WHO sets up external panel to review pandemic response

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Source: http://www.cidrap.umn.edu/cidrap/content/influenza/swineflu/news/mar2910review-br.html


WHO sets up external panel to review pandemic response

Lisa Schnirring * Staff Writer

Mar 29, 2010 (CIDRAP News) ? The World Health Organization (WHO) today said it is in the final stages of putting together an independent committee to review its preparation for and response to the H1N1 pandemic, a group of about 29 experts that will meet for the first time in the middle of April.

Keiji Fukuda, MD, special advisor on pandemic influenza to the WHO director-general, shared details about the review group with journalists in Geneva. The WHO posted an audio recording of the press conference on its Web site.

Fukuda said the independent review will parallel another review effort within the WHO that will examine pandemic response as part of a required evaluation of how the International Health Regulations (IHR) functioned during the outbreak. He said the H1N1 pandemic was the first major test of the IHR, which are an agreement outlining how governments should handle global health emergencies.

Fukuda and other WHO health officials have often said the group looks forward to the lessons learned from its pandemic response. "The bottom line is how we can do better with our preparations and response," he said.

The review's timing isn't a signal that the pandemic is over, he said. Instead, the review comes one year into the pandemic, when health officials have accumulated a lot of experience with the response and the actions are still fresh in people's memories.

Some elected officials and health ministers have criticized the response of the WHO and governments, claiming that health officials overreacted to the disease threat and were influenced by pressure from pharmaceutical companies to buy vaccine stockpiles. The WHO and health authorities from several countries have strongly denied the claims.

The Council of Europe (COE) has launched its own inquiry into the WHO and governmental pandemic responses, and today in Paris the social, health, and family affairs committee of the COE's Parliamentary Assembly (PACE) held its second hearing on the issue. The COE, separate from the European Union, works on issues such as civil rights, economics, and democracy. The group was established after World War II and is made up of elected officials from 47 nations.

The WHO is still putting together the pandemic review group, which will have a broad range of expertise, including scientists and public health experts both inside and outside the infectious disease arena. Fukuda said that though the review group will operate independently from the WHO, members will be required, like the WHO's internal expert groups, to make declarations of interest and reveal potential conflicts of interest.

The group will hold its first meeting Apr 12 to 14. The committee will elect its own chair and cochair, set its own agenda, and seek out its own expert assessments. It will produce a preliminary report on its actions for the WHO director-general to present to the World Health Assembly in May.

Fukuda said the WHO anticipates that many countries will want to air their views with the new committee, and countries will have the opportunity to speak or submit written comments at the group's first meeting. Though there won't be a public gallery for the meetings, representatives from governments and other groups will be welcome to observe, and the WHO is still working out how to provide media access.

A final report on the WHO's pandemic response will likely be completed in time for the WHO director-general to present to the May 2011 World Health Assembly.

At today's COE hearing, Paul Flynn, a socialist member of the British Parliament, presented an initial inquiry report on the WHO's pandemic response. Flynn said the report reflects a recent meeting with Gillian Merron, Britain's public health minister. He said he will meet with WHO officials on Apr 15 to gather more information. COE said in a press release that the PACE committee will likely approve the report in late April, in advance of a possible debate on the topic in Strasbourg in June.

Today the committee focused on transparency issues related to the WHO and governmental pandemic responses. The group heard from Poland's health minister, Ewa Kopacz, about the country's decision not to buy pandemic vaccine.

Also on the agenda were Marc Gentilini, a member of France's National Academy of Medicine, who spoke on France's pandemic response; Dr Tom Jefferson, from the Cochrane Collaboration, who spoke on the use of scientific evidence when making flu-related decisions; and Michele Rivasi, a European Parliament member who is calling for that group to launch an inquiry. The European Parliament is an elected group and is one of the European Union's two legislative branches.

See also:

Jan 26 CIDRAP News story "European hearing airs WHO pandemic response, critics' charges"

Mar 29 WHO press conference audio transcript

Mar 29 video transcript of COE hearing and press conference

Mar 29 COE press release

 

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Re: WHO sets up external panel to review pandemic response

Panel of external experts starts review of WHO, international response to H1N1

By Helen Branswell Medical Reporter (CP) ? 7 hours ago

TORONTO ? A panel of external experts begins the task Monday of critiquing how the World Health Organization and the international community responded to the H1N1 pandemic.

The WHO, which was drawing members of the review committee from a list of experts nominated by countries, has insisted on keeping the roster secret until the work begins.

Among the 29 committee members is Dr. Arlene King, Ontario's chief medical officer of health. King, who took over the Ontario job last spring, was for years Canada's point person for pandemic planning at the Public Health Agency of Canada.

The committee, which is expected to complete its work over the course of the next 13 months, is being asked to identify what went right and what went wrong in the pandemic response so public health officials at the WHO and elsewhere can apply the lessons to future pandemic planning.

But the group is not being charged with deciding whether H1N1 should have been declared a pandemic in the first place. That question has already been answered, suggests Dr. Keiji Fukuda, the WHO's top flu expert.

"Here we are very clear," says Fukuda, who serves as special adviser to WHO Director General Margaret Chan on pandemic influenza.

"We have always been very clear that based on the virologic information, based on the immunologic information, the epidemiologic information, the differences in clinical patterns that we see from seasonal influenza, we have never had a moment's doubt of whether this is a pandemic or not."

The WHO may have no doubts, but a chorus of critics - especially in Europe - has been highly critical about the decision to declare the outbreak a pandemic. They suggest the virus, which in most cases caused only mild illness, was no more serious than seasonal flu.

Some have suggested the WHO made the pandemic call under the influence of experts with ties to the pharmaceutical industry, companies which stood to make fortunes from the decision to make pandemic vaccine and use stockpiles of antiviral drugs.

Fukuda says some of the criticism has been constructive, and the WHO welcomes it.

"We have never been under the illusion that we would ever be able to handle something like this perfectly," he says.

"We have a burning push on our side to figure out where we can improve both the performance of the international community as well as ourselves."

But some of the criticisms fail to take into account that what is known now about the severity of the virus wasn't known last spring when the new virus emerged in Mexico and the Southwestern United States.

"There are comments which really do take the perspective that what we know now is what we knew at the beginning," Fukuda says, noting that as the pandemic virus started to spread, decisions had to be made "in the absence of a lot of information."

"That is simply the nature of dealing with urgent issues."

Members of the review panel have been drawn from lists of experts that countries are asked to submit as part of the International Health Regulations, a treaty designed to help the international community respond to disease threats.

That list provides a resource for the WHO's director general, who draws on their expertise and seeks their advice. It was that list to which Chan turned last spring when she set up an emergency committee of experts to guide her on how to proceed with H1N1.

For the pandemic review committee, the aim is to draw committee members from developing and developed countries and get a mix that represents different areas of relevant expertise, Fukuda says.

"I think that the credibility of the review committee is really going to rest with the calibre of the people that are part of the review committee, the thoroughness with which it does its work and the kinds of questions it poses to address," he said.

Under WHO rules, all participants in the panel have had to declare their financial interests. Those reports are being scrutinized for potential conflicts of interest.

"I think one of the things that has been difficult to convey or it has been difficult for people to accept is the difference between declarations of interest and true conflicts of interest," Fukuda says.

"We are very much trying to make sure that the guidance and the input that we get is truly good guidance. It's not a hidden Trojan horse. But ... it does not help to get advice from people who are theoreticians. We really want advice and guidance from people who know what they're talking about."

The committee will choose its own chair and determine how it will proceed, Fukuda says. While he expects the group will want to gather evidence from others, it will be up to them to decide whether they want to hold hearings or dispatch groups of panellists to meet with officials outside of Geneva.

The pandemic review will be part of a broader review of the International Health Regulations. When the IHR came into force in 2005, it was stipulated that the workings of the treaty would be reviewed in five years.

The aim is for that report to be ready for presentation to the World Health Assembly - the WHO's annual meeting - in May 2011.


http://www.google.com/hostednews/canadianpress/article/ALeqM5iABxVjr7K0azuSLWk4CjBy0ZPVTw

 

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Re: WHO sets up external panel to review pandemic response

Hindsight the wrong way to judge H1N1 response


TORONTO ? Judging the world's response to the H1N1 pandemic requires a special perspective -- looking at the past through eyes that aren't clouded by the present, suggests the man leading an international review of the global pandemic response.

Dr. Harvey Fineberg, who is chairing the World Health Organization's pandemic review committee, says critiquing decisions made last spring, summer and fall based on what is now known about the H1N1 virus won't uncover the lessons the world needs to learn.

"This is one of the really, I would say, sine qua non of a fair assessment," says Fineberg, using the Latin phrase that means an essential ingredient.

"You have to look at each decision from the vantage point of what was understood and known at that time. You still may be very critical, or you may be laudatory or you may be somewhere in between. But it's certainly inappropriate to look at it from a vantage point after the fact."

Still, Fineberg, who is president of the U.S. Institute of Medicine, says assessing the response based on what was known at the time won't give decision makers a free pass.

"Even prospectively you can still attend to errors of calculation and insufficient utilization of available information, failure to outline all of the options, failure to think about alternatives, failure to communicate successfully," he said in an interview with The Canadian Press.

"That's part of what I hope we'll look into. And part of what I hope we can maintain as a committee, is this sense of looking retrospectively but with a prospective attitude."

Wednesday marked the first anniversary of the initial revelation that a storm might be brewing on the influenza front.


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