[Ip-health] Scrip: WHO reveals H1N1 committee's links with big pharma

Thiru Balasubramaniam thiru at keionline.org
Tue Aug 31 02:15:00 PDT 2010


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

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Thiru Balasubramaniam
Geneva Representative
Knowledge Ecology International (KEI)
thiru at keionline.org


Tel: +41 22 791 6727
Mobile: +41 76 508 0997








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