Arthur Reingold, MD, head of the division of epidemiology at the University of California Berkeley School of Public Health and head of the California Emerging Infections Program, said, "WHO would have received identical advice [regarding] the need to stockpile antiviral drugs and speed the development of vaccines from any competent expert in the field without industry ties."
But not all researchers were willing to give WHO a free pass on its handling of H1N1. Henry Miller, MD, a biotechnology expert at Stanford University's Hoover Institution, said WHO made a number of mistakes, and its declaration of a pandemic was one of them.
That said, Miller added, "the stockpiling of anti-flu medicines and the production of vaccine weren't among [WHO's mistakes]."
Cohen and Carter detailed WHO's pandemic influenza preparation starting in 1999, when a preparedness plan was drafted by six researchers in collaboration with the European Scientific Working Group on Influenza (ESWI). Over the next decade, according to their investigation, WHO failed to disclose industry ties among researchers advising the organization.
The document drafted in 1999 did not include information on conflicts of interest. Cohen and Carter pointed out that ESWI is funded entirely by Roche, which makes Tamiflu (oseltamivir) and that two of the authors of the document had participated in Roche-sponsored events in the previous year. Both were also involved in a randomized controlled trial of Tamiflu supported by the company.
In 2002, WHO called together flu experts to craft guidelines for the use of vaccines and antivirals during an influenza pandemic. The panel included representatives of Roche and Aventis Pasteur (now Sanofi-Pasteur), which makes flu vaccine, and three experts who had been named in marketing material for Tamiflu.
The resulting report, which advised stockpiling antivirals, was published in 2004, and the main author, Frederick Hayden, MD, of the University of Virginia in Charlottesville, confirmed that Roche was paying him for lectures and consulting when the report was produced and published.
Several additions to the report did not include information about conflicts of interest, according to Cohen and Carter.
"WHO has failed to provide any details about whether such conflicts were declared by the relevant experts and what, if anything, was done about them," they wrote.
Compounding this lack of transparency is the fact that the 16 members of the emergency committee that has been advising WHO during the H1N1 pandemic have remained anonymous, at least officially. The chair is known to be John MacKenzie of Curtin University in Perth, Australia.
The BMJ investigation turned up another three members, including Arnold Monto, M.D., of the University of Michigan School of Public Health; John Wood, Ph.D., of the National Institute for Biological Standards and Control in the U.K.; and Masato Tashiro, M.D., Ph.D., director of the WHO collaborating center for surveillance and research on influenza in Tokyo.
Wood and Tashiro said they have no conflicts of interest, but Monto has received speaker's fees from GlaxoSmithKline, maker of another antiviral, Relenza (zanamivir).