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Industry, experts and the pandemic scandal at WHO

Will the scandal about undeclared industry ties of experts who advised the World Health Organisation on pandemic influenza claim the scalp of the Director-General, Dr Margaret Chan?

Such a question might have seemed far-fetched even just a few months ago, but no less an authority than the editor of the BMJ, Dr Fiona Godlee, has suggested this may be possible, given the scale of the “public cost and private profit” involved in the influenza pandemic.

Following a series of revelations about the WHO’s failure to effectively and transparently manage experts’ conflicts of interests, Godlee said there had been called for Chan’s resignation.

“It may come to that,” Godlee wrote at Twitter.

The latest issue of the BMJ reports on an investigation, jointly conducted by the journal with the Bureau of Investigative Journalism, which found that some of the experts advising WHO on the pandemic had financial ties with drug companies that were producing antivirals and influenza vaccines.

As an example, WHO’s guidance on the use of antivirals in a pandemic was authored by an influenza expert who at the same time was receiving payments from Roche, the manufacturer of oseltamivir (Tamiflu), for consultancy work and lecturing.

Although most of the experts consulted by WHO made no secret of their industry ties in other settings, WHO itself has so far declined to explain to what extent it knew about these conflicts of interest or how it managed them. They were not declared in relevant WHO publications, and it appears the organisation did not follow its own 2003 guidelines for handling conflicts of interest.

The BMJ says the “lack of transparency” is compounded by the existence of a secret “emergency committee,” which advised Chan on when to declare the pandemic—a decision that triggered costly pre-established vaccine contracts around the world.

Apart from the name of the Australian scientist who chairs the committee, Professor John Mackenzie, who was quoted recently in this Reuters article, the committee members’ identities are kept secret. The WHO has, however, said it plans to release the names once the committee’s work is finished.

Meanwhile, the Council of Europe has also been extremely critical of the WHO, with an inquiry concluding that decision making around the influenza A/H1N1 crisis has been lacking in transparency.

The Guardian cites a UK MP, Paul Flynn, who sits on the Council’s health committee as saying: “The tentacles of drug company influence are in all levels in the decision-making process.” He also said there had been “distortion of priorities of public health services all over Europe, waste of huge sums of public money and provocation of unjustified fear.”

The BMJ says WHO’s response to such concerns had been “disappointing” and a “knee jerk defence”.

The BMJ notes that the WHO will not be the only body to come under scrutiny for its handling of the pandemic, and that coming months will see a spate of reports, from the European Commission, the European Parliament, and from national bodies including the French Senate, and the UK’s Cabinet Office.

So far as I’m aware we won’t be seeing any such reports released in Australia. Not because experts’ ties to industry are not an issue here. And not because we can be sure the policy making process has been squeaky clean.

It’s more that all of the reviews and debriefings that I’ve heard about have been conducted behind firmly closed doors. No accountability or reporting back to the public in full. I gather that another such process is to be held soon.

Even experts who have been involved in providing advice to government have many questions about how policies were devised, and who has been involved in what decisions.

Meanwhile, the crisis engulfing the WHO has far bigger ramifications than simply pandemic influenza. It raises broader questions for public health and medicine about the role of experts with industry ties.

As one influenza expert said to Croakey in the last few days: “Just declaring conflict of interest then going on with life normally (ie, conflicted) is not the appropriate path. Experts who are in the pay of Big Pharma should excuse themselves from discussions about spending public money, not declare potential conflicts of interest, then go on with influencing decisions. The problem is that these people are genuinely expert and governments and other bureaucracies such as WHO like to have access to their expertise. But their expertise may not be unbiased.”

Godlee put it another way on Twitter: “We need to create a world in which the best, most respected, most sought after experts are those who are NOT in the pay of industry.”

These are not only issues for the WHO, or for pandemic influenza policy…