WHO pandemic review group concludes third session

Sep 29, 2010 (CIDRAP News) – The external committee tasked with reviewing the World Health Organization's (WHO's) response to the H1N1 pandemic wrapped up its third round of live meetings in Geneva today, hearing from an array of country and organization health representatives, as well as WHO Director-General Margaret Chan, who strongly defended the organization's response.

Chan, who spoke to the group yesterday during a public plenary session on the second day of its meeting, also said the WHO learned some important lessons that will position it to, for example, ease the flow of pandemic vaccine to developing countries. Her address to the group appeared yesterday on the WHO's Web site. The pandemic review committee is simultaneously reviewing how the International Health Regulations (IHRs) functioned during their first use in an international health emergency.

Dr Harvey Fineberg, the group's chairman, briefed reporters today at the conclusion of the group's 3-day meeting. He said the committee is still in an information-gathering mode and that the agenda consisted of public plenary sessions and deliberation meetings during which members met by themselves. He is president of the Institute of Medicine of the US National Academy of Sciences.

The review committee's last meeting in Geneva was in early July, and Fineberg told reporters the committee will meet again in November for deliberation sessions. He projected that the group would have a draft of a report for its own members to review by early January in time for its final plenary meeting. The members will submit a final report that includes a response from Chan in advance of the World Health Assembly next May.

Fineberg said the group heard testimony from a wide range of health and industry experts and confirmed, based on a journalist's question, that Michael T. Osterholm, PhD, MPH, addressed the group during the plenary sessions. Osterholm is director of the University of Minnesota's Center for Infectious Disease Research and Policy, publisher of CIDRAP News.

One of the largest blocks of testimony came from key people who led the WHO's response and were involved in administering the IHRs, including Chan, Fineberg said. At the committee's last meeting in July they heard from some of sharpest critics of the WHO's response, including a Council of Europe representative and the editor of the British Medical Journal.

"One of the things that was not surprising, but very revealing, was that the principals at the WHO secretariat were very eager to tell their story," he said. "They are as eager to tell their story as the critics are to tell theirs."

Chan spoke candidly about the challenges and successes she observed during the WHO's pandemic response and said the group welcomes the review and is mindful of the praise and criticisms it has received. She said the WHO is grateful for the moderate impact the pandemic had, and she said in retrospect some response measure may look excessive.

"Had the virus turned more lethal, we would be under scrutiny for having failed to protect large numbers of people," Chan said. "Vaccine supplies would have been too little, too late, with large parts of the developing world left almost entirely unprotected."

She said experts assumed that H5N1, with its more lethal severity, would cause the next pandemic, which guided preparations for a more severe pandemic than what emerged with the 2009 H1N1 virus. The phased pandemic alert approach was developed as cues to help countries increase their preparedness levels without causing public alarm. "In reality, it had the opposite effect. It dramatized the steps leading to the declaration of the pandemic and increased the build up of anxiety," Chan said.

Chan rejected charges that the WHO exaggerated the pandemic threat and said when she announced the move to alert phase 6 she reminded the world that the number of deaths were small, that she didn't expect to see them increase suddenly, and that most patients were recovering without medical care.

During a time when health officials had to make decisions in an environment of scientific uncertainty, most health officials erred on the side of caution, she said. "In this regard, the phased approach to the declaration of a pandemic was rigid and confining. In communicating the level of alarm, authorities need to be able to move down as well as up," Chan said, adding that limited vaccine capacity and long production times also hampered the flexibility of countries' pandemic responses.

She strongly rejected charges that commercial interests tainted the WHO's pandemic alert level decisions. "I can assure you: never for one moment did I see a single shred of evidence that pharmaceutical interests, as opposed to public health concerns, influenced any decisions or advice provided to WHO by its scientific advisors," Chan said in her statement.

On a positive note, Chan said some elements of the world's pandemic response worked well, including the IHRs, which she said provided a useful set of checks and balances, and the early distribution of oseltamivir stockpiles to developing countries.

"In my view, the Emergency Committee, with both experts and affected states represented, functioned well as a balanced and inclusive advisory body," she said. The emergency committee met at least nine times to advise Chan during pandemic phase and response discussions, and some critics charged that the process lacked transparency, because member names were confidential. The WHO has said the names were kept secret during the pandemic to protect members from undue influence. It revealed the member names on Aug 10 when the WHO declared that the pandemic was over.

In response to journalists' questions, Fineberg said several times that the role of the committee isn't to assign blame, but to identify ways that the WHO can improve its pandemic response.

He said the review committee is hearing a lot about the challenge of decision making under conditions of great uncertainty and that some response measures, such as the vaccine donation process, are very complex.

"Everyone came at this from their own perspective, but few had a vision of the whole. Each told an important side of the story," Fineberg said. "Our job is making a coherent whole out of these perspectives."

See also:

Sep 28 Margaret Chan comments to IHR review committee

Sep 29 IHR review committee meeting media briefing audio

Jul 2 CIDRAP News story "WHO pandemic review wraps up second meeting"

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