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Preventing iatrogenic pandemics of panic/ BMJ

Posted Jun 13 2010 1:46am
June 9 BMJ article by Luc Bonneux and Wim Van Damme
The decisions to stockpile antivirals and influenza vaccines to control avian flu (2005-6) and swine flu (2009) cost large amounts of money. 1 2 Both epidemic threats were mostly iatrogenic pandemics of panic, which caused little human suffering, but the global plans to control them were largely a waste of money. 1 Was this the consequence of rational risk management in conditions of uncertainty, of fear accompanying any epidemic threat, 3 or of close working relationships between disease experts and the drugs industry?
Severe acute respiratory syndrome (SARS) in 2003 was an epidemic by an unknown and therefore scary new virus, but we know much more about influenza viruses. 2 4 5 The new A/H1N1 swine flu was a far cry from the lethal A/H1N1 pandemic of 1918. There has never been evidence that the recent A/H1N1 virus was anything but mild, 6 and it was not reasonable to consider it the first wave of a much more serious second wave. The theory that the 1918 influenza pandemic was caused by a second wave of a mutated virus that had caused a benign epidemic in a first wave has never been supported by any evidence. 4 The nature of the organisms that caused mild respiratory disease in the spring of 1918 is unknown, but many better candidates than a "Spanish influenza virus light" exist. Both recent iatrogenic pandemics of panic were caused, or at least exaggerated, by disease expert committees.
The core of health economics and health policy is that resources are scarce. If resources were infinite, all possible measures could be taken to fight disease, including prevention of all hypothetical possibilities. Because resources are limited, wise allocation saves lives...
The World Health Organization failed to give appropriate guidance in both pandemics of panic. To prevent this from recurring, WHO should "do it the NICE way." Disease experts are necessarily and fatally biased. It is not reasonable that they bear the entire responsibility for decisions related to their disease. This has been convincingly shown over the past years with the two iatrogenic pandemics of influenza panic. Advice of disease experts, of course, is valuable and indeed crucial, but this advice should be tested against the available evidence, balanced by other stakeholder views, and checked by the transparent evaluation of costs and values. At last, the final evidence based policy advice should be drafted by independent scientists trained in evaluation and priority setting.
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