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From public health to public anxiety Recent disclosures implicating the World Health Organisation (WHO) have highlighted the problem of conflicts of interest in public health. Arguing that such conflicts of interest can have devastating consequences, Dr T Jayabalan calls for stringent measures to overcome this problem. IN many countries, the first wave of the H1N1 outbreak has receded, and to date, the threat of a second and third wave of the pandemic is yet to be seen. It is speculated that the number of deaths from the H1N1 outbreak world-wide would be lower than from the typical seasonal flu and that the overreaction to H1N1 was due to the World Health Organisation (WHO)'s zeal to declare it a pandemic. By definition, a pandemic is an epidemic of infectious disease that is spreading through human populations across a large region; is completely novel, exhibiting a shift in its antigenicity (the capacity to stimulate the production of antibodies and to induce an immune response) from previous viruses and the potency to cause both serious as well as widespread consequences. But WHO redefined the term 'pandemic' when it dropped the last three key requirements, thereby altering the meaning of a pandemic. In line with this new definition, countries were duty-bound to WHO to put in place their pandemic plans, one of which was mass vaccinations against the virus. The H1N1 outbreak reached its peak in October 2009 and the need for mass vaccinations, including immunising healthy people, had virtually disappeared. Yet, WHO still considers this a moderate pandemic and there are as yet no plans to downgrade the threat of the H1N1 outbreak. The
chairman of the health subcommittee of the Council of Europe's parliamentary
assembly has alleged that drug companies have raised needless fears
over the H1N1 outbreak for the purpose of profiteering from sales of
the vaccines. These allegations have surfaced because several European
countries including the Conflicts of interest Industry support of biomedical research has increased tremendously in both developed and developing countries. In fact in the US, industry's share of total investment in biomedical research and development rose sharply from 32% in 1980 to 62% in 2000 (Journal of the American Medical Association, Vol. 289 No. 4, January 22, 2003). This figure declined slightly in 2007 to 58% - still a substantial share (Journal of the American Medical Association, Vol. 303 No. 2, January 13, 2010). Over the years, the relationship between industry on the one hand and academic and professional institutions on the other, has prospered. This in turn gave rise to very unhealthy trends where conflicts of interest became quite common. A recent disclosure that a senior member of the WHO advisory group of experts had not declared a conflict of interest he had with a multinational pharmaceutical company makes one wonder how non-partisan these agencies are. For instance, GlaxoSmith-Kline (GSK), which produces the H1N1 vaccine 'pandemrix', had supported the institute where the senior member of the WHO advisory group worked with grants for research on vaccines in 2009. Although this grant, worth $9 million, was to study the impact of a new vaccine in the Finnish Vaccination Programme and was purportedly not linked to H1N1, the fact is that there was a conflict of interest which remained undeclared. It's a moot point that the Finnish government had stockpiled the H1N1 vaccine after recommendations from the same institute. Drug companies have been accused of raising the spectre of fear over infectious diseases so that they can benefit from increased sales of their vaccines, as was seen previously in the case of the Human Papilloma Virus (HPV). In this instance, the messages and the methods used by the drug companies to market the HPV vaccine were questionable; they maximised the threat of cervical cancer to adolescents and minimised the role of sexual transmission of the disease.ÿ Further, the drug companies provided educational grants to professional medical associations and others to produce educational materials and promote the need for the HPV vaccine. In the case of the H1N1 vaccine, the situation was not very different. When WHO declared the H1N1 outbreak as a pandemic, countries clamoured to stockpile the vaccines in the belief that they were facing a severe outbreak of the virus. There were to be mass vaccinations against the virus but by the time the stock of vaccines arrived, the situation had peaked and the threat had abated. Just as you would find a new use for an old drug formulation, there was a need to find new uses for the excess stock of vaccines and the vaccination game-plan had to take a new turn. Now, instead of mass vaccinations, those at higher risk (people with underlying chronic diseases) were to be targeted. Countries must reexamine this issue and a national agenda must be formulated to handle outbreaks of disease. In the light of what has taken place, public health must not be treated in an ad-hoc manner, or be manipulated by drug companies out to make a profit. Recommendations Countries need to put in place a system, including regulations that will evaluate new information and not merely follow orders. For instance, when WHO made recommendations for containing the virus by mass vaccinations, countries should have reserved the right to evaluate these recommendations in the light of their own public health needs. In the issue of public health, conflicts of interest have devastating consequences because scarce resources might have to be deployed and allocated for non-obligatory health issues. Conflicts of interest need to be addressed more vigilantly and any doubts that arise must be clarified. There must be stringent vetting of applications for advisory positions in regulatory agencies and punitive measures must be taken against anyone, including drug companies, found to violate these requirements. It is not merely a question of accountability but also one of integrity. T
Jayabalan is a medical doctor and Honorary Lecturer in social and administrative
pharmacy at the *Third World Resurgence No. 233, January 2010, pp 4-5 |
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