Did the WHO cry wolf over swine flu?

MEDICAL MATTERS:Was the severity of the H1N1 virus overestimated?

THE CONSPIRACY theorists are having a field day about swine flu. The gist of their argument is that the whole swine flu saga was a hoax, put together by capitalist forces driven by the pharmaceutical industry. But leaving aside those extreme views, did the World Health Organisation (WHO) and public-health experts overestimate the risk of the H1N1 virus to the population?

Based on the figures, the answer would seem to be yes. The WHO predicted a global death toll of 7.5 million from the pandemic. Now that the dust has settled it appears 14,000 people died from the disease worldwide. Compared with an estimated global death toll from regular seasonal influenza of some 500,000, H1N1 looks like a viral pussycat.

In the UK, the severity predictions were well off the mark. Liam Donaldson, England’s chief medical officer, predicted 65,000 deaths in the UK as a worst-case scenario, and warned of half the nation’s children falling ill. The death toll in Britain from H1N1 remains below 500. Here in the Republic, 26 deaths have been reported up to May 8th this year. Some 4,586 cases of swine flu were confirmed; children and young adults were most affected, with 80 per cent of cases occurring in those under 35.

On the cost side of the equation, we purchased 7.7 million doses of H1N1 vaccine from two pharmaceutical companies, GlaxoSmithKline and Baxter. The cost was estimated to be €80 million, based on the need for double vaccination. By the end of 2009, the actual cost of vaccines was €12.8 million; the total cost of providing vaccination by then had come to €26.4 million.

While there has been no direct questioning of policy or expenditure here, internationally the hunt is on for a scapegoat. Chief suspect is the WHO itself, which has set up an external committee to examine its performance. Prof Ulrich Keil, a WHO advisor, has suggested the decision to declare a flu pandemic has led to a major misallocation of health budgets.

By changing the definition of a pandemic between the reporting of first cases in Mexico in March and the declaration of a full phase-six pandemic in June, the WHO has left itself open to charges of moving the goalposts mid- match. The new definition left out references to the severity of the illness caused by the virus. As a result, what was emerging as a mild illness for most people became, by definition, a full-blown pandemic, complete with images of a 1918-like devastation of the world’s population. No one appears to have allowed for the possibility of a mild pandemic.

Could this have happened as a result of groupthink among experts focused on a doomsday scenario? The European Medicines Agency and the European Centre for Disease Prevention and Control have been criticised for not carrying out their own assessments of the threat, independent of the WHO. But Poland stood alone and refused to launch a vaccine campaign after its own national experts concluded the risks were not as grave as predicted by others.

The Council of Europe is examining whether undue influence from the pharmaceutical industry led to the WHO labelling the H1N1 outbreak a pandemic. Some have suggested a conflict of interest between public-health experts and “big pharma” out to maximise commercial profits.

But no matter what the outcome of the various inquiries into the saga, one result is already clear: the level of public trust in the WHO and other public-health institutions has been severely dented. Rightly or wrongly, the perception of organisations “crying wolf” over Sars, bird flu and swine flu lessens the chance of most people taking the next pandemic seriously.

And yet if the WHO hadn’t declared a pandemic and national governments weren’t prepared, and if the virus had killed large numbers, the same critics would be first in line to demand accountability. Is the whole area of infectious disease planning akin to the Y2K bug? And does the failure of disaster to occur mean that disaster-planning ought to be abandoned?