A panel of independent experts has harshly reviewed the World Health Organization’s handling of the 2009 epidemic of H1N1 swine flu, though it found no evidence supporting the most outlandish accusation made against the agency: that it exaggerated the alarm to help vaccine companies get rich.
The world is still unprepared to handle a severe pandemic, and if a more dangerous virus emerges, “tens of millions would be at risk of dying,” the panel said in its draft report, which was posted on an obscure corner of the W.H.O.’s Web site on Thursday.
Although millions of doses of vaccine ultimately went unused, the panel found “no evidence of malfeasance.”
The virus appeared severe during its spring outbreak in Mexico City, and it was not clear how relatively mild it really was until late summer, “well past the time when countries would have needed to place orders for vaccine,” the panel said.
Later, when rich nations donated 78 million doses for use in poor ones, the health agency could not deploy them because it was bogged down in negotiations with vaccine companies over liability and costs.
The panel, which has experts from 24 countries and is led by Dr. Harvey V. Fineberg, president of the Institute of Medicine, criticized the agency’s “needlessly complex” definition of a pandemic, which had six levels of alert, based on the virus’s geographical spread, not its severity. At one point, the agency altered, without explanation, its online pages to remove references to severity. That “invited suspicion,” the panel said.
While the names of the agency’s expert advisers were kept secret for months to shield them from pressure, the tactic “paradoxically fed suspicions that the organization had something to hide,” the panel said.
Some advisers had done research for the vaccine industry, and those potential conflicts of interest “were not managed in a timely fashion,” the report said. Nonetheless, it concluded, “no critic of W.H.O. has produced any direct evidence of commercial influence on decision-making.”
Communications were also clumsy. Ceasing routine news conferences after the disease was elevated to pandemic status was “ill advised,” the report said, and the agency responded “with insufficient vigor” when its integrity was questioned.
Countries that needed technical help could not obtain it in enough languages, and the W.H.O. bureaucracy created “an unmanageable number of documents,” according to the report.
Asking countries to submit counts of laboratory-confirmed cases created confusion, the report said, adding that knowing hospitalization and death rates would have been better.
Although the W.H.O. excels at sending small teams to focused outbreaks like a village overwhelmed by Ebola, it fumbled even simple aspects of a prolonged effort, like food, lodging and child care for its staff.
The panel did offer some praise. With help from national health agencies like those of the United States and Canada, the W.H.O. identified the virus quickly and got seed strains to vaccine makers. It also sent experts to countries that asked for help.
The W.H.O. will not respond to the report until the final version is released in May at the annual assembly of the world’s health ministers, a spokeswoman for the agency said. Under W.H.O. rules, the draft had to be made public early to invite comment in time for the final draft.
Dr. Fineberg declined to discuss the report’s conclusions, because it is a draft. His panel invited testimony from both critics and the W.H.O. staff, “but everything was voluntary,” he said. “We don’t have subpoena power.”
The report also acknowledges that many problems were beyond the health agency’s control. Vaccine companies use slow 60-year-old technology, diagnostic tests are cumbersome, and virologists know too little about which mutations are the most dangerous.
The panel urged the creation of a “global reserve corps” of experts for emergencies, and a $100 million fund for their use. It urged vaccine makers to reserve 10 percent of their production for poor countries. It also criticized some international rules. For example, there is no way to punish nations that needlessly close borders or curtail trade. In 2009, many countries banned pork imports in the mistaken belief that a human flu with some swinish genes could be spread by bacon. Others closed borders or forcibly quarantined visitors with fevers.
