External panel issues draft report saying WHO response to H1N1 lacked cohesion, clarity

An independent panel of experts commissioned by the WHO to probe its response to the H1N1 (swine flu) pandemic on Thursday released a draft report (.pdf) stating that while the organization performed well in many ways, it made "crucial mistakes" and "warned tens of millions could die if there is a severe flu outbreak in the future," the Associated Press reports (3/10).

"Despite new health regulations introduced in 2005, 'the world is ill-prepared to respond to a severe influenza pandemic or to any similarly global, sustained and threatening public health emergency,'" the committee concluded in the draft report, which is open to public comment before a final report is issued at the end of March, according to Deutsche Presse-Agentur/M&C (3/10).

However, the group of experts from 24 countries, led by Institute of Medicine President Harvey Fineberg, "found no evidence supporting the most outlandish accusation made against the agency: that it exaggerated the alarm to help vaccine companies get rich," the New York Times reports. "Although millions of doses of vaccine [to protect against H1N1] ultimately went unused, the panel found 'no evidence of malfeasance,'" according to the newspaper (McNeil, 3/10).

Still, "the panel said WHO had failed to recognize and manage conflicts of interest among some experts on its advisory Emergency Committee who had disclosed their ties to pharmaceutical companies," Reuters writes. In addition, "[t]he panel criticised the WHO's lack of a consistent and measurable description for judging a pandemic's severity which had created confusion" and noted "WHO bureaucracy had also prevented a timely distribution of donated vaccines in poor countries during the pandemic" (Nebehay, 3/10).

Additional breakdowns in the WHO's communication on H1N1 included the fact "there was a 'lack of timely guidance in all official languages of WHO' and a 'lack of a cohesive, overarching set of procedures and priorities for publishing consistent and timely technical guidance,'" the group found, according to Agence France-Presse (3/10).

Despite such issues, "[t]he panel did offer some praise," the New York Times continues. "With help from national health agencies like those of the United States and Canada, the WHO identified the virus quickly and got seed strains to vaccine makers. It also sent experts to countries that asked for help," according to the newspaper. 

The panel made 15 recommendations to the WHO, many of which relate to the International Health Regulations, including that the organization "improve its methods for appointing an emergency committee and tackle the difficult task of defining terms to describe severity," CIDRAP News writes. The report also suggests "that the WHO set up advance agreements for vaccine distribution and delivery to ease the flow of pandemic vaccine to developing countries" and urges the organization and its member states "to finish reaching an agreement on virus sharing and access to vaccines, which it said will help the world better prepare for the next pandemic," according to CIDRAP News (Schnirring, 3/10). The New York Times adds that the group also recommended "the creation of a 'global reserve corps' of experts for emergencies, and a $100 million fund for their use," and "urged vaccine makers to reserve 10 percent of their production for poor countries" (3/10).

"In spite of the IHRs and WHO's success at mobilizing global contributions, tens of millions of people are still at risk for death in a severe pandemic," the expert panel said, according to CIDRAP News. The report's overall recommendation is for the WHO to design and implement a "comprehensive influenza research program, covering everything from surveillance technology to the development of universal and more effective flu vaccines," the news service reports (3/10).

According to a WHO spokesperson, the organization will not issue a response to the report until its final version is submitted in May at the annual assembly of health ministers. Similarly, Fineberg "declined to discuss the report's conclusions," because of its draft status, according to the New York Times. "Under WHO rules, the draft had to be made public early to invite comment in time for the final draft," the newspaper writes (3/10).

In a letter (.pdf) accompanying the release of the draft, however, Fineberg "said the committee is … eager to hear the public's views on its 15 recommendations and how they can be accomplished," CIDRAP News adds (3/10).

Scientists Call For Increased Surveillance, Preparation To Tackle Influenza Viruses

In related news, AFP examines scientists' warnings over possible mutations to H1N1 that could make it capable of spreading more rapidly, or the return of H2N2 (Asian flu), a strain that first appeared in 1957 and "killed one to four million people despite a major vaccination campaign." In a study published last week in PLoS One, researchers described how they were able to create a version of H1N1 with a single mutation that greatly increased the virus' binding strength, which could "greatly boost its ability to spread among humans," according to the news service. "There is a constant need to monitor these viruses," MIT's Ram Sasisekharan, who led the study, said in a statement calling for increased virus and information sharing among governments, according to the news service (Hood, 3/10).

Similarly, in a Nature Comment published Thursday, Gary Nabel of NIH's Vaccine Research Center, and colleagues write that "H2N2 looms as a public health threat, and could re-emerge in a similar way [as that seen with H1N1]." They say that "[g]overnments, regulatory agencies and industry should develop a pre-emptive vaccination program for H2N2" and describe several strategies for approaching such an effort (Nabel et al., 3/10).