The World Health Organization on Monday conceded shortcomings in its handling of the H1N1 swine flu pandemic, including a failure to communicate uncertainties about the new virus as it swept around the globe.
Keiji Fukuda, the WHO's top influenza expert, said the U.N. agency's six-phase system for declaring a pandemic had sown confusion about the flu bug which was ultimately not as deadly as the widely-feared avian influenza.
"The reality is there is a huge amount of uncertainty (in a pandemic). I think we did not convey the uncertainty. That was interpreted by many as a non-transparent process," Fukuda said.
A small but vocal minority of scientists and government officials around the world have accused WHO of overplaying the danger of the virus, while others have claimed its decision to declare a pandemic was unduly influenced by commercial interests.
WHO Director-General Margaret Chan Margaret Chan called for a frank and critical review of its handling of the swine flu pandemic.
"We want a frank, critical, transparent, credible and independent review of our performance," Chan told the experts assembled for a three-day meeting in Geneva, a gathering of 29 external flu experts called to review WHO's handling of the first influenza pandemic in 40 years.
Critics have said the WHO created panic about the swine flu virus, which turned out to be moderate in its effect, and caused governments to stockpile vaccines which went unused.
Some questioned its links to the pharmaceutical industry after companies like GlaxoSmithKline and Sanofi-Aventis made big profits from producing H1N1 vaccine.
H1N1, which emerged in Mexico and the United States almost exactly a year ago, has killed 17,770 people in 213 countries, according to the WHO, which declared a pandemic underway in June. Most victims were young, with an average age of 37, versus 75 for seasonal flu.
The WHO will need another year or two after the pandemic is declared over to determine a final death rate from the virus. The pandemic is still officially underway.
Fear and confusion
The separate but highly lethal H5N1 bird flu virus — which has killed 60 percent of those infected since 2003 — "injected a high level of fear about the next pandemic," Fukuda said.
It had been difficult to meet public demands for advice as the H1N1 virus spread quickly across borders, and blogs and other new media generated speculation and criticism, according to the WHO official.
"Populations around the world have very high expectations for immediate information," Fukuda said. "In many ways it is unforgiving out there."
One big surprise had been that only one dose of vaccine was needed to provide immunity, whereas most planning had been built around two doses being required, he said.
This meant that some countries were left struggling with an oversupply of unused vaccines while poorer ones had little or no access to supplies.
"Confusion about phases and level of severity remains a very vexing issue," Fukuda said, referring to the WHO's six-level scale for pandemics which takes into account the geographic spread of a virus but not its severity.
The WHO tried to come up with quantitive basis for measuring the pandemic's severity using death rates, but this proved difficult as countries provided different levels of information. Many lack even basic birth and death registries.
"Many countries don't have the actual capacity to determine reliably the severity of the virus," said Dr. Martin Cetron of the U.S. Centers for Disease Control and Prevention, one of the experts taking part in the review.
Chan said her agency welcomed a frank review of its handling of the pandemic to help it prepare for future public health emergencies.
"We want to know what worked well. We want to know what went wrong and, ideally, why. We want to know what can be done better and, ideally, how," Chan told the session.