Critique of the WHO pandemic response is now out

We blogged early and often about the H1N1 pandemic, including posts about the controversy surrounding the WHO response and whether there was any industry influence at play. An independent expert panel has now released a draft report on the 2009 H1N1 response. Here are the media summaries from the NY Times, Science Magazine, and the Nature blog The Great Beyond.

Regarding the industry conflict-of-interest (COI) issue, the report takes WHO to task for poor handling of COI and lack of transparency, but concludes that there is "no evidence of attempted or actual influence by commercial interests on advice given to or decisions made by WHO." I’m not sure what such evidence would be required…direct cash payments to members of the WHO advisory committee? Anyway, given that the panel felt that WHO waited too long to call the pandemic, it is unlikely they’d conclude that this decision was driven by industry COI.

Read the report yourself—now that Iowa has thawed out and the sun has appeared, I have no time to detail all 15 of the recommendations the panel made.

WHO update: no antibiotics and new H5N1 death

There is an article in the February 2011 Bulletin of the World Health Organization that outlines the reasons behind the shrinking antibiotic pipeline even in the setting of emerging antimicrobial resistant pathogens.  The range of reasons offered goes from the biological (the low hanging fruit has been picked) to the economic (why invest in meds that will only be taken for 7 days).  The article does offer hope in both cases by describing recent discoveries and offering potential incentive arrangements that could encourage antibiotic development and proper use.

Bulletin of the WHO (February 2011)  html or pdf

Note: World Health Day on April 7th is devoted to raising awareness around the issue of antimicrobial resistance. Although, when you read the description of World Health Day, it only talks about HIV, TB and malaria.  I wonder what it will take for the ID folk to mention a bacteria?

Finally, the WHO has announced a confirmed H5N1 related death in a 5-year old Cambodian girl. This is the first reported mortality due to avain flu since early 2010. The girl had been exposed to sick poultry during the 7-days prior to disease onset. The influenza clock keeps ticking.

WHO backs rapid test for TB - If only we had rapid treatment

I heard on NPR this morning that the WHO (Keith Moon died 32 years ago) is supporting the new rapid TB test made by Cepheid (MTB/RIF test).  You can read more about the test characteristics in the recent NEJM article. They reported 98% sensitivity in smear-positive patients but only 73% sensitivity in smear-negative patients after a single test.  Sensitivity rises to 85% after a second test and to 90% after a third test.  The test was very good at identifying rifampin-resistant and rifampin-sensitive strains (both around 98% of the time).

The NPR article states that the processor costs $64,000 in US but could be $17,000 for developing countries.  Tests will cost $17.  If you need to do three tests in smear-negative patients to rule out TB with a sensitivity of 90%, it would cost $51. I wonder if developing country budgets can absorb that cost?