No matter what governmental bodies do—be they at the state, national, or international level—there is always a group against them. Of course, this is one reason politics and political parties exist—to sort out disagreements among individuals and organizations and, ideally, to find compromise. Political and ethical issues are now surrounding the World Health Organization (WHO) and its handling of the H1N1 swine-flu, which appeared in 2008/early 2009 and quickly spread around the world. WHO declared the situation a Phase 6 pandemic in June 2009. (There are six official pandemic alert Phases with Phases 6 being the highest level, based on human-to-human spread of the virus in at least two countries in one WHO region and at least one additional country in a different WHO region. The Phase descriptions are on the WHO website).

WHO Director-General Margaret Chan noted in the June 2009 announcement that, “No previous pandemic has been detected so early or watched so closely, in real-time, right at the very beginning. The world can now reap the benefits of investments, over the last five years, in pandemic preparedness.”

Previous pandemics were declared in 1968 when about 1 million died of influenza, and in 1918, when the Spanish flu killed tens of millions. As for the definition of “pandemic,” the public, politicians, advocacy groups, and the media are currently debating what it means and whether WHO changed its definition of the word before declaring the 2009 H1N1 swine flu disease as such. As of June 11, 2009, when WHO made the Phase 6 announcement, 74 countries had officially reported 28,774 cases of influenza A (H1N1) infection, including 144 deaths. The US Centers for Disease Control and Prevention (CDC) estimated  that between 14 million and 34 million cases of 2009 H1N1 had occurred between April 2009 and Oct. 17, 2009, including between 63,000 and 153,000 2009 H1N1-related hospitalizations, and between 2,500 and 6,000 2009 H1N1-related deaths. Ultimately, a pandemic declaration means that countries should implement their national pandemic plans.

About a year after the declaration, groups on both sides of the Atlantic are claiming that WHO falsely led the public to believe there was a pandemic based on influence and input from the pharmaceutical industry. A Council of Europe report said that WHO “vastly overrated” the seriousness of the situation. Another report, published in the British Medical Journal, claims that some experts advising WHO were paid consultants of drug companies that manufacture influenza treatments and vaccines. 

On the Pan American Health Organization (PAHO, the US office of WHO) website’s myths and facts page, the organization counters that it did not exaggerate the pandemic. “We have always known that pandemics can range in severity from mild to severe and can even undergo a change in severity as they run their course. WHO and other responsible health authorities have adopted a preventive approach-that is, preparing for the worst-case scenario in order to save lives. Better to prevent than regret…. In making this decision, WHO consulted independent world experts through Advisory Committees. WHO is constantly verifying that the experts who sit on its Advisory Committees have no conflicts of interest that could influence their technical opinion. So far, the health impact of this pandemic, compared to that of past pandemics, has been moderate. Countries have found means and have taken actions that were critical to reducing the severity of the pandemic.”

Because the H1N1 swine-flu was relatively new, more stringent precautions were taken, says the website.

Of note, WHO commissioned its own 29-member external panel to examine how it addressed and managed the H1N1 swine-flu pandemic in April 2010. The panel’s report is expected to be presented to the 2011 World Health Assembly. And the US Government Accountability Office (GAO) produced a report in November 2009 about how the US government handles pandemics. GAO recommended that the Homeland Security Council instruct the White House National Security Staff to help develop a monitoring and reporting process for action items at the nonfederal level.

The irony of the situation is that if WHO had not declared a pandemic and lives were lost as a result of swine flu (indeed, CDC estimates that as many as 18,300 deaths occurred between April 2009 and April 2010 as a result of the 2009 H1N1 virus) , the world would be harping on the organization for not doing its job and not declaring a pandemic. At the end of the day, WHO was unlikely to receive full public and political support no matter what action it took. As citizens, we depend on governments and governmental bodies to protect us. It seems WHO and its 193 member states—including the US—were trying to do just that.

See related blog post, “In the Name of Accountability”