WHO reveals H1N1 committee's links with big pharma

11 August 2010
Elizabeth Sukkar

The World Health Organization has revealed the names of the 16 experts/advisors on its emergency committee, which recommended the declaration of the H1N1 pandemic in June 2009, showing that five of them have or have had ties with the pharmaceutical industry.

Their identities were revealed after the committee was dissolved following the announcement of the end of the H1N1 influenza pandemic by the WHO on 10 August, which had always been the organization's plan.

However, there had been earlier calls, including from the British Medical Journal, to release the names of committee members and their conflicts of interest, in the interest of transparency and to monitor any possible commercial influence (scripintelligence.com, 9 June 2010). The pandemic has proved profit-making for the industry, with one estimate (by JP Morgan) putting 2009 vaccine profits alone at $7-10 billion.

The declaration of interests by the committee members ranged from some of them receiving paid consultancies from vaccine makers (including GlaxoSmithKline, Novartis, Roche and Baxter); their place of employment receiving pharmaceutical funding for certain projects; or their organisations performing contract research (see table below for full details).

BMJ deputy editor Tony Delamothe, speaking on behalf of the journal, told Scrip that while it welcomed the publication of the emergency committee's membership and conflicts of interest, it remained unconvinced of the reasons why this had to wait  until the end of the pandemic.

"It would be useful to know the definition of conflicts of interest used by WHO in its selection process and what level of  conflicts of interest disqualified a potential committee member from selection. We'd welcome the same degree of  transparency for all WHO committees. This would go a long way to dispel the unhelpful atmosphere of suspicion that  sometimes clouds the organisation's decisions," he said.

One NGO also feels that the WHO needs to do more. James Love, director of Knowledge Ecology International, a  Washington, DC-based advocacy group promoting access to medicines, told Scrip: "Under Dr Margaret Chan [the WHO  director general], more than other leaders, the WHO has seen itself as a partner of giant pharmaceutical companies. This  attitude has led to problems, where the narrow interests of the firms conflict with WHO responsibilities to protect the public."

In a statement on its website, the WHO said: "The interests summarised ... do not give rise to a conflict of interest such that  the experts concerned should be partially or totally excluded from participation in the emergency committee. However,  following the WHO's policy, they were disclosed within the committee so that other members were aware of them."

Gregory Hartl, a spokesperson for the WHO, told Scrip that none of the members with "interests" was excluded from any of  the committee's meetings and that none of the other committee members had an issue with the declaration of interests.

He said the WHO has good conflict of interest policies and processes in place. "We feel ours is robust. It is not going to be  perfect...as it reflects the declarations of people. It is an honour-based system."
He reiterated the argument that all bodies, including the industry, want to use the best experts. "If you are the best footballer,  everyone wants that footballer ... The influenza community is quite small and we can understand the experience [these  experts] have accumulated before working with us. Also, [the experts] have more to lose without declaring their interests. The  quality of [members in] the emergency committee was very high. You want those types of people advising on monumental decisions [such as H1N1 pandemic]."

An insider's view from the committee Professor Neil Ferguson, director of the MRC centre for outbreak analysis and modelling in the department of infectious disease epidemiology at Imperial College London, acted as an advisor to the emergency committee, and he too declared an interest (see table) as he had previously acted as a consultant to Roche and  GSK.

He told Scrip that he had no current commercial interests at the time of his work with the emergency committee, and was not  influenced in any way by his past interests.

"I actually stopped doing consultancy work for pharma companies two years before the pandemic. My relationship with  Roche and GSK was limited to sitting on a scientific advisory board for each... and speaking at a Roche-sponsored scientific  symposium at a conference. All these activities related to research I published in 2005 and 2006 (before my relationship with Roche and GSK) on the likely impact of antiviral and vaccine use during a pandemic."

He said Roche and GSK were interested in the relevance of that work to their activities on pandemic preparedness and asked him to present his work to their scientists.

"I chose to end the relationship with GSK and Roche in 2007 due to the mounting pressures of other (more important) work, and because I wanted to pursue advisory work with public bodies which is more easily done without current relationships  with commercial companies."

He too agrees with Mr Hartl with the problem of finding truly independent advisors.

"Almost by definition, I think it would be difficult to find a true expert on influenza vaccines and antiviral drugs who has not worked at some time with pharma companies. The development of such products is undertaken by commercial companies,  they have the data, and they are interested in research which relates to their products. I think science generally benefits from  links between academic and commercial research, as does the quality of scientific advice offered to public health agencies."

He stressed that the most important issue is transparent disclosure of such links. "And of course, where a scientist has a current financial relationship with a company making a particular product, it is probably inappropriate for that scientist to  participate in policy-related discussions relating to that product."

An important issue is whether the emergency committee actually discussed drugs and vaccines. Professor Ferguson said at  no point did the committee offer advice to the WHO on the use of antiviral drugs or vaccines, never mind specific products.

"We advised on the epidemiological and clinical characteristics of the pandemic and on the stage the pandemic had  reached. So I don't think past or current commercial interests were relevant. However ... had we needed to discuss individual  products, it would have been appropriate for individuals with current financial interests in the companies making those  products to have excluded themselves from those discussions."

Scrip also contacted Professor Arnold Monto for his comments, but he was unavailable. Professor Monto was highlighted in  the BMJ's "flu conspiracies" investigation in June, which found that he prepared the annexe dealing with vaccine usage in  pandemics in the WHO 2004 pandemic guideline, but that his financial links to companies, including Roche and GSK, had  not been declared.

The UK's Health Protection Agency spoke on behalf of two other committee members - Professor Maria Zambon, director of  the Centre for Infections, and Dr John Wood, principal scientist at the agency's National Institute for Biological Standards and  Control - who had made a declaration of interest. The HPA told Scrip that the scientists did not "receive any personal  financial gain from HPA work with pharmaceutical companies".

The HPA also defended its work with commercial bodies: "The HPA is an independent, statutory, not for profit body. As is the  case in similar institutions worldwide, and with government approval, the HPA periodically engages in research projects  funded wholly or in part by commercial companies. This approach is entirely consistent with the recommendations in the  Cooksey report that the public sector should maximise the returns on its intellectual property."(David Cooksey had been  appointed by the UK Labour government to review publicly funded research, publishing his report in 2006.)

Dr Chan has already promised to look at the WHO's performance during the H1N1 pandemic when she set up a review  committee earlier this year. The review committee has had two meetings so far, in April and at the end of June/beginning of  July, and is next due to meet at the end of September. It will make its final report to the World Health Assembly in May 2011.

WHO emergency committee members who declared interests Member of Emergency Committee

Declaration of Interest

Dr Nancy Cox
Her public health and surveillance research unit at the US Centers for Disease Control & Prevention (CDC) receives financial  support from the IFPMA for activities of CDC as a WHO Collaborating Centre in the field of influenza vaccine  research and virus isolation work.

Professor Arnold Monto
He has declared current and past consultancies in the field of pandemic and/or seasonal influenza for GSK, Novartis, Roche,  Baxter and Sanofi. The remuneration for each of these consultancies is below $10,000. In addition, his research unit  at the University of Michigan has received a grant from Sanofi Pasteur for a clinical trial conducted in 2007-2008 on the  comparative efficacy of inactivated and live attenuated influenza vaccines.

Dr Claude Thibeault
Since 2004, he has been the consultant medical advisor to International Air Transport Association.

Dr John Wood
His research unit at the National Institute for Biological Standards and Control (NIBSC), a centre of the UK Health Protection  Agency, has performed contract research for Sanofi Pasteur, CSL, IFPMA, Novartis and PowderMed in the field of influenza  vaccine research and development.

Professor Maria Zambon
The UK Health Protection Agency's Centre for Infection receives funding from vaccine manufacturers, including Sanofi,   Novartis, CSL, Baxter and GSK, for contract work in her laboratory.

Professor Neil Morris Ferguson (advisor)
He has acted as a consultant for Roche and GSK Biologicals (ceasing in 2007), with total remuneration from all such work  being under $7,000 in 2007.

Source: WHO