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Expert panel to review response to H1N1 pandemic
The Canadian Press
Updated: Sun. Apr. 11 2010 5:49 PM ET
TORONTO — A panel of external experts begins the task Monday of critiquing how the World Health Organization and the international community responded to the H1N1 pandemic.
The WHO, which was drawing members of the review committee from a list of experts nominated by countries, has insisted on keeping the roster secret until the work begins.
Among the 29 committee members is Dr. Arlene King, Ontario's chief medical officer of health. King, who took over the Ontario job last spring, was for years Canada's point person for pandemic planning at the Public Health Agency of Canada.
The committee, which is expected to complete its work over the course of the next 13 months, is being asked to identify what went right and what went wrong in the pandemic response so public health officials at the WHO and elsewhere can apply the lessons to future pandemic planning.
But the group is not being charged with deciding whether H1N1 should have been declared a pandemic in the first place. That question has already been answered, suggests Dr. Keiji Fukuda, the WHO's top flu expert.
"Here we are very clear," says Fukuda, who serves as special adviser to WHO Director General Margaret Chan on pandemic influenza.
"We have always been very clear that based on the virologic information, based on the immunologic information, the epidemiologic information, the differences in clinical patterns that we see from seasonal influenza, we have never had a moment's doubt of whether this is a pandemic or not."
The WHO may have no doubts, but a chorus of critics -- especially in Europe -- has been highly critical about the decision to declare the outbreak a pandemic. They suggest the virus, which in most cases caused only mild illness, was no more serious than seasonal flu.
Some have suggested the WHO made the pandemic call under the influence of experts with ties to the pharmaceutical industry, companies which stood to make fortunes from the decision to make pandemic vaccine and use stockpiles of antiviral drugs.
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"We have never been under the illusion that we would ever be able to handle something like this perfectly," he says.
"We have a burning push on our side to figure out where we can improve both the performance of the international community as well as ourselves."
But some of the criticisms fail to take into account that what is known now about the severity of the virus wasn't known last spring when the new virus emerged in Mexico and the Southwestern United States.
"There are comments which really do take the perspective that what we know now is what we knew at the beginning," Fukuda says, noting that as the pandemic virus started to spread, decisions had to be made "in the absence of a lot of information."
"That is simply the nature of dealing with urgent issues."
Members of the review panel have been drawn from lists of experts that countries are asked to submit as part of the International Health Regulations, a treaty designed to help the international community respond to disease threats.
That list provides a resource for the WHO's director general, who draws on their expertise and seeks their advice. It was that list to which Chan turned last spring when she set up an emergency committee of experts to guide her on how to proceed with H1N1.
For the pandemic review committee, the aim is to draw committee members from developing and developed countries and get a mix that represents different areas of relevant expertise, Fukuda says.
"I think that the credibility of the review committee is really going to rest with the calibre of the people that are part of the review committee, the thoroughness with which it does its work and the kinds of questions it poses to address," he said.
Under WHO rules, all participants in the panel have had to declare their financial interests. Those reports are being scrutinized for potential conflicts of interest.
"I think one of the things that has been difficult to convey or it has been difficult for people to accept is the difference between declarations of interest and true conflicts of interest," Fukuda says.
"We are very much trying to make sure that the guidance and the input that we get is truly good guidance. It's not a hidden Trojan horse. But ... it does not help to get advice from people who are theoreticians. We really want advice and guidance from people who know what they're talking about."
The committee will choose its own chair and determine how it will proceed, Fukuda says. While he expects the group will want to gather evidence from others, it will be up to them to decide whether they want to hold hearings or dispatch groups of panellists to meet with officials outside of Geneva.
The pandemic review will be part of a broader review of the International Health Regulations. When the IHR came into force in 2005, it was stipulated that the workings of the treaty would be reviewed in five years.
The aim is for that report to be ready for presentation to the World Health Assembly -- the WHO's annual meeting -- in May 2011.
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