H1N1 (photo: CDC)
In light of a perceived swine flu outbreak, the World Health Organization raised its influenza pandemic alert to its second highest level in May – but evidence reveals the agency may have made it easier to classify the flu outbreak as a pandemic by changing its definition to omit “enormous numbers of deaths and illness” just prior to making its declaration.
WHO, a specialized agency of the United Nations, issued its pandemic declaration – the first in 40 years – just as 74 countries had reported 144 deaths from the novel H1N1 infection.
The world was gripped with fears of swine flu as the alert increased from Phase 5 to Phase 6, the highest level. Immediately, pharmaceutical companies began working to develop vaccines, and countries tailored their responses to address the situation.
Dr. Thomas Frieden, who assumed leadership of the U.S. Centers for Disease Control and Prevention, or CDC, on June 8, announced that the U.S. would respond aggressively to the virus.
“There has been excellent global cooperation with the World Health Organization, with countries around the world,” Frieden said. “This is one of the many conditions that reminds us that we are all connected and many of our decisions in the U.S. will rely on good information from countries in Latin America, in Africa, in Asia, Australia and elsewhere. It’s very important that we confront this jointly.”
The current WHO phase of pandemic alert remains at 6, indicating a full-blown global pandemic.
But in early May, just prior to the initial declaration, WHO made little-noticed changes to its definition of a pandemic.
The previous definition of a pandemic stated:
An influenza pandemic occurs when a new influenza virus appears against which the human population has no immunity, resulting in several, simultaneous epidemics worldwide with enormous numbers of deaths and illness. With the increase in global transport and communications, as well as urbanization and overcrowded conditions, epidemics due the new influenza virus are likely to quickly take hold around the world (emphasis added).
WHO definition of “pandemic” prior to May 2009 (archive located at WayBackMacine)
The WHO changed that definition, omitting the section indicating “enormous numbers of deaths and illness.” It now states:
A disease epidemic occurs when there are more cases of that disease than normal. A pandemic is a worldwide epidemic of a disease. An influenza pandemic may occur when a new influenza virus appears against which the human population has no immunity. With the increase in global transport, as well as urbanization and overcrowded conditions in some areas, epidemics due to a new influenza virus are likely to take hold around the world, and become a pandemic faster than before. WHO has defined the phases of a pandemic to provide a global framework to aid countries in pandemic preparedness and response planning. Pandemics can be either mild or severe in the illness and death they cause, and the severity of a pandemic can change over the course of that pandemic (emphasis added).
WHO definition of “pandemic” as currently stated on its website
WHO’s current pandemic phase description chart makes no mention of “enormous numbers of deaths and illness.”
According to CNN, WHO had the “enormous numbers of deaths and illnesses” definition on its website until May 6 when a reporter pointed it out.
WHO spokesperson Natalie Boudou said the definition was in error, according to the report.
“It was a mistake, and we apologize for the confusion,” she said. “(That definition) was put up a while ago and paints a rather bleak picture and could be very scary.”
Epidemiologist Tom Jefferson, formerly a general practitioner in the British Army, has worked for the Cochrane Collaboration for 15 years. He evaluates all published flu-related studies.
In a July 21 interview with Der Spiegel magazine, Jefferson asked, “Don’t you think there’s something noteworthy about the fact that the WHO has changed its definition of pandemic?”
He continued, “The old definition was a new virus, which went around quickly, for which you didn’t have immunity, and which created a high morbidity and mortality rate. Now the last two have been dropped, and that’s how swine flu has been categorized as a pandemic.”
Jefferson said there’s money to be made when a pandemic occurs.
“The WHO and public health officials, virologists and the pharmaceutical companies. They’ve built this machine around the impending pandemic,” he said. “And there’s a lot of money involved, and influence, and careers, and entire institutions! And all it took was one of these influenza viruses to mutate to start the machine grinding.”
He said he saw no difference in the definition between the swine flu and a normal flu epidemic. Jefferson told the magazine that there are hundreds of other viruses that can be deadly, but researchers aren’t as interested in those because the money isn’t as readily available.
“With rhinoviruses, RSV and the majority of the other viruses, it’s hard to make a lot of money or a career out of it. Against influenza, though, there are vaccines, and there are drugs you can sell,” he said. “And that’s where the big money from the pharmaceuticals industry is. It makes sure that research on influenza is published in the good journals. And that’s why you have more attention being paid there, and the entire research field becomes interesting for ambitious scientists.”
Teresa Forcades, a nun at the monastery of Sant Benet, in Montserrat-Barcelona, Spain, is a physician specializing in internal medicine who received her education at the State University of New York. She also earned a Ph.D. in public health from the University of Barcelona. Forcades addressed the WHO definition switch in a recent video circulating online.
She noted that the H1N1 virus has a high infection rate but lower mortality rate than the annual seasonal flu virus.
“How could WHO declare a pandemic, taking into account that this virus has a mortality rate lower than the yearly virus?” she asked. “Then how come there isn’t a pandemic every year if the yearly virus is worse than this new virus? How come we don’t declare a pandemic every year?”
Forcades expressed concern that countries may subject citizens to mandatory vaccine orders against their will in circumstances where the WHO issues widespread pandemic alerts.
Likewise, MIT doctoral student Peter Doshi argues in a Sept. 3 article published by the British Medical Journal that officials responded to the H1N1 outbreak as an “unfolding disaster.”
“Measures were taken that in hindsight may be seen as alarmist, overly restrictive, or even unjustified,” he wrote. “The large sums of public money spent on pandemic preparedness underlined the seriousness of the threat, and often repeated phrases such as ‘not a question of IF a pandemic will happen, but WHEN’ characterized the next flu pandemic as a high probability, high consequence event.”
However, Doshi said the 2009 “pandemic,” taken as a whole, bears little resemblance to the forecasted pandemic. According to today’s estimates from the U.S. Centers for Disease Control and Prevention, at least 22 million Americans have come down with H1N1 since April, 98,000 have been hospitalized and approximately 3,900 have died. In August, White House officials warned the virus could cause 30,000 to 90,000 deaths.
But during an average U.S. winter, normal seasonal flu strains result in an average of 200,000 hospitalizations and 36,000 deaths – about 10 times the current swine-flu death rate reported by the CDC.
As of Nov. 1, WHO reported the global H1N1 death toll at more than 6,000.
Doshi noted that WHO declared a Phase 5 pandemic alert on April 29, only one week after news of the first outbreak.
“Epidemiological information at this time was mixed, suggesting a severe disease in Mexico but mild everywhere else,” he wrote. “Actions were thus taken in an environment of high public attention and low scientific certainty.”
Doshi warned, “Public health responses not calibrated to the threat may be perceived as alarmist, eroding the public trust and resulting in people ignoring important warnings when serious epidemics do occur.”
WHO also acknowledges a 2009 change of the phase descriptions on its website, claiming the phases “have been revised to make them easier to understand, more precise, and based upon observable phenomena.”