Were swine flu advisors working for drug companies?

The integrity of the the World Health Organisation (WHO) has been called into question following an investigation into the organisation’s advice on swine flu. Serious accusations of conflict of interest have led to demands that the WHO name the members of its secret ‘emergency committee’.

A year on from the WHO’s official declaration in June 2009 of a flu pandemic, it is alleged that the scientists who advised the WHO had also done paid work for the pharmaceutical companies who stood to make billions from sales of drugs to treat the virus to worried governements worldwide.

The investigation by the BMJ and The Bureau of Investigative Journalism may throw light on the reason why so many drugs against A/H1N1 virus were stockpiled and so little of them needed.

It goes back to 2004 when the WHO published its guidance on the use of antivirals in a pandemic. The guidance concluded that ‘countries should consider developing plans for ensuring the availability of antivirals’ and that they ‘will need to stockpile in advance, given that current supplies are very limited.’ According to the investigation, this guidance was prepared by an influenza expert who had received payment from Roche, manufacturers of the antiviral drug oseltamivir (Tamiflu), and GSK, manufacturers of the antiviral drug zanamivir (Relenza), for lecturing and consultancy work. Two other scientists who prepared annexes to this guidance guidelines had recent financial links to Roche.

According to Deborah Cohen of the BMJ and Philip Carter of The Bureau of Investigative Journalism, the WHO did not publicly disclose any of these conflicts of interest when it published the 2004 guidance. It is not clear whether these conflicts were notified privately by WHO to governments around the world, many of which followed its advice.

Secret 'emergency committee'

But although we now know the names of those who prepared to 2004 guidance we don’t know the names of those who advised WHO's director general Margaret Chan to act on it five years later. Cohen and Carter reveal the existence of a secret ‘emergency committee’ which advised on declaring an influenza pandemic. The names of the 16 committee members are known only to people within WHO, and as such their possible conflicts of interest with drug companies are unknown.

Definition of 'pandemic' changed

Meanwhile, a report The handling of the H1N1 pandemic: more transparency needed prepared by British MP Paul Flynn and adopted by the Council of Europe today suggests that the WHO definition of a ‘pandemic’ was changed in May 2009 in the run up to the declaration of the swine flu pandemic. The report says: ‘there is clear evidence that changes were made and that, most importantly, the former criteria of ‘impact and severity’ of an epidemic in terms of the number of infections and deaths was no longer considered relevant in the updated document. In other words, the pandemic could be declared without the need to show that it was likely to be severe in terms of its impact on the population.’

One year on, the so-called pandemic has killed fewer than 18,000 people worldwide according to the report.

The WHO deny any industry influence on the scientific advice it received. It also says it takes conflicts of interests seriously and has the mechanisms in place to deal with them. But the BMJ and the Bureau suggest that WHO seems not to have followed its own rules for the decision making around the pandemic.

And, the investigators say, despite repeated requests, the WHO has refused to provide any information about the conflict of interest declarations made to it, leaving the investigation to wonder ‘whether major public health organisations are able to manage the conflicts of interest that are inherent in medical science effectively.’

The WHO also deny changing the definition of a pandemic when documents were ‘revised’.

In an editorial in the BMJ, Dr Fiona Godlee, Editor in Chief of the BMJ says WHO’s credibility has been badly damaged. She believes that ‘recovery will be fastest if it publishes its own report without delay or defensive comment, makes public the membership and conflicts of interest of its emergency committee, and develops, commits to, and monitors stricter rules of engagement with industry that keep commercial influence away from its decision making.’

Both reports leave big questions unanswered by the WHO and fuel suspicions that the drug industry is able to exert undue influence on its decisions.

• Original BMJ article (BMJ 2010;340:c2912)
• Council of Europe press release