WHO Director-General replies to the BMJ

In her editorial accompanying the feature on conflicts of interest at the World Health Organization,1 2 Godlee notes that it is “almost certainly true” that the mildness of the H1N1 pandemic, compared with the severity long expected from a virus like H5N1, has contributed to the current critical scrutiny of WHO’s decisions. As the editorial further states, this reality does not make it wrong to ask hard questions.

We fully agree. Good investigative journalism brings problems, and their potential consequences, into sharp focus and identifies the need for remedial action. Potential conflicts of interest are inherent in any relationship between a normative and health development agency, such as WHO, and profit driven industry. WHO needs to establish, and enforce, stricter rules of engagement with industry, and we are doing so. However, let me be perfectly clear on one point. At no time, not for one second, did commercial interests enter my decision making.

I take issue with the assumption that WHO simply dismisses these hard questions as unfounded. In January 2010 I suggested that a review committee, an independent mechanism under the International Health Regulations, be used to evaluate WHO’s performance during the influenza pandemic. This recommendation was accepted by members of the WHO Executive Board, and the committee’s work began on 12 April 2010. The committee agreed to address criticism currently being levelled at WHO as part of its evaluation. I have publicly expressed my desire to see a critical, independent, and transparent assessment of WHO’s performance.3

The implication that WHO provoked unjustified fear also needs to be addressed. The record is otherwise, and not a matter of interpretation. On 11 June 2009, when I announced the start of the pandemic, I drew attention to the fact that the worldwide number of deaths was small, and clearly stated that we did not expect to see a sudden and dramatic jump in the number of severe or fatal infections.4 In every assessment of the pandemic, WHO consistently reminded the public that the overwhelming majority of patients experienced mild symptoms and made a rapid and full recovery, even without medical treatment.

Concerning the members of the emergency committee that advised WHO on the pandemic, including phase changes, the names will be released when the committee finishes its work, as has always been intended. Our decision not to make these names public was motivated by a desire to protect the experts from commercial or other influences. The members themselves welcomed this decision as a protective measure, and not as an attempt to veil their deliberations and decisions in secrecy. Records of all emergency committee meetings were kept, and these and all other documents pertaining to WHO’s pandemic decisions and actions have been placed at the disposal of the review committee.

Without question, the BMJ feature and editorial will leave many readers with the impression that WHO’s decision to declare a pandemic was at least partially influenced by a desire to boost the profits of the pharmaceutical industry. The bottom line, however, 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.

Accusations that WHO changed its definition of a pandemic to accommodate a less severe event (and thus benefit industry) are not supported by the facts. The current pandemic preparedness plan, which includes phase definitions, was finalised in February 2009 following two years of consultations.5 A new strain of H1N1 was neither on the horizon nor mentioned in the document.

A full record and timeline of events leading to the publication of the 2009 plan have been placed at the disposal of the review committee. Should this committee decide that the current definition of a pandemic and the phases leading up to its declaration need to be tightened or otherwise revised, this will be another recommendation that we will welcome, and act on.