‘WHO advisers on swine flu worked for drug companies’

Billions of dollars of antiviral drugs were stockpiled and not used.

Swine flu patient  (photo credit: Ariel Jerzolomiski)
Swine flu patient
(photo credit: Ariel Jerzolomiski)
Key scientists advising the World Health Organization on planning for a swine flu (h1N1) pandemic had done paid work for pharmaceutical firms that stood to gain from the guidance these scientists were preparing, a joint investigation by the BMJ (British Medical Journal) and the Bureau of Investigative Journalism revealed on Friday.
A year ago, the WHO, an agency of the UN, coordinated the actions of governments around the world to fight H1N1, declared the new strain of swine-origin H1N1 as a pandemic, encouraging vaccination and giving daily press conferences. Its advice induced governments around the world to stockpile billions of dollars of antiviral drugs. Yet these conflicts of interest have not been publicly disclosed by the WHO, the British Medical Journal//Bureau of Investigative Journalism probe said. Despite repeated requests, the 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 authors said.
Israel’s Health Ministry followed the WHO’s recommendations, with PrimeMinister and formal Health Minister Binyamin Netanyahu ordering thepurchase of 7 million doses of vaccine and enough antiviral medicationsto cover the entire population at a cost of about half a millionshekels. However, most of these were left unused because most Israelisdeclined to be vaccinated, and the H1N1 complications were mild enoughin most people to make the antivirals unnecessary. No comment wasavailable over the weekend from senior ministry officials who wereinvolved in handling the H1N1 pandemic.
The new report echoes a highly critical inquiry by the Council ofEurope, whose findings were also published on Friday and fueledsuspicions that the drug industry was able to exert undue influence onthe WHO’s decisions about the swine flu pandemic and the massstockpiling of drugs.
The investigation found that the WHO’s 2004 guidance on the use ofantivirals in a pandemic was prepared by an influenza expert who hadreceived payment from the Basel-based Hoffmann–La Roche, manufacturersof oseltamivir (Tamiflu), and the London-based GlaxoSmithKline,manufacturers of zanamivir (Relenza), for lecturing and consultancywork. The guidance concluded that “countries should consider developingplans for ensuring the availability of antivirals” and that they “willneed to stockpile in advance, given that current supplies are verylimited.”
In addition, the investigation found two other scientists who preparedannexes to the WHO 2004 pandemic guidelines had recent financial linksto Roche. Authors Deborah Cohen of the British Medical Journaland Philip Carter of the Bureau of Investigative Journalism maintainedthat the WHO “did not publicly disclose any of these conflicts ofinterest when it published the 2004 guidance. It is not clear whetherthese conflicts were notified privately by WHO to governments aroundthe world, many of which followed its advice.”
This “lack of transparency,” they continued, “is compounded by theexistence of a secret ‘emergency committee’ that advised WHO’sdirector-general Margaret Chan on declaring an influenza pandemic.Significantly, the names of the 16 committee members are known only topeople within WHO, and as such their possible conflicts of interestwith drug companies are unknown.”
The WHO has denied that any industry influenced the scientific adviceit received. It also says it takes conflicts of interests seriously andhas the mechanisms in place to deal with them. But the British Medical Journal and the Bureau suggest that WHO seems not to have followed its own rules for the decision-making around the pandemic.
“And, despite repeated requests, the WHO has refused to provide anyinformation about the conflict of interest declarations made to it,leaving the investigation to wonder whether major public healthorganizations are able to manage the conflicts of interest that areinherent in medical science effectively,” the joint report stated.
Cohen and Carter wrote that the WHO’s response to criticism “is alsodisappointing, given WHO’s track record of standing up to industry. Inthe late 1970s, WHO sparked two iconic clashes with multinationalcompanies over the marketing of breast milk substitutes in thedeveloping world and the setting up of the Essential Drugs Programme.Both issues set WHO at loggerheads with the US, where these industrieshad major holdings. Partly in response to WHO’s position, Americawithdrew contributions to WHO’s budget.”
In an accompanying editorial, British Medical Journaleditor-in-chief Dr Fiona Godlee wrote that “the WHO’s credibility hasbeen badly damaged” and that recovery will be fastest if it “publishesits own report without delay or defensive comment, makes public themembership and conflicts of interest of its emergency committee anddevelops, commits to, and monitors stricter rules of engagement withindustry that keep commercial influence away from its decision-making.”
On the basis of their own investigation and those of others, they saidthe answer to the question about what to do about conflicts “is nowinescapable... No one should be on a committee developing guidelines ifthey have links to companies that either produce a product – vaccine ordrug – or a medical device or test for a disease. The same, and more,must apply to committees making major decisions on public health. Whereentirely independent experts are hard to find, experts who are involvedwith industry could be consulted but should be excluded fromdecision-making. The US has made important progress with its SunshineAct and other legislation. European legislation on managing conflictsof interest is long overdue,” Cohen and Carter concluded in their paper.