A committee tasked with investigating the World Health Organization (WHO)'s response to the 2009 H1N1 influenza pandemic says it identified some shortcomings but found no evidence of malfeasance in the process. It also says that the world still finds itself ill-equipped to handle major global pandemics and other health emergencies.
In January 2010, WHO's director-general, Dr. Margaret Chan, called for the convening of a committee to review the experience gained in the global response to the influenza A (H1N1) 2009 pandemic, in order to inform the review of the functioning of the regulations; to help assess and to modify the ongoing response, and to strengthen preparedness for future pandemics.
The review committee conducted a major portion of its work through plenary meetings at WHOs headquarters in Geneva. The committee heard testimony from individuals representing member states, National IHR Focal Points, intergovernmental organizations, nongovernmental organizations, United Nations agencies, industry, health professionals, experts, members of the media, chairs of relevant committees and the WHO secretariat.
The commitee's report, "Report of the Review Committee on the Functioning of the International Health Regulations (2005) and on Pandemic Influenza A (H1N1) 2009," emphasizes that a review of the functioning of the IHR and how successfully WHO performed in response to the pandemic requires an understanding of the context of the pandemic. The review committee identified five factors that framed the events and help explain what happened in the pandemic response:
- the core values of public health
- the unpredictable nature of influenza
- the threat of avian influenza A (H5N1) and how it shaped general pandemic preparedness
- WHOs dual role as a moral voice for health in the world and as a servant of its member states
- the limitations of systems that were designed to respond to a geographically focal, short-term emergency, rather than a global, sustained, long-term event
As the report notes, "The response to the emergence of pandemic influenza A (H1N1) 2009 was the result of a decade of pandemic planning, largely centred on the threat of an avian influenza A (H5N1) pandemic. However, H5N1 and H1N1 have markedly different characteristics. H5N1 infection in humans results in about 60 percent mortality among confirmed cases, yet it is only sporadically transmitted to humans and even less often between humans. When thinking about a potential H5N1 pandemic, large numbers of fatalities could be assumed because the virus had proved itself to be highly lethal. Since H5N1 was not easily transmissible from human to human, suppression of an outbreak through the use of antiviral drugs and other measures could be thought feasible. WHOs web site has described the prospect of severe disease in a possible pandemic, which was understandable in the context of expectations about H5N1. But the reality of H1N1 was quite different. Because H1N1 caused illness that did not require hospitalization in the vast majority of cases, the question of severity of the pandemic and how to characterize it became a key challenge. As the H1N1 virus spread to several countries within days, the possibility of rapid containment, a tenet of planning in WHOs multi-stage response, was never really feasible."
With this background and context, the review committee reached three overarching conclusions:
1. The IHR helped make the world better prepared to cope with public health emergencies. The core national and local capacities called for in the IHR are not yet fully operational and are not now on a path to timely implementation worldwide.
2. WHO performed well in many ways during the pandemic, confronted systemic difficulties and demonstrated some shortcomings. The committee found no evidence of malfeasance.
3. The world is ill-prepared to respond to a severe influenza pandemic or to any similarly global, sustained and threatening public health emergency. Beyond implementation of core public health capacities called for in the IHR, global preparedness can be advanced through research, strengthened healthcare delivery systems, economic development in low- and middle-income countries and improved health status.
To access the draft "Report of the Review Committee on the Functioning of the International Health Regulations (2005) and on Pandemic Influenza A (H1N1) 2009," CLICK HERE.