COMMENTARY: The Pandemic That Wasn’t

PALO ALTO – Last June, the United Nations’ World Health Organization, responding to an outbreak of the H1N1 virus, or swine flu, boosted the pandemic alert to the highest level, Phase 6, meaning that a pandemic was under way – the first time in 41 years that the organization had taken that declared step. But the outbreak appears to have ended less like the rogue wild boar that WHO bureaucrats predicted and more like roasted pork tenderloin with apples and sage. In fact, the WHO repeatedly violated Sherlock Holmes’ warning, “It is a capital mistake to theorize before you have all the evidence.” And the pandemic alert was doubly strange, given that ordinary seasonal flu sweeps the world annually, is invariably far more lethal than the currently circulating low-virulence H1N1, and certainly meets the WHO’s definition of a pandemic: infections over a wide geographic area and affecting a large proportion of the population.

Ironically, the appearance of the H1N1 flu during the past nine months might be thought of as a net public-health benefit, because it appears to have suppressed, or at least supplanted, the far more virulent and lethal seasonal flu strains. During the second week of January, 3.7% of Americans tested positive for the seasonal flu, compared to 11.5% during the same week in 2009. The official death toll worldwide from H1N1 is under 14,000, while seasonal flu kills about 36,000 on average in the United States and hundreds of thousands elsewhere.

Most flu and public-health experts consider the WHO to have been overly alarmist. The decision in April 2009 to raise the pandemic flu threat to the penultimate level, Phase 5 (“Pandemic Imminent”), already raced far ahead of the accumulated data, so the Phase 6 declaration in June revealed the organization’s paradigm to be fundamentally flawed. A warning system based solely on how widely a virus has spread, but that does not consider the nature and severity of the illness it causes, would classify as “pandemics” not only seasonal flu, but also the frequent but largely inconsequential outbreaks of virus-caused colds and gastroenteritis, for example. (The WHO has never explained why these obvious examples do not meet their criteria.)

False alarms make the “pandemic under way” designation almost meaningless and diminish its usefulness. And that, in turn, has important consequences: as Jack Fisher, a professor of surgery at the University of California, San Diego, School of Medicine, observed, “Keep crying ‘wolf,’ and WHO can expect lower than customary compliance with flu vaccine advisories next fall.” Worse, imagine what would happen when we encounter a genuinely dangerous new pathogen, such as a strain of H5N1 avian flu (which in its current form has a mortality rate more than 100 times higher than H1N1) that is easily transmissible between humans.

The UN’s false alarms also have had more immediate negative effects. According to Matthew Hingerty, the managing director of Australia’s Tourism Export Council, the country lost thousands of tourists because of the WHO’s pandemic declaration. Egyptian public-health authorities overreacted and ordered the slaughter of all pigs in the country. In addition to the direct economic losses, because the pigs were no longer available to consume much of the garbage produced in Cairo, the numbers of rodents rose to fearsome levels.

The publicity and resulting panic surrounding the WHO’s announcement of Phase 5 and 6 alerts – especially in the absence (until December) of widely available vaccine – also brought out fraudsters peddling all sorts of ineffective and possibly dangerous protective gear and nostrums: gloves, masks, dietary supplements, shampoo, a nasal sanitizer, and a spray that supposedly coats the hands with a layer of anti-microbial “ionic silver.”

For all these reasons, the declaration of a pandemic must not be a prediction but rather a kind of real-time snapshot.

The WHO’s performance has been widely criticized: the Parliamentary Assembly of the Council of Europe, for example, said on January 12 that it plans to debate “false pandemics, a threat to health” later this month. And yet WHO officials continue to defend their actions. In a January 14 conference call with reporters, Keiji Fukuda, the special adviser to the WHO’s director general for pandemic flu, argued that the organization did not overplay the dangers but “prepared for the worst and hoped for the best.”

The WHO’s dubious decisions demonstrate that its officials are either too rigid or incompetent (or both) to make necessary adjustments to the pandemic warning system – which is what we have come to expect from an organization that is scientifically challenged, self-important, and unaccountable. It may be able to perform and report worldwide surveillance – i.e., count numbers of cases and fatalities – but its policy role should be drastically reduced.

Henry I. Miller, a physician, molecular biologist, and former flu researcher, is a fellow at Stanford University’s Hoover Institution and at the Competitive Enterprise Institute. He was a US government official from 1977 to 1994. Copyright: Project Syndicate, 2010.www.project-syndicate.org