Vaccination administration publication nation

Swine flu - not really anyone's finest hour. Alternatively Swine flu - a disaster averted. Alternatively, Swine flu - who are these people anyway?.

It looks like a really hard question, but hard questions are what has to be answered when an awful lot of public money has gone up the swannee. And readers will not be surprised to learn that in terms of taking responsibility for a massive forecasting error, the doctors are about as good as the bankers were. Interpreting who's right and who's wrong is the devil's own job, there are points on both sides, but my tentative conclusions would be:

• The Flynn report is pretty good - the New Scientist blog's description of it is a real hatchet job and the actual report is nothing like as sensational as it suggests (I think the NS writer is partly replying to the somewhat irresponsible title of the original Council of Europe proposal). I really don't think it's helpful to respond to a case where the plain facts of the matter are that a pandemic was massively misforecast by accusing people of being paranoid schizophrenics.



• The WHO's disclosure policies are clearly all over the place - anyone with any familiarity with the financial sector will recognise the classic signs of an organisation that had historically believed itself to be above question, reacting in a panicky fashion when it does get questioned, and needs to suddenly justify all its internal and tacit processes according to an external and juridical standard. I don't actually believe there is any impropriety here, but it's clearly a right old state and needs sorting out.



• Further to the above, I am not really happy with the way in which the NS blog deals with quite material suggestions of conflict of interest or breaches of transparency (this one, for instance) by just saying "that's the way the world works, deal with it". If it's true that every medical researcher in the world is in some way or other financially linked to a couple of large drug companies, that's an entirely proper object of critical comment, and it isn't "conspiracy theory" to say it's not a satisfactory state of affairs.



• The practice of having "sleeper contracts" triggered by the WHO's announcement of a pandemic is clearly a problem waiting to happen, as was the misspecification of those contracts so as to allow the suppliers to use vaccines with patented adjuvants (I didn't know what an "adjuvant" was previously - now I do) which knocked up the price by a factor of two or three. Given the existence of these contracts, much more work should have been done on sharpening up the WHO criteria - the fact that they were still in development (and subject to a major change in May 2009 which had the effect of making pandemics much more likely to be declared) has to be seen as really unsatisfactory.



• In general, I don't like the way in which the WHO global influenze framework has developed hand in hand with the patent life cycle of Tamiflu and Relenza, or the way in which the issues of antivirals and vaccinations got mixed together in all of the public health communication. Nothing beyond a spidey-sense here, but it does seem to me to be a potentially conflict-rich "business as usual" environment.



• Finally, this was a massive great thumping failure of a vaccination campaign and a really bad piece of communication, which is particularly problematic given that the H1N1 virus hasn't gone away and might very well come back for a second tap. Having done quite a lot of my own work trying to forecast H1N1 last year I am well aware that the WHO was working with really poor quality data, but the Flynn report is absolutely correct to say that its communication of the uncertainty surrounding its estimates (and particularly, its failure to be clear about the fact that the virulence of the 2009 outbreak was very much lower than initial estimates suggested) was not good.

Really though, it's just another example of the genre - large bureaucracies are in general much too close to people they're meant to be regulating, in general prone to groupthink and in general much too prone to retreating into their shell when challenged by outsiders in the event of major failures.