H1N1 offered a reality check: WHO

For the director general of the World Health Organization, the best news of the decade is the fact that the first influenza pandemic of the 21st century is a moderate — some would even call it mild — one.

OTTAWA — For the director general of the World Health Organization, the best news of the decade is the fact that the first influenza pandemic of the 21st century is a moderate — some would even call it mild — one.

Still, that lucky break, disease-wise, has created a communications challenge for those in public health in general and the WHO in particular, Dr. Margaret Chan acknowledged Monday.

For years, the WHO and health officials around the world had worried about and planned for the possibility the dangerous H5N1 avian flu virus might trigger the next pandemic. (Many still worry humankind may have a future date with the so-called bird flu.)

Instead, two swine flu viruses swapped genes, giving rise to a new variant that started spreading among people. It was new enough to cause disease and occasionally death. But it was sufficiently similar to viruses that have spread among people in the past that its impact hasn’t been the crisis many feared.

“The reality check by the new H1N1 virus caused a disconnect or a mismatch between the expectations and the reality,” Chan said from Geneva, noting people’s views of the H1N1 pandemic depend on whether it touched their lives or not.

“The reaction would span from complacency to some kind of suspicion,” she said.

Some critics have castigated the WHO for declaring the pandemic in the first place. Some question the merits of efforts to vaccinate hundreds of millions of people against the virus, given the relatively small number of deaths so far in comparison with other pandemics.

Chan, who on June 11 declared the first pandemic in 41 years, has been at the centre of public health crises before.

In 1997, as Hong Kong’s director of health, she ordered the destruction of the city’s poultry flocks — more than one million birds — in an effort to contain the newly emergent H5N1 virus. She was also in charge during the SARS outbreak of 2003, which ravaged Hong Kong’s hospitals.

With that kind of experience, Chan knows to expect criticism.

“Very few people have foresight, but everybody has hindsight,” she said, noting that is a lesson she learned from SARS.

She also knows the fullness of time can cast a more favourable light on decisions that are initially criticized.

“All the measures I put in place in Hong Kong in 1997 became the gold standard,” she noted. “The aggressive approach by WHO, together with countries, to put SARS back into the . . . box . . . is paying dividends, isn’t it?”

The agency and its scientific advisers — some of the best minds on influenza and immunization issues in the world — have been accused of being in cahoots with the pharmaceutical industry to sell pandemic vaccine and antiviral drugs.

And in wild and wacky reaches of the Internet — fertile ground for those who sow seeds of speculation and conspiracy — there are even accusations that the WHO colluded to create and unleash the new virus on an unsuspecting world.

“I can understand all these suspicions and conspiracy thinking, but I must emphasize there’s no basis for that. Absolutely no basis,” Chan insisted.

Asked if she really does understand how people could conclude the agency she heads had a hand in starting a pandemic, Chan’s tone changed.

“If indeed that conspiracy, if there is any evidence and basis to it, I want to see that (evidence), number 1,” she said.

If there is any solid proof, “I will personally kill the organization,” she said.

“We exist and survive to protect people. If we are the person who created this virus to harm people, we don’t deserve the trust and the respect and the existence.”

Chan, who on June 11 declared the first pandemic in 41 years, has been at the centre of public health crises before.

In 1997, as Hong Kong’s director of health, she ordered the destruction of the city’s poultry flocks — more than one million birds — in an effort to contain the newly emergent H5N1 virus. She was also in charge during the SARS outbreak of 2003, which ravaged Hong Kong’s hospitals.

With that kind of experience, Chan knows to expect criticism.

“Very few people have foresight, but everybody has hindsight,” she said, noting that is a lesson she learned from SARS.

She also knows the fullness of time can cast a more favourable light on decisions that are initially criticized.

“All the measures I put in place in Hong Kong in 1997 became the gold standard,” she noted. “The aggressive approach by WHO, together with countries, to put SARS back into the … box … is paying dividends, isn’t it?”

She even coaches her staff not to get defensive about the criticism levelled at the agency, saying critiquing of a public health response is part of the cycle.

“It is important to listen. If there is any substance or if the criticism is constructive and it can bring us to understand there is some failings and make us do better, we should thank people,” Chan said.

Still, there’s a hint of frustration as she describes the new reality facing officials trying to plan for and respond to a global reality like a pandemic — the unfettered, unchallenged reach of the Internet.

“We have never, in public health, had to experience this diversity of channels of communications,” Chan said.

“And you, the media, representing the public, hold me accountable. You hold ministries of health accountable. … You follow up on what we say.”

“But where is the accountability with individuals who put things on YouTube, on Facebook, on blogs? … Anything goes on the web. And individuals have to see through this avalanche of information — or disinformation — to make their judgment.”

“That is the communications challenge that we are dealing with.”

Despite the criticism, Chan said she doesn’t believe the WHO’s credibility has suffered, either from the declaration of the pandemic or the way the agency has handled it.

“In the mainstream scientific community, my member states, the industry, others are appreciative of what we are doing,” she said.

“But I am mindful of some of the criticism I hear. But everything will come to light when we do the review and the lessons learned (process) later on.”

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