WHO and accusations of a 'false pandemic'

This does not look like it will be pretty. The World Health Organization (WHO) announced this week that it plans to launch an investigation into the global response to the H1N1 pandemic. The organization interest in such an investigation is not neutral . The WHO has been accused in many quarters of overestimating the scope and impact of the pandemic, i.e. overselling the threat. The rhetoric of urgency emanating from the WHO was in counterpoint to relatively modest statistics in terms of mortality and morbidity. It does not help that major pharmaceutical companies are the chief beneficiaries of the rapid production and distribution of H1N1, since this obviously makes delicious fodder for conspiracy theorists. You can imagine how it goes: credulous populations living in fear of death, a fear whipped up by a respected international health body, a fear that can only be managed by purchasing pharmaceutical products in vast quantities.

For the moment, the WHO is sanguine on the subject. It has not said when they will start their investigation, suggesting this would be premature given that the pandemic is not over yet. According to one WHO spokesperson, the investigation is not meant as a (self-)criticism, but rather a means of (self-) improvement: if that tepid language is anything to go by, a hard-hitting report is not in the works. That sort of report, if appropriate, is likely to come from somewhere else. The Parlementary Assembly of the Council of Europe is making 'false pandemics' a major issue in its next plenary session. And if they don't turn over some interesting rocks, someone else surely will.

Hand-me-down vaccines?

There have been months of fear and trembling (especially in the United States) about shortages of H1N1 vaccine. The idea of shortage -- in this one context at least -- in the land of plenty has motivated a rapid increase vaccine production and distribution, on the one hand, while the number of new cases of H1N1 has in fact decreased on the other. In little time, everyone in the United States who wants (and can afford) to have the vaccine, can get it. In fact, there will most probably be way too much of the stuff.

What should be done with the surplus? In a recent editorial in the San Francisco Chronicle, immunology and bioethics experts argue that the surplus should be donated to the world's poorer countries. These countries have health systems under tremendous stress, unhealthy populations at risk for H1N1, and have very limited access to the vaccine despite promises made by powerful governments and pharmaceutical companies. The argument for giving is especially pertinent at time of year. It is, as they point out, Christmas season.

It is hard to know what to make of this. First, the public health issue. The burden of disease that H1N1 constitutes is paltry in comparison to the diseases and conditions faced in developing countries. (It was already not very significant in terms of mortality and morbidity in developed countries themselves.) Sure, H1N1 will exacerbate pneumonia, one of the great killers in these nations. But we don't see significant donations of antibiotics which could save many more lives.

And then there is the symbolic issue. When the richer nations have had their fill of vaccines, and are getting out of danger, then we can think about the poor. The image is that of hand-me-downs, leftovers. Things we no longer need or want and can afford without sacrifice to give away as charity. Of course, it is not that it would be better if such donations were withheld. Some lives could be saved. But what do such acts of charity express about the relationship between richer and poorer countries? Should either party feel good about such a donation initiative? Perhaps some will find the spirit of Christmas in it somewhere, but the whole thing strikes me as deeply, deeply sad.

Let us compare epidemics

There is always something a bit distasteful about comparing human tragedies, but it is also inevitable. The tsunami in 2004 was terrible, but was it as bad as the ongoing HIV/AIDS epidemic in Africa, which has taken millions of lives over the last decades? Darfur is bad, but has it really reached Rwandan genocidal proportions? We inevitably make these sorts of comparisons in order to get some sort of grip on what people ought to care about, and what nations ought to respond to with their finite resources. And we often lose our way.

The H1N1 virus has captured media attention, as well as substantial funding for task forces, response plans and research, particularly as increasingly more deaths have been linked to it. As has been observed many times, the 'media life' of a virus depends in large part on the extent to which citizens (especially ordinary citizens) of North America and Europe are affected by it, or are likely to be affected by it. When the centers of the world's power is under viral threat, vast resources may be mobilized, even if the numbers in terms of morbidity and mortality are, relatively speaking, small. Worse epidemics, elsewhere, receive much less press and support.

The point was not lost on those aware that today was World Pneumonia Day. Pneumonia is the greater killer of children worldwide. It is responsible for more deaths in children (2 million a year) than HIV/AIDS, measles and malaria combined. The tragedy is that we long ago developed effective vaccines to prevent it, and antibiotics to treat it, but it generally affects children away from the centers of the world's power, particularly in sub-Saharan Africa and South-East Asia. While many lives could be saved in delivering known effective medicines to these populations, there is not much money to be made in the endeavor, so rallying support for pneumonia initiatives tends to be an uphill battle. But it is a matter of fighting the good fight, a matter of trying to regain some sense of proportion, and a matter of not being entirely distracted by the latest virus on the 24-hour news cycle.