The World Health Organization admits there were some shortcomings in its handling of the H1N1 swine flu pandemic, including a failure to communicate how little the agency itself understood about the new virus as it swept the globe.
Keiji Fukuda, the WHO's top influenza expert, admitted Monday that agency's six-phase system for declaring a pandemic -- which assesses geographic spread of a flu virus, not its severity -- led to confusion about H1N1.
"Confusion about phases and level of severity remains a very vexing issue," Fukuda said.
He added: "The reality is there is a huge amount of uncertainty (in a pandemic). I think we did not convey the uncertainty. That was interpreted by many as a non-transparent process."
He added it was difficult to meet intense demands for news and advice as the virus spread and world influenza experts worked to understand what they were dealing with.
"Populations around the world have very high expectations for immediate information," Fukuda said. "In many ways, it is unforgiving out there."
Fukuda made the remarks as he addressed a three-day meeting of 29 external flu experts called to review WHO's handling of the first influenza pandemic in 40 years.
The committee, which is expected to complete its work over the course of the next 13 months, is being asked to identify what went right and what went wrong in its response to the pandemic, so public health officials -- at the WHO and elsewhere -- can apply the lessons to future pandemic planning.
WHO Director-General Margaret Chan said her agency welcomed a frank, critical review of its handling of its performance.
"We want to know what worked well. We want to know what went wrong and, ideally, why. We want to know what can be done better and, ideally, how," Chan told the session.
The WHO declared a pandemic in June. The agency has yet to declare the pandemic over.
Fukuda acknowledged that H5N1 (bird flu), which does not spread anywhere as easily as H1N1 among humans but which has a much higher death rate, really worried many flu experts. He said that "really sent up expectations not only among planners but also among populations. It really set the emotional tone."
Infectious disease expert Dr. Neil Rau believes the WHO became hamstrung by its own pandemic planning.
"They had focused so much on bird flu, on worst-case scenarios, that once the idea of a pandemic being declared was raised, there were no so many things written in that playbook, that they couldn't stop themselves," Rau told CTV News Channel Monday.
"It was almost a spaceship had been launched: we just couldn't pull this back into orbit."
Still, Fukuda told the Canadian Press last week that his agency does not regret declaring the pandemic, noting that H1N1's spread met the agency's definition.
"We have always been very clear that based on the virologic information, based on the immunologic information, the epidemiologic information, the differences in clinical patterns that we see from seasonal influenza, we have never had a moment's doubt of whether this is a pandemic or not," he said.
Critics have said the WHO unnecessarily created panic about H1N1, which caused overwhelmingly mild illness and not the huge numbers of deaths seen in previous flu pandemics.
Some have even questioned whether the United Nations agency had links to the pharmaceutical industry, since the panic led vaccine makers such as GlaxoSmithKline and Sanofi-Aventis to reap big profits from producing vaccine against the virus.
The World Health Organization has denied the allegations and says it will review its response with the help of its expert review committee.
One of the experts sitting on the panel, called the International Health Regulations Review Committee will be Dr. Arlene King, Ontario's chief medical officer of health. King worked for many years as Canada's point person for pandemic planning at the Public Health Agency of Canada.
WHO Director-General Margaret Chan will provide an interim report to the World Health Assembly -- the WHO's annual meeting -- in May 2010, with a second final report expected in May 2011.
Since H1N1 emerged almost exactly a year ago, more than 17,770 people in 213 countries have died, according to the WHO, though estimates of the entire death toll are still being tallied.
Most of those who died were young, with an average age of 37. That compares to 75, the average age of death for those infected with seasonal flu.
