Commentary by Henry I. Miller
June 14, 2009
Cases of H1N1 swine flu continue to appear – especially in Australia, which has seen cases quadruple in a week, with confirmed cases surpassing 1,200. But that is hardly a surprise. Flu virus is transmitted more efficiently in cold temperatures, and winter is just beginning in the Southern Hemisphere.
It must have surprised officials at the World Health Organization, however, because on Thursday they boosted the pandemic alert to the highest level, Phase 6, meaning a pandemic is under way – the first time in 41 years WHO has declared a pandemic.
But like Rip van Winkle, WHO must have been asleep during that time, because ordinary seasonal flu, which sweeps the world annually – and invariably is far more lethal than the mildly virulent H1N1 swine flu – certainly meets its definition of a pandemic: widespread geographical spread. A June 11 New York Times headline said it all, "To Flu Experts, ‘Pandemic’ Confirms the Obvious."
Something else has been obvious: From the beginning of the H1N1 swine flu outbreak, WHO’s decisions and pronouncements have been far from reassuring. Most flu and public health experts consider WHO to have been overly alarmist and say the organization’s decision during the week of April 27 to raise the pandemic flu threat to the penultimate level, Phase 5, "Pandemic Imminent," far outpaced the accumulated data and was unwarranted.
Even worse was its official declaration of a pandemic, which illustrates that WHO’s fundamental paradigm is flawed: A warning system based solely on how widely a virus has spread and not considering the nature of the illness it causes is prone to false positives; it would classify as "pandemics" not only seasonal flu but also the frequent but largely inconsequential outbreaks of virus-caused colds and gastroenteritis, for example. It makes the term almost meaningless.
WHO’s dubious decisions demonstrate that its officials are either too rigid or too incompetent to make needed adjustments in the warning system – perhaps both, because that’s what we have come to expect from an organization that is scientifically challenged, self-important and unaccountable. WHO may be well-equipped to perform and report worldwide surveillance – i.e., count numbers of cases and fatalities – but its policy role should be limited drastically.
The decisions that need to be made are difficult, encompassing virology, medicine, economics and ethics. Should nations close borders and restrict domestic and international travel and trade? Given the relatively indolent spread and low virulence of the H1N1 virus, should we rush to prepare vast amounts of vaccine? If so, what viral isolates should be included in the vaccine, and to whom should it be administered?
I have had the misfortune to work with United Nations officials for many years, most recently at the meetings of the task force on biotechnology-derived foods of the Codex Alimentarius Commission, a creature of the United Nations’ WHO and Food and Agriculture Organization (FAO) that sets international food standards. The group established standards that were unscientific and excessively stringent and ensure that new, innovative foods will be so expensive to develop that they will remain largely unavailable to the poorest of the poor, who need them most.
During a task force meeting, Jorgen Schlundt, director of the WHO department concerned with food safety, zoonoses (diseases that spread from animals to humans) and food-borne diseases, repeatedly exhorted the group to add ethical concerns about biotech foods to the regulatory barriers that already impede their adoption. He was more like a witless Monty Python character than an official entrusted with serious international responsibilities – including issues pertaining to swine flu, avian flu, West Nile virus and SARS.
But the United Nations’ influence is no laughing matter. Its involvement in international public health policy is just one manifestation of the organization’s even grander designs: The United Nations has become the regulator-wannabe for all manner of products and human activities, from desertification and biodiversity to the regulation of chemicals, uses of the ocean and new genetic varieties of plants.
The United Nations’ regulatory policies, requirements and standards regularly defy scientific consensus and common sense: U.N. agencies’ virtual ban on DDT for mosquito control and their stultifying regulation of agricultural biotechnology are lamentable examples. The result is a more precarious, more dangerous and less resilient world.
Henry I. Miller, a physician, molecular biologist and former flu researcher, is a fellow at Stanford University’s Hoover Institution. He headed the Food and Drug Administration’s Office of Biotechnology from 1989 to 1993.