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The swine flu scam?

Article  in  Journal of Public Health · September 2010

DOI: 10.1093/pubmed/fdq059 · Source: PubMed

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 Journal of Public Health | Vol. 32, No. 3, pp. 296 –297 | doi:10.1093/pubmed/fdq059 | Advance Access Publication 4 August 2010
Editorial
The swine flu scam?
There is a conspiracy theory about nearly everything. So
claims that swine flu was a scam come as no surprise. ‘This
was a pandemic that never really was’ according to Paul
Flynn, MP who prepared a recent report on the flu pan-
demic for the Council of Europe.1 The report expresses
alarm about the way the pandemic was handled. It criticizes
the proportionality of the response and argues that over
reaction led to waste of public money, distortion of public
health priorities and unjustified fears about health risks. It
identifies ‘grave shortcomings’ in the transparency of
decision-making processes and concerns about the influence
of the pharmaceutical industry. The World Health
Organization (WHO) comes in for particular criticism for
failing to publish the declarations of interest of members of
its Emergency Committee, the group advising director
general Dr Margaret Chan on the pandemic response.
These themes are taken up by Cohen and Carter2 in the
British Medical Journal. They found that key scientists had
done paid work for pharmaceutical firms that stood to gain
from advice they gave to WHO. However, declarations
made by members of the Emergency Committee, and of
other WHO committees that helped produce influenza pre-
paredness plans, have never been disclosed by WHO. Even
the identities of the 16 member Emergency Committee
remain a closely guarded secret.
Conflicts of interest have been defined by the US
National Academies as: ‘any financial or other interest which
conflicts with the service of the individual because it could
significantly impair the individual’s objectivity, or could
create an unfair competitive advantage for any person or
organization’.3 There are many ways in which conflicts of
interest can influence professional behaviour. The General
Medical Council in its guidance for doctors focuses almost
exclusively on the doctor–patient relationship.4 But conflicts
of interest can equally arise in postgraduate education, guide-
line development, research conduct, programme evaluation
and public policy formulation.
When it comes to policies on pandemic flu, there is an
inherent conflict between the pharmaceutical industry,
WHO and the global health system. Almost inevitably, they
all draw on the same pool of experts. The issue is therefore
not so much about avoiding conflicts of interest but about
296 # The Author 2010, Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved.
properly dealing with them. As Friedman points out, ‘there
is no moral or ethical failing in having a conflict of interest;
the problem occurs when conflicts are not disclosed appro-
priately and when conflicts are allowed to bias research,
teaching or practice’.5 There are several possible strategies.
At the very least, public disclosure of conflicts of interest is
essential to maintain transparency. The US National
Academies have gone further and ruled that no individual
can be appointed to serve on one of its committees if that
individual has a conflict of interest that is relevant to the
functions of the committee.3 However, such an approach
may bar experts who have important information to contrib-
ute. Another option is to consult the relevant experts, but
exclude them from decision-making. For example, the
American College of Chest Physicians has developed a
three-point plan to address this tension when developing
practice guidelines.6 First, equal emphasis is placed on intel-
lectual and financial conflicts with explicit criteria for both.
Second, a person without conflicts of interest is given
primary responsibility for each guideline chapter. Thirdly,
experts with conflicts of interest can collect and interpret
evidence, but only panel members without conflicts of inter-
est can be involved in developing guideline recommen-
dations. Drug regulation agencies often have very
formalized procedures for dealing with conflicts of interest.
For example, the European Medicines Agency (EMEA)
maintains a database of members’ conflicts of interest.
These are evaluated to determine ‘level of risk’, and infor-
mation on individuals deemed ‘high risk’ is referred to an
assessment group who may restrict the individual from
taking part in specific activities. However, even such appar-
ently stringent procedures have been criticized in favour of
following a precautionary principle that completely prohibits
any involvement of individuals with conflicts of interest.7
So was swine flu a scam? Did the pharmaceutical industry
manipulate a fake pandemic? Were the scientific experts, con-
sciously or unconsciously, part of a conspiracy to promote
anti-viral stockpiles and boost vaccine sales? Corporate influ-
ences on epidemiology have a long history.8 The tobacco
industry has undertaken elaborate campaigns to undermine
WHO activities on tobacco control in the past.9 More recently,
the alcohol beverage industry and the food industry have come
under scrutiny for possible attempts to influence public

opinion, regulation and the conduct of science.10,11 But the
swine flu affair smells more of cock-up than conspiracy.
Ultimately, the issue boils down to a problem of confidence
in public policy-makers. There is a great deal at stake finan-
cially. Decisions made within WHO led to national govern-
ments committing millions of pounds to buy anti-virals and
vaccines. The public, politicians and national governments
need to be convinced not only that the right decisions are
made, but that they are also made for the right reasons. It is
vital that such influential decisions are made in the clear light
of day and that the decision-making bodies involved can
demonstrate that they have effective mechanisms to deal with
conflicts of interest. In this regard, the WHO arrangements
can be seen to be woefully inadequate. Indeed, Chan, respond-
ing to the BMJ article, concedes that ‘WHO needs to establish,
and enforce, stricter rules of engagement with industry’.12
Next time we need to be more transparent in our
decision-making,13 more adept at communicating risk to the
public14 and more flexibly in responding to the pandemic,
whatever form it takes.15 In the meantime, WHO needs to
put its house in order.
Conflict of interest: M.R.E. is a member of the UK
Scientific Pandemic Influenza Advisory Committee and the
UK Scientific Advisory Group on Emergencies.
Meirion R. Evans
Senior Lecturer in Epidemiology and Public Health,
School of Medicine, Cardiff University,
Regional Epidemiologist, Public Health Wales
References
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View publication stats
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