the same week last year. The official death toll worldwide from H1N1 is 17,700, while seasonal flu kills hundreds of thousands.

Most flu and public-health experts consider the WHO to have been overly alarmist. The decision in April last year to raise the pandemic flu threat to the penultimate level, Phase 5 ('Pandemic Imminent'), had already raced far ahead of the accumulated data, so the Phase 6 declaration in June revealed the organisation's paradigm to be fundamentally flawed. A warning system based solely on how widely a virus has spread, but does not consider the nature and severity of the illness it causes, would classify as 'pandemics' not only seasonal flu, but also the frequent but largely inconsequential outbreaks of virus-caused colds and gastroenteritis, for example. (The WHO has never explained why these obvious examples do not meet its criteria.)

False alarms make the 'pandemic under way' designation almost meaningless and diminish its usefulness. And that, in turn, has important consequences. As professor of surgery Jack Fisher at the University of California, San Diego's School of Medicine, observed: 'Keep crying 'wolf', and WHO can expect lower than customary compliance with flu vaccine advisories next fall.' Worse, imagine what would happen when we encounter a genuinely dangerous new pathogen, such as a strain of H5N1 avian flu (which in its current form has a mortality rate more than 100 times higher than H1N1) that is easily transmissible between humans.

The WHO's false alarms also have had more immediate negative effects. According to Mr Matthew Hingerty, managing director of Australia's Tourism Export Council, the country lost thousands of tourists because of the WHO's pandemic declaration. The Egyptian public-health authorities overreacted and ordered the slaughter of all pigs in the country. In addition to the direct economic losses, because the pigs were no longer available to consume much of the garbage produced in Cairo, the numbers of rodents rose to fearsome levels.

The publicity and resulting panic surrounding the WHO's announcement of Phase 5 and 6 alerts - especially in the absence (until December) of widely available vaccine - also brought out fraudsters peddling all sorts of ineffective and possibly dangerous protective gear and nostrums: gloves, masks, dietary supplements, shampoo, a nasal sanitiser and a spray that supposedly coats the hands with a layer of anti-microbial 'ionic silver'.

For all these reasons, the declaration of a pandemic must not be a prediction but rather a kind of real-time snapshot.

The WHO's performance has been widely criticised. The Parliamentary Assembly of the Council of Europe, for example, said on Jan 12 that it plans to debate 'false pandemics, a threat to health' later this month. And yet WHO officials continue to defend their actions.

In a Jan 14 conference call with reporters, Dr Keiji Fukuda, the special adviser to the WHO's director-general for pandemic flu, argued that the organisation did not overplay the dangers but 'prepared for the worst and hoped for the best'.

The WHO's dubious decisions demonstrate that its officials are either too rigid or incompetent (or both) to make necessary adjustments to the pandemic warning system - which is what we have come to expect from an organisation that is scientifically challenged, self-important and unaccountable. It may be able to perform and report worldwide surveillance - that is, count numbers of cases and fatalities - but its policy role should be drastically reduced.

The writer - a physician, molecular biologist and former flu researcher - is a fellow at Stanford University's Hoover Institution and at the Competitive Enterprise Institute. He was a United States government official from 1977 to 1994.


Apr 13, 2010
WHO admits to flawed response to H1N1
UN agency concedes there were shortcomings in its handling of flu pandemic

GENEVA: The World Health Organisation (WHO) yesterday conceded shortcomings in its handling of the H1N1 flu pandemic, including a failure to communicate uncertainties about the new virus as it swept around the globe.

Dr Keiji Fukuda, the WHO's top influenza expert, said the United Nations agency's six-phase system for declaring a pandemic had sown confusion about the flu bug, which was ultimately not as deadly as the widely feared avian influenza.

'The reality is there is a huge amount of uncertainty (in a pandemic). I think we did not convey the uncertainty. That was interpreted by many as a non-transparent process,' Dr Fukuda said.

He was addressing a three-day meeting of 29 external flu experts called to review the WHO's handling of the H1N1 flu pandemic, amid accusations it was overblown and may have been tainted by commercial interests.

WHO Director-General director-general Margaret Chan said the review should be 'independent, credible and transparent'.

'We want to know what worked well. We want to know what went wrong and, ideally, why. We want to know what can be done better and, ideally, how,' Dr Chan told the session.

The novel virus was first discovered in Mexico in April last year and spread swiftly around the world. Two months later, the WHO declared the first influenza pandemic in more than 40 years.

But the H1N1 virus has turned out to be less lethal than feared. About 17,700 people in more than 200 countries are known to have died from it, including more than 20 in Singapore. By comparison, between 250,000 and 500,000 are killed by seasonal flu each year, the WHO said.

Several governments have sought to cancel orders of hundreds of millions of dollars worth of special vaccines.

European parliamentarians conducting their own probe have criticised the transparency of decision-making, especially the potential influence of the pharmaceutical industry.

The separate but highly lethal H5N1 bird flu virus - which has killed 60 per cent of those infected since 2003 - 'injected a high level of fear about the next pandemic', Dr Fukuda said.

The response to swine flu has been dogged by doubts since the early stages.

By the WHO's annual assembly in May last year, several health ministers publicly urged Dr Chan not to rush into declaring a pandemic, highlighting relatively mild symptoms and public doubts.


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