World Health Organization (WHO) hyped up a "false pandemic." Now the backlash is in full swing

Foreign Policy: Don't Put Away Your Face Mask Yet

by Scott Rosenstein

Enlarge Khaled Desouki/AFP/Getty Images

Egyptian school girls wear masks in class for protection against swine flu at a school in Cairo on October 4, 2009. Though much of the hysteria around swine flu had subsided over the summer a second wave hit many in the fall.

When the novel A(H1N1) virus ("swine flu") emerged in April 2009, many media outlets painted a picture of looming disaster, and the public looked for assurances that every precaution was being taken. The doomsday scenario appears to be off the table for now, and mainstream media interest in this issue now focuses primarily on criticizing the response. The World Health Organization (WHO) and many governments are now being taken to task for overreacting to a nonexistent threat that really only benefited pharmaceutical companies. This presents significant risks for institutions that now must defend themselves against a backlash that will likely reduce public engagement on this issue and reduce preparedness planning to emerging infectious disease threats of all kind.

In May 2009 we wrote about how the world was starting to get sick of swine flu. At that point, there were early signs that the virus might not produce the nightmare pandemic scenario that many public health experts were (and still are) worried about. The media was transitioning away from around-the-clock coverage as public interest began to wane. There were, however, lingering concerns about a more severe second wave of swine flu, and uncertainties about the quantity of and timeline for a vaccine.

Ten months later, those concerns are mostly gone. But the Council of Europe, a watchdog group, recently made headlines by claiming that the World Health Organization (WHO) hyped up a "false pandemic." Now the backlash is in full swing.

A second wave of the swine flu strain did, in fact, hit in September. And though many more non-elderly people died or became severely ill than is typical during normal flu seasons, the overall health burden of this pandemic pales in comparison to the other three flu pandemics of the twentieth century. The 1918 "Spanish flu," for instance, killed between 50 million and 100 million people worldwide.

Past pandemics have allowed public health experts to establish red flags. The 2009 H1N1 outbreak included two significant red flags: a novel strain of flu that humans had never been exposed to and an inordinate impact of this flu on young people (both important similarities with the 1918 pandemic). As a result, surveillance was increased and vaccine development was implemented. But this was by no means a guarantee that a 1918-style pandemic was imminent. Assessing the severity and overall health burden of a flu pandemic is a notoriously long and difficult process: scientific research into the origins and death toll of the 1918 pandemic continues to this day.

Communicating the long time horizon and uncertainty surrounding this type of research has proven difficult, particularly for media outlets trying to parse qualified reports and recommendations from health experts. As we warned in May, the media doesn't have the luxury of waiting for epidemiological information and biological research. Oversimplifications in reporting created misinformation as the most sensational projections were broadcast without caveat or context.

Governments, meanwhile, must often make expensive decisions with little information. Considering the health and political risks of inaction, many developed countries had little choice but to stock up on vaccines.

However, the supply of the swine flu vaccine now far exceeds demand. A recent article in the New York Times reveals that developed countries are now having trouble donating it to developing countries. Once a frighteningly scarce commodity, the vaccine is now an object of ridicule — particularly in Europe, where policymakers who championed vaccination are now under attack from opportunistic political rivals who accuse them of wasting public money and of scaremongering.

The Council of Europe now claims that employees within the WHO knew that the threat to public health posed by the virus was low — and pushed for vaccination to drive profits for big pharma and to boost the WHO's profile and funding. Forgetting for a moment the moral bankruptcy of such a plan and the suggestion that WHO scientists were able to predict what no other scientists could in the spring of 2009, this theory fails on many levels. First, the WHO is typically the No. 1 enemy of pharmaceutical companies. Second, red flags regarding a possible pandemic were raised and corroborated by many experts not associated with the WHO or big pharma. Third, vaccines are expensive, difficult to make, controversial, and offer substantially less profit potential for big pharma than other drugs, making them an unlikely candidate for such a plot. Fourth, the reputational risks to the WHO far outweigh any financial gains that a false pandemic could produce for them or their employees. Finally, trumping up a pandemic threat that doesn't come to pass would seriously undermine future support for influenza R&D and the WHO's influenza preparedness activities — not increase it, as the Council of Europe suggested.

Regardless of the merits of such claims, they reveal the response challenges for low probability/high impact scenarios like pandemic flu. The backlash against a less-than-severe pandemic will likely increase public skepticism in the future. The WHO will suffer further damage to its reputation. Coordinating a global response to emerging infectious diseases is tricky in the best of times, but with its credibility on the decline, carrying out this costly activity without enough resources of its own and its reliance on U.N. member state support will be particularly difficult. For the big pharmaceutical companies, who will see a modest revenue boost from this pandemic (not the windfall profits that have sometimes been reported), willingness to invest in vaccine production capacity — a major shortfall during the spring of 2009 — will likely be reduced amid this current round of bad press and government cancellations of their vaccine contracts. While it may be difficult for some critics of big pharma to accept that a for-profit venture plays a critical role during these pandemics, the reality is that they will be the only game in town for the foreseeable future. Longer term, government investment in surveillance, diagnostics, logistics, and vaccine development will be limited by fears of political recrimination, as we are currently seeing in Europe and, to a lesser extent, the United States.

To be sure, this mild pandemic has provided important lessons on risk communication and response that may be useful if and when another infectious disease threat emerges. Presuming, of course, we're not all dead.