Effect Measure

WHO prepares to don a hair shirt

The finger pointing and the told-you-so-ers are out in force these days and WHO seems to be one of their targets. In the face of wealthy European countries cutting their swine flu vaccine orders because of limited demand, critics are claiming that WHO exaggerated the threat in league with or under the influence of Big Pharma vaccine makers out to make a killing. This is really two issues. One, did WHO appropriately appraise the risk; and two, were they unduly influenced by greedy drug makers. I think the answer to these questions are “Yes” and “No.”

In our view WHO was caught between a rock and a hard place. It is true that a great deal of effort was expended envisioning and preparing for a pandemic that didn’t happen, the bird flu or H5N1 pandemic. That one is still “out there” (along with other plausible pandemic subtypes like H7 and H9) but the one that actually materialized and did produce a genuine pandemic started in a different place, spread faster and had the virulence of seasonal flu rather than bird flu. That meant that the criteria for “calling a pandemic” were not quite right for what really happened. If there was anyone who saw that coming, I don’t know who they were. Yes, there were “bird flu skeptics” (I would call them bird flu deniers, but that’s another argument) but anyone who predicts what influenza A will or won’t do is a fool. No one knows. The best you can do is prepare for what is reasonably plausible and hope for the best. We should be happy that we got one of the better scenarios for a pandemic, because some of what was and remains reasonably plausible is too terrible to contemplate and we weren’t anywhere near prepared for it.

WHO, taken by surprise and being pressured by powerful member states like the UK and China looked, and was, indecisive. All their stated criteria for a pandemic were fulfilled weeks ahead of the actual call but the situation was sufficiently unclear that they hesitated with their finger on the button. In hindsight it’s being claimed they should never have pushed the button. Our view is they should have pushed it sooner. When this virus poked its head above water last spring its future evolution was pregnant with possibilities. Instead of recriminations we should be grateful that — so far — it hasn’t fulfilled reasonable fears, because the recriminations could easily be going in the other direction: why weren’t we better prepared and why didn’t WHO act sooner?

WHO is not the world’s health department. It has essentially no authority beyond what is granted to it by its member states, acting individually and often selfishly. Nor is pandemic flu its main preoccupation. On a pitiful budget it does a powerful amount of good with a vast range of diseases that afflict the world, often in places many of us cannot pronounce. But for global infectious disease, like influenza, its effectiveness is severely hampered by the current international legal framework. It could be argued that in some spheres — and influenza may be one of them — WHO is becoming irrelevant.

The influence of drug companies is more of an example than a condemnation. Yes, big vaccine makers have influence with WHO (and CDC and the EU) because they are the only game in town. But that influence was mainly passive. They weren’t going to do anything significant unless someone guaranteed they could make a buck on vaccines. Their view is that they had a duty to their stockholders to maximize return on dollars invested. Investments in impotence or cholesterol drugs are vastly more profitable than vaccines. Practically this means WHO has to get governments to guarantee their market to the extent there is no risk and hopefully the promise of significant profit. One reason we have had to rely on old egg technology is that Big Pharma didn’t invest much in proving the new technologies that could have made vaccines more quickly and more cheaply. When the time came when we needed them, these technologies hadn’t progressed far enough to allow governmental regulators to recommend their use on hundreds of millions of people.

I’m not letting WHO, big national governments (like the US) or the drug makers off the hook. The former shouldn’t be relying on private companies and a market system that doesn’t work for this purpose; and the drug makers acted only for their private purposes, not the public good (not at all surprising or unexpected). For flu vaccines the market is always too late. We should have had an international system for flu vaccine production that doesn’t have to make obscene profits before it acts, can afford to be inefficient in production, is geographically distribu†ed for the sake of equity and uses the latest technologies it develops under a public license. But we’ve been beating that drum for years and so far we have nothing. Hope springs eternal.

Meanwhile when the pandemic is over WHO says it will examine how it could have done better:

The Council of Europe is planning an investigation, to begin later this month, into whether pharmaceutical companies influenced public health officials to spend money unnecessarily.

In Geneva, a WHO spokeswoman acknowledged there were questions to be answered.

She said the the review of its management of the pandemic would be conducted with independent experts, and the results would be made public. (Imogen Foulkes, BBC)

I think WHO could have done better but not easily within the present international framework which almost guarantees a distorted outcome. I think CDC got it just about right. Yes, here and there you can point to things that might have been done better. But overall, impressively competent under great pressure. It could have been much better still if we, as a society, had not foolishly decided to disinvest in public health.

Would WHO or CDC or anyone have done things differently if they could see the future? It’s a stupid question but it’s being asked by a lot of stupid people.

Comments

  1. #1 Tom DVM
    January 13, 2010

    Revere

    In your opinion, should World Health Organization employees be required to disclose conflicts of interests?

    For example, being employed by pharmaceutical etc. companies at the same time they are employed by the WHO…immediate familly members, spouses or children employed by pharmaceutical companies…investments in pharmaceutical etc. companies.

  2. #2 revere
    January 13, 2010

    Tom: Absolutely. I assume (but don’t know) there is an existing disclosure or prohibition policy for the employee. Don’t know about family members. But we here at the university must disclose and must disclose for NIH all the info you requested. I think this is entirely reasonable.

  3. #3 Wes Dodson
    January 13, 2010

    The Who?

  4. #4 Jody Lanard
    January 13, 2010

    Here is a link to one version of the WHO conflict of interest form for outside experts.

    http://tinyurl.com/ygazlvl

    Regarding family members’ potential conflicts of interest, the form states:

    Any financial or other interests that could constitute a real, potential or apparent conflict of interest should be declared (1) with respect to yourself or partner, as well as (2) with respect to the administrative unit with which you have an employment relationship.

    In my case, I have always interpreted “partner” to mean “spouse.”

    The version above starts with a discussion of who might or might not have to fill out this form, and includes with the form itself.

    There are variations on this form for when one is hired as short-term staff, but I can’t find one at the moment. I don’t know what the terms are for full-time staff.

  5. #5 Jerry Laws
    January 13, 2010

    Excellent points, revere. WHO and CDC can’t be blamed, in my opinion, if individuals choose not to receive H1N1 vaccinations. Last time I checked, WHO reported more than 12,000 H1N1 deaths to date worldwide. I believe both organizations made the right call.

  6. #6 M. Randolph Kruger
    January 13, 2010

    Remember folks what I said before about plausible deniability. The buyers for the government were in it up to their necks with stock options all bought and well before the outbreak of swiney. And, remember it was the same for H5N1 and the H3N2 treatment for it in poultry. Could they have not known by lab tests and iterations by generations that chickens would spread it ? Thats a big question that needs to be answered.

    Now we have this burned lung version… The samples for which were stolen from the back of a DHL truck on the way to Switzerland and Mill Hill for sequencing. Yep the gooey bloody tissue that would have be loaded with the shit and it just disappears…

    Uh-huh… I have a load of real estate to sell you in Port au Prince too.

    You know also Jerry if you have been following for a while that one of the contributors went to the WHO meetings for H5N1 and was shut out of the “closed door” sessions along with the media. Nice work if you can get around it. Transparency? Forget it. The very idea of mandatory vaccinations tips the hand on this. I was already with ACP ammo and a pre-written injunction for the state court here to prevent any vaccinations for anyone who didnt want it.

    Swine flu? I got a headache for about 4 hrs. Both kids got it, one bad, one cleared it in four days. Lets rush down to use untested vaccine that has had about as many adverse reactions at 40 million doses as 1976 Swine vax.

    I think we can all safely say that we dont trust our government…. at all.

  7. #7 revere
    January 14, 2010

    Randy: Have any evidence for anything you are saying here?

  8. #8 M. Randolph Kruger
    January 14, 2010

    Swine Flu Blood Samples Stolen in Bulgaria’s Razgrad
    Crime | November 10, 2009, Tuesday Novinite
    Two packages with blood samples intended for A(H1N1) testing have been stolen from a van of a freight forwarding company in the northeast Bulgarian city of Razgrad…

    Same thing happened in Ukraine two weeks later… Wonder what the burned lung vax will look like and how long before it becomes the new fun and games bug we have to spend money on.

    I dont float an opinion on it but flu is the easiest thing in the world to weaponize and doesnt need much of a push to get it going. Hundreds of billions of dollars for vax of questionable efficacy? Go back two months before the meetings and hit the insider tradings list – MarketWatch.com. Lots of recognizable names there Bubba.

    Pharma was making seasonal and making no money at it, then suddenly H1N1 kicked loose. Drop what you are doing, make new vax (untested at that) have no liability and then jam it into people with a known…It might make you susceptible later to the next problem. Are they generating bugs to make money Revere? If they did then it would bring this country and a bunch of the others down.

    Storming of the Bastille kind of thing.

    Remember the Baxter error?

    http://www.bloomberg.com/apps/news?pid=newsarchive&sid=aTo3LbhcA75I

    Now to me there is beginning to be a pattern but do lets continue. But also remind yourself that I am all for companies making money legally. So far there isnt any proof that they havent. If they went out and spilled some bio-tinkertoy to make money then I would find them, try them and then execute them one by one. I would be elected President the next day by general accord.
    ——————————————————————–
    CDC and St. Jude’s: worse than Indonesia?

    Category: Bird flu • CDC • Intellectual property • Surveillance • Vaccines
    Posted on: August 27, 2008 7:09 AM, by revere

    Recall Ed’s trip to the WHO meetings when Big Pharma was put into a room and next thing we know we have swine flu and not H5N1?

    I am not much of a consipracist Revere… The who thing has a 750 billion world dollar stink to it. Were the Swine Flu cases more virulent than normal seasonal? You would know more than I would about it and now we have all this neat shit floating around in our bloodstreams of questionable usefulness. Does it make you susceptible to other diseases… And then there was that mandatory “participation” thing. Well, they would be carrying needles to a gun fight around here.

    Did it help anything? So far I have seen that a lot of people got sick, they still got sick with Swiney after vaccination and I question whether it kept anyone alive. Hey look, they can say anything and you are the first to say that about them. Vax spin? I dont know. It costs too much to prove it to be shit. They know that… You and I know it. So you have to have a whistleblower if it is. Can you say Tobacco ?

    If it had been H5N1…then I would be asking the same questions and yes, I would have taken that vax if I had seen them keeling over in high numbers here.

    BTW, I am still waiting for those three suppressed papers from Canada that said that taking the seasonal for the last three years made you more susceptible to swine. Haven heard a word since.
    ——————————————————————–
    You’ll like this one Revere.

    http://cecaust.com.au/pubs/pdfs/20-23_3621.pdf

  9. #9 Patch
    January 14, 2010

    Revere,

    How could he? If he forms ideas and theories with any similarity to penning them, he is simply chasing his tail.

    While not a true skeptic of the possibility of a severe global pandemic, I was (and remain) a skeptic of many of the folks that were ready to call a Pandemic (of H5N1 even!) long, long ago.

    I have always admired the Revere’s calm and calculated approach to culling through flu information and coming to reasonable conclusions. Most times it seemed, the Revere’s simply took a step back and took a “wait and see” approach analyzing FACTS as they came to light and making reasonable assumptions, as well as forming reasonable possibilities.

    When flubogia was screaming “Outbreak!” I came here to often be calmed and become more informed. When I heard the flu community condemn the WHO for not declaring a Pandemic soon enough, I saw The Revere’s defend the WHO position on occasion (and rightly so).

    Personally, I owe a debt of thanks to the Revere’s in understanding the WHO better. Perhaps they didn’t have full faith and confidence in the WHO, but understood their mission well enough to give them (and their actions and ideas) careful thought. I’m happy to see the Reveres continue to offer some type of support to an organization that seems to be the scape goat of our larger world health care problem.

    And I’m not surprised to see some condemn the WHO for “over-reacting” when they were condeming them for “under-reacting” a short time ago.

Current ye@r *