MEDICAL MATTERS:H1N1 has further tainted WHO's credibility
ALTHOUGH the secretary general of the World Health Organisation, Dr Margaret Chan, declared an end to the H1N1 pandemic in August, the fallout continues. Inquiries are ongoing into whether the WHO response was excessive and whether there were ethically questionable links between WHO experts and pharmaceutical companies manufacturing the vaccine.
Some critics have suggested the WHO and expert advisory committees may have been unduly influenced at critical junctures, such as in the upgrading of the H1N1 outbreak from phase five to six, which triggered the declaration of the pandemic in June 2009. There is also concern that the WHO rewrote their definition of pandemic during the outbreak.
Certainly, the WHO and individual governments overestimated the potential severity of the illness. 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 remains about 500.
Here in the Republic, children and young adults were most affected, with 80 per cent of cases occurring in those under 35. Worldwide, young people have been disproportionately affected in terms of hospitalisation and deaths compared to seasonal influenza, in which older people come off worst. Similarly, the risk to pregnant women has been higher than for seasonal influenza.
It’s fair to say the credibility of the WHO has been tainted. To some observers, the organisation has cried wolf over three consecutive infectious disease episodes – Sars, bird flu and swine flu – and should now declare swine flu a “non-demic”.
Whether it did or not is of more than just academic interest. A perception that the risk is different than previously understood can trigger a reassessment of its significance, which may in turn cause further social and economic impacts.
I suspect that, were a new global health threat to emerge in the coming months, the assessment and advice of the WHO would be analysed a lot more critically than before the swine-flu pandemic. And while it is healthy for the public to question regulatory authorities and government, when do we reach a tipping point where a lack of credibility causes people to ignore official advice?
Leaving officialdom to one side, what is our current knowledge of the H1N1 virus? As of week 41, national surveillance data show low levels of flu-like illness in the Republic. The first identified flu virus was a H1N1 (2009) case. In the southern hemisphere winter, three flu viruses have been in circulation and are likely to make their presence felt here from next month onwards. They are: the pandemic influenza A H1N1 2009 virus, an influenza A H3N2 virus similar to last year’s “regular flu” and an influenza B strain. The good news is all three strains are contained in the seasonal flu vaccine now available from your family doctor.
The powers-that-be recommended an extension of its national vaccine programme to cover pregnant women, those with extreme obesity and children with chronic illness who attend special schools. Which brings me to my critical question of the week: why, given the particular severity of swine flu in young adults (many became seriously ill with acute respiratory distress syndrome), are we not recommending influenza vaccination for this section of the population? Would anyone in the National Immunisation Office or the Health Protection Surveillance Centre care to comment?
Nominations are being sought for this year’s Fiona Bradley Medal, which is open to those who have made a difference in healthcare. Fiona was one of the most courageous people I have known, and many of us remember her encouraging us to speak out against inequities or fear of change and progress. The closing date for nominations is November 12th. Further information from the Fiona Bradley Foundation at andrew.murphy@nuigalway.ie
mhouston@irishtimes.com