Director-General responds to assessment of WHO's handling of the influenza pandemic

Dr Margaret Chan
Director-General of the World Health Organization

Remarks at the fourth meeting of the Review Committee of the International Health Regulations
28 March 2011

Opening remarks

Excellencies, distinguished members of the Review Committee, representatives of Member States, colleagues in the UN system, representatives of nongovernmental organizations, ladies and gentlemen,

Let me join your Chair in welcoming you to this fourth meeting of the Review Committee of the International Health Regulations.

I and my staff have carefully reviewed the preview document that will be presented and discussed during this session. We have looked especially closely at the document’s three preliminary conclusions and its 15 preliminary recommendations.

Since the beginning of this process, WHO has expected to receive a frank, critical, and evidence-based assessment of strengths and weaknesses in the response as the 2009 influenza pandemic evolved.

We sought guidance on the performance of the IHR during this first major roll-out of its functions. In particular, we wanted a critical assessment of the performance of WHO in as many areas, and with as much detail as possible.

Above all, we wanted the Committee’s conclusions and recommendations to be actionable. In other words, we wanted guidance on what needs to change, at technical, managerial, policy, and even financial levels, to improve WHO leadership when the next pandemic inevitably occurs.

Based on the preview document and the Committee’s rigorous methodology, I am confident that your final report will meet these expectations.

Let me thank this Committee and its Chairman, Dr Harvey Fineberg, for the diligent, thorough, and objective approach you have taken and for your determination to collect and critically assess a vast amount of evidence and expert opinion.

You have heard testimony from people with widely divergent backgrounds, and also widely divergent views about the appropriateness and effectiveness of the WHO response. You were given unfettered access to the complete set of WHO internal documents.

As we all know, discussions today will be focused on the preview document. The Committee will then prepare its final report, which will be submitted to the World Health Assembly in May.

I look forward to hearing your views.

Response to interventions

Thank you, Chair, for giving me this opportunity to respond. I will stick to some big-picture issues.

The Secretariat has prepared a written response to the Committee’s preliminary findings, and this response has been submitted to the Committee for its consideration.

As I said earlier today, WHO welcomes the preview document, its conclusions, and its recommendations. We will do our utmost to implement them.

But let me be very frank. Some of your recommendations will be far easier to implement than others, as has been mentioned by some Member States

In general, changes in policies, practices, and priorities that fall entirely within the purview of WHO and its governing bodies are comparatively easy to implement, though the amount of time needed for full implementation will vary, as will resource needs.

For example, your recommendation to accelerate implementation of core capacities required by the IHR echoes an explicit request made during the January Executive Board. This is a clear and urgent priority for WHO.

As noted, WHO needs to manage potential conflicts of interest much better. We are already doing so.

The document underscores the importance of flexibility to accommodate unexpected and changing conditions and to adapt rapidly to new circumstances. I could not agree more. Operational management was hemmed in by rigid definitions and plans.

An understanding of severity is part of the risk assessment of any public health emergency. It provides critical guidance to all ministers of health who need to make far-reaching decisions, often with significant financial implications, in an atmosphere of considerable scientific uncertainty.

We will need to manage these, and other issues identified in the report, better in the future.

More difficult to address are weaknesses in the pandemic response that lie outside the direct authority and beyond the direct influence of WHO.

These are weaknesses that arise from larger systemic difficulties. In other words, from the way this world and its international systems work.

Let me give you an example. The document refers to difficulties that impeded WHO’s ability to achieve a timely distribution of donated vaccines.

I was personally, and passionately engaged in efforts to ensure that all developing countries had access to at least some vaccines quickly. That did not happen fast enough. In all sincerity, WHO could not have tried harder, devoted more energy and staff to this task, or acted with a greater sense of urgency.

The hurdles that slowed us down arise from the lack of harmonization of registration for medicines and vaccines, issues of liability that are part of company policies, and the simple fact that no country is willing to give up its sovereign right to authorize the marketing of a medical product. Issues surrounding the cold chain were another source of problems.

In my view, no amount of advance planning is going to change this reality or alter the way the systems work.

Ladies and gentlemen,

For me, personally, as head of this agency, the assessment of the pandemic response needed to address two absolutely critical questions and to give everyone a firm answer.

First, did WHO make the right call? Was this a real pandemic or not?

Second, were WHO decisions, advice, and actions shaped in any way by ties with the pharmaceutical industry?

In other words, did WHO declare a fake pandemic in order to line the pockets of industry?

The document exonerates WHO on both counts.

Had the Committee identified shortcomings in either of these two areas, such findings would have raised grave questions about the Organization’s neutrality, technical credibility, and integrity.

At no point does the report question the decision to declare a pandemic. As noted, evidence from early outbreaks led many experts at WHO and elsewhere to anticipate a potentially more severe pandemic than subsequently occurred.

As also noted, WHO did not rush to declare a pandemic, but did so only when fully satisfied that all criteria for doing so had been met.

As stated, “no critic of WHO has produced any direct evidence of commercial influence on decision-making.” The Committee found “no evidence of attempted or actual influence by commercial interests on advice given to or decisions made by WHO.”

The report suggests that WHO responded with insufficient vigour to criticism that questioned its integrity. It is in this spirit that I am responding, hopefully with sufficient vigour, on these two specific points.

Ladies and gentlemen,

As the document clearly states: “The world is ill-prepared to respond to a severe influenza pandemic or to any similarly global, sustained and threatening public health emergency.”

We are only three months into this year. But 2011 has already witnessed a cascade of global crises and calamities that have placed unprecedented demands on the international community and its resources. These resources were already stretched thin by the new reality of financial austerity.

I am speaking not only about the devastating triple tragedies in Japan, but also about the health and safety of civilians in a host of hot spots in the Middle East and Africa, including Cote d’Ivoire.

In such a context, recommendations to improve the capacity of WHO and the international community to respond to public health emergencies take on added urgency.

This brings me to my final comment. Apart from the value of the findings, recommendations, and conclusions you have been discussing today, I believe the report embodies great wisdom.

I believe it will stand the test of time. I believe it will continue to provide guidance, for different types of emergencies, for WHO and the wider public health community, for many years to come.

Again, let me express my appreciation to members of the Review Committee and your Chair.

I wish you productive deliberative sessions and look forward to reading your final report.

Thank you.