WHO responds to BMJ article on conflicts of interest

Financial relationships between committee members and the pharmaceutical industry in no way influenced WHO’s decision to label and handle influenza A (H1N1) as a pandemic, Margaret Chan, MD, MPH, director-general of WHO, wrote in a letter to the editors of the British Medical Journal.

Her response was provoked by a report that uncovered undisclosed conflicts of interest between researchers advising WHO and the pharmaceutical industry. The article and an accompanying editorial, which recently appeared in the BMJ, implied that these ties may have shaped WHO’s recommendations during the 2009 pandemic. Chan, however, refutes this claim.

“At no time, not for one second, did commercial interests enter my decision-making,” she wrote. “Without question, the BMJ feature and editorial will leave many readers with the impression that WHO’s decision to declare a pandemic was at least partially influenced by a desire to boost the profits of the pharmaceutical industry. The bottom line, however, is that decisions to raise the level of pandemic alert were based on clearly defined virological and epidemiological criteria. It is hard to bend these criteria, no matter what the motive.”

Chan said, however, she has no problems with raising questions about some of these financial relationships, and necessary measures should be taken to preserve the integrity of the organization.

“Potential conflicts of interest are inherent in any relationship between a normative and health development agency, like WHO, and profit-driven industry,” she wrote. “WHO needs to establish, and enforce, stricter rules of engagement with industry, and we are doing so.”

Nevertheless, Chan said she is dissatisfied with the notion that WHO has brushed off concerns about the matter. “I take issue with the assumption that WHO simply dismisses these hard questions as unfounded,” she wrote. “I have publicly expressed my desire to see a critical, independent, and transparent assessment of WHO’s performance.”

Chan also responded to accusations that WHO generated unwarranted fear and concern regarding the severity of H1N1.

“On 11 June 2009, when I announced the start of the pandemic, I drew attention to the fact that the worldwide number of deaths was small, and clearly stated that we did not expect to see a sudden and dramatic jump in the number of severe or fatal infections,” she wrote. “In every assessment of the pandemic, WHO consistently reminded the public that the overwhelming majority of patients experienced mild symptoms and made a rapid and full recovery, even without medical treatment.”

The article also charged WHO with lowering disease severity in the definition of pandemic so that H1N1 fit the description. Chan denied this allegation: “The current pandemic preparedness plan, which includes phase definitions, was finalized in February 2009 following two years of consultations. A new strain of H1N1 was neither on the horizon nor mentioned in the document.”

The article and editorial cited a “lack of transparency” as another troubling issue due to the anonymity of the Emergency Committee that advised WHO during the pandemic. Chan, however, said this security measure was taken to prevent commercial and other influences, and names will be released when the committee is finished. She added that detailed records and timelines are documented, and the Review Committee may evaluate them at any time.

“Should this Committee decide that the current definition of a pandemic and the phases leading up to its declaration need to be tightened or otherwise revised, this will be another recommendation that we will welcome, and act on,” Chan wrote.

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