The original article was published on the website of the French Newspapaer Le Monde (16 juin 2010) : "Les gens de la grippe: une histoire de famille"
I belong to the community of flu people. A community of specialists, industrialists, public health decision makers and researchers who meet regularly at international conferences and gatherings across the world. It’s rather like coming to a family reunion: we greet each other politely, ask after one another, make dates to spend time together, discuss the latest scientific data and share useful information, anecdotes and confidences. Each one plays his or her part at the plenary sessions, including the excellent speakers, the experienced professionals who command respect in the auditorium, the eccentrics, those bearing the impatiently expected latest results, the brilliant young scientists with a promising future, the schemers and others who, like myself, work in the background. A family of top specialists, bound by a common culture – influenza (virus, diseases, preventive measures, treatment and public health policies) and committed to the same cause, some driven by passion and belief in science and others by career and power. But at the end of the day, however smart, they are all just people with their strengths, weaknesses, bravery, fears, light and dark sides.
The system seemed well-oiled during the years of preparation for the pandemic: the virologists provided information on the evolution of the flu viruses and the threats involved, the epidemiologists conducted studies to gain a better understanding of the different facets of flu, the mathematicians developed models to simulate the impact of a pandemic, the manufacturers developed new vaccines and techniques, and, as knowledge and resources developed, the World Health Organisation (WHO) adjusted its recommendations accordingly.
Then, hey presto, a new virus emerged from Mexico. Although not what was expected, it was nevertheless a true pandemic virus, leaving a trail of potential threats and uncertainty in its wake. Level 6 of the pandemic plan had to be implemented. Manufacturers got busy producing vaccines, national programmes were rolled out, and scientists and epidemiologists closely monitored the evolution of the new virus and ensuing disease to alert the health authorities, as relevant. Everything was working fine; we could congratulate ourselves for the years of thinking and preparation that were proving to be so fruitful.
Absolutely everything? No… because there was a glitch in the system. And that glitch was the outside view, the view of “the others”, those who are not part of the flu community. The pandemic involves them too; so their view blew our common culture to pieces. The working methods and concepts familiar to the flu people were all of a sudden viewed from a different angle. The seemingly obvious uncertainty inherent in a flu virus became subject to misunderstanding, the usefulness of vaccination was questioned, and the terms of collaboration between industrialists and specialists suspect. This outside view destabilised us, made us feel uncomfortable; and we began to think that they had not understood anything at all. At that point, how could we get things into perspective and incorporate their view without letting ourselves be destroyed?
Although I believe it was necessary, in November 2009, to blow the whistle on the underlying obscurantism in refusing vaccination, I feel it is just as necessary now to get the record straight on the grey areas surrounding conflicts of interest. For better or for worse, the pharmaceutical industry has a role to play in health, and it is normal that it collaborates closely with the specialists. Without its investment in Research and Development, the antiviral drug revolution would never have taken place and AIDS would no doubt still be the same disease it was 15 years ago. But these are also powerful multinational firms, driven by profit.
The financial crisis and the ensuing cascade of economic and social crises heated up the general debate on multinational practices. So the question that arises is perfectly legitimate: in managing H1N1 influenza, did the economic aspects weigh in the balance? This issue is all the more delicate insofar as the others do not have access to the complex data required for making public health decisions. The WHO declaration of pandemic was justified and vaccination is necessary since this flu is far from being harmless. Nonetheless, transparency is required. Margaret Chan, Director-General of the WHO, responded to the British Medical Journal survey by acknowledging that the safeguards against conflicts of interest must be strengthened. Furthermore, the specialists need to adopt a clear position. Hiding behind the argument that the expertise is in the hands of just a few specialists is tantamount to telling only part of the flu family story because it preserves the unsaid around the way in which conflicts of interest are managed. And the unspoken words can only damage the specialists’ credibility and the public’s faith in vaccination. So this should not become a family secret.
English translation: Catherine Gabel (Gabel Rejder Associés)
