The H1N1 swine flu outbreak appears to have ended less like the rogue wild boar that United Nations bureaucrats predicted and more like roasted pork tenderloin with apples and sage. From the beginning the World Health Organization's actions have ranged from the dubious to the flagrantly incompetent.
Last June the WHO boosted the pandemic alert to the highest level, Phase 6. That meant that, according to the WHO, a pandemic was under way--the first time in 41 years that the organization had made such a declaration. But the WHO must have been suffering from four decades of amnesia because ordinary seasonal flu, which sweeps the world annually--and which is far more lethal than the currently circulating low-virulence H1N1 swine flu--certainly meets the organization's definition of a pandemic: infections over a wide geographic area that affect a large proportion of the population.
Ironically, one might even consider the emergence of the H1N1 flu during the past year a net public health benefit, since it appears to have suppressed, or at least supplanted, the far more virulent and lethal seasonal flu strains. During the second week of January, 3.7% of Americans tested positive for the seasonal flu, compared with 11.5% during the same week last year. The death toll in the U.S. from H1N1 is estimated by the Centers for Disease Control and Prevention to be around 3,900, while in an average year seasonal flu kills about 36,000.
The WHO's April 2009 decision to raise the pandemic flu threat to the penultimate level, Phase 5, "Pandemic Imminent," was unwarranted and far outpaced the data accumulated. Even worse was the June declaration that a pandemic was under way, which exposed the WHO's flawed fundamental paradigm. A warning system based solely on how widely a virus has spread, but that does not consider the nature, severity and impact of the illness it causes, is prone to false positives; it would classify not only seasonal flu but also the frequent but largely inconsequential outbreaks of virus-caused colds and gastroenteritis as "pandemics." WHO has never offered any explanation for why these examples that seem to fit its definition of a pandemic do not meet its criteria.
False alarms make the "pandemic under way" designation almost meaningless, and they diminish its usefulness, which, in turn, has important consequences. As Dr. Jack Fisher, a professor of surgery at the University of California, San Diego, School of Medicine, observed, "Keep crying 'wolf,' and WHO can expect lower than customary compliance with flu vaccine advisories next fall." Not only next fall, but also at some future time when we encounter a genuinely dangerous new pathogen such as a strain of H5N1 avian flu (which in its present form boasts a mortality rate more than 100 fold higher than the H1N1 swine flu) that is easily transmissible between humans.
The U.N.'s false alarms have had more immediate, negative effects. Matthew Hingerty, managing director of Australia's Tourism Export Council, lamented that the country lost thousands of tourists because of the WHO's pandemic declaration. Egyptian public health authorities overreacted and summarily ordered the slaughter of all the pigs in the country. In addition to the devastating economic losses, garbage filled the streets of Cairo and the numbers of rodents rose to fearsome levels because the pigs were no longer available to consume much of the garbage produced in the city. The U.N. indicted by the Law of Unintended Consequences.
The publicity and resulting panic surrounding the WHO's announcement of Phase 5 and 6 alerts--especially since the vaccine was not widely available until December--also brought out the fraudulent peddling of all sorts of ineffective and possibly dangerous protective gear and nostrums, including gloves, masks, dietary supplements, shampoo, a nasal sanitizer and a spray that supposedly coats the hands with a layer of anti-microbial "ionic silver."
For all these reasons, the declaration of a pandemic cannot be a prognostication but rather should be a real-time snapshot, and it must only be made when science and common sense support it.
WHO's performance has been widely criticized. Most flu experts believe that the WHO's actions were overly alarmist and precipitous and the Parliamentary Assembly of the Council of Europe announced that it plans to debate "false pandemics, a threat to health."
And yet WHO officials continue to defend their actions. In a Jan. 14 conference call with reporters, Keiji Fukuda, special adviser to the WHO's director general for pandemic flu, remonstrated that the organization had not overplayed the dangers but "prepared for the worst and hoped for the best." Other communications were more strident. "The world is going through a real pandemic. The description of it as a fake is wrong and irresponsible," the WHO said on Jan. 25. A particularly problematic statement came from WHO spokesman Greg Hartl, who said, "We cannot control how people react to" WHO announcements concerning pandemics. He would benefit from tutoring in risk communication.
The WHO's dubious decisions demonstrate that its officials are too rigid or too incompetent (or both) to make needed adjustments in the pandemic warning system--deficiencies we have come to expect from an organization that is scientifically challenged, self-important and unaccountable. The WHO may be able to perform and report worldwide surveillance--i.e., count numbers of cases and fatalities--but its policy role should be drastically limited.
U.N. bureaucrats pose as authorities on all manner of products, public policy and human activities, from desertification and biodiversity to the regulation of chemicals, uses of the ocean and the testing of genetically engineered plants. However, the U.N.'s regulatory policies, requirements and standards often defy scientific consensus and common sense. Its officials are no friends of commerce, public health or environmental protection. The result is a more precarious, more dangerous and less resilient world. When it comes to pestilence, the U.N. may be the greatest plague of all.
Henry I. Miller, a physician, molecular biologist and former flu researcher, is a fellow at Stanford University's Hoover Institution and at the Competitive Enterprise Institute. He was an official at the National Institutes of Health and Food & Drug Administration.
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