WHO admits to “inconsistencies” in its policy on conflicts of interest

BMJ 2010; 340 doi: (Published 15 June 2010) Cite this as: BMJ 2010;340:c3167
  1. Zosia Kmietowicz
  1. 1London

    The World Health Organization has admitted that its policies governing the publication of conflicts of interests of its expert advisers have “inconsistencies” and that safeguards “surrounding engagements with industry” need to be tightened.

    The agency was responding to criticisms of its handling of the swine flu pandemic in an investigation by the BMJ and the Bureau of Investigative Journalism and a report from the Council of Europe published last week.

    The joint BMJ and bureau investigation found that key scientists advising WHO on planning for a flu pandemic had done paid work for drug firms that stood to gain from the guidance and that the agency had not declared these conflicts of interests (BMJ 2010;340:c2912, 3 Jun, doi:10.1136/bmj.c2912). In addition, the names of 16 members of the WHO “emergency committee” have been kept secret to outsiders, and as such their possible conflicts of interest with drug companies are unknown.

    Despite repeated requests WHO has failed to provide any details about whether such conflicts were declared by the relevant experts and what, if anything, was done about them.

    The Council of Europe’s draft report too complained of a lack of transparency at WHO and claimed that the seriousness of the pandemic was vastly over-rated and led to a distortion of public health priorities (BMJ 2010;340:c3033, 7 Jun, doi:10.1136/bmj.c3033). Governments around the world had stockpiled millions of dollars worth of antiviral drugs as part of pandemic preparedness that they were now trying to sell back to the manufacturers.

    In a letter to the BMJ Margaret Chan, WHO’s director general, defended the agency’s actions leading up to, during, and following its decision to declare the A/H1N1 flu pandemic in June 2009 ( She said, “At no time, not for one second, did commercial interests enter my decision-making.”

    Dr Chan refuted accusations that WHO had changed its definition of a pandemic to boost the profits of the drug industry.

    She said, “The bottom line is that decisions to raise the level of pandemic alert were based on clearly defined virological and epidemiological criteria. It is hard to bend these criteria, no matter what the motive.

    “The current pandemic preparedness plan, which includes phase definitions, was finalised in February 2009 following two years of consultations. A new strain of H1N1 was neither on the horizon nor mentioned in the document.”

    Dr Chan said that “a full record and timeline of events leading to the publication” of the flu guidance has been available to the review committee that began work in April to look at criticisms levelled at the agency.

    However, she conceded that “WHO needs to establish, and enforce, stricter rules of engagement with industry, and we are doing so.” She said that the names of the members of the emergency committee would be announced when its work was finished. But a request as to when this would be and if their conflicts of interests would be published was not answered at the time the BMJ went to press.

    Iain Overton, managing editor of the Bureau of Investigative Journalism, welcomed WHO’s response to the investigation but called for all conflicts of interest documents relating to the guidance on antivirals and vaccines to be published in full.

    He added, “As our reports clearly stated, the eminent professors we examined all regularly declared possible conflicts elsewhere. Even given possible conflicts on this occasion, each would have been permitted to take part in 2002 and 2004 so long as their COIs [conflicts of interest] were made public. They were not. Indeed, no COI information has ever been issued relating to these crucial meetings, for any adviser involved.”


    Cite this as: BMJ 2010;340:c3167