Pandemic controversies: The global response to pandemic influenza must change

'Evil' scientists, deadly viruses and terrorist plots are usually the preserve of Hollywood blockbusters. But when it comes to pandemic influenza, it is the stuff of real life. As controversy about research into the H5N1 bird flu virus continues, a new paper argues for a complete overhaul of current approaches to pandemic preparedness.

To Pandemic or Not? Reconfiguring Global Responses to Influenza, by Dr Paul Forster, of the ESRC STEPS Centre, investigates the H1N1 swine flu pandemic of 2009-10 and sets out some vital lessons if we are to prepare for pandemic influenza effectively, while avoiding confusing and costly mistakes.

When the H1N1 outbreak in 2009-10 was milder than the World Health Organization had predicted, WHO was accused of colluding with the pharmaceutical industry and national governments of squandering billions. The Council of Europe said US$18 billion was wasted, and branded WHO's actions one of the greatest medical scandals of the century. The event revealed weaknesses in the world's current configuration of planning for and responding to pandemic influenza, according to Dr Forster.

Science, public health policy makers and the worldwide public were confounded by the uncertainty, complexity and politics of pandemic influenza and the high emotions it inspires. Amid this confusion, the global and national institutions responsible for protecting public health were shown to be over-reliant on a reductive, science-led approach that prioritised a one-size-fits-all response, and failed to address the needs and priorities of the world's poorest and most vulnerable people. Dr Forster suggests new ways to construct plural responses more suited to tackling the globalised mix of politics, people and pathogens that pandemics produce.

Preparing for an influenza pandemic means preparing for surprises and being ready to respond rapidly and flexibly under conditions of uncertainty. If people across the globe are to be ready, plural and diverse response pathways are required, said Dr Forster, an independent development consultant and STEPS Centre researcher. The world would be better protected by a re-ordering of pandemic preparedness and response efforts around the needs of the world's poorest, most vulnerable, and most exposed people, he added.

A re-ordered response would allow the undue pre-eminence of pharmaceuticals to be examined, and bring focus on the pressing need for disease surveillance in animals, scrutiny of contemporary agricultural practices and a broadening of research efforts. It might also refresh the World Health Organization's approach, which Dr Forster believes supports an inflexible and narrow set of interests by default, rather than conspiracy.

With most flu experts agreeing that it is not so much a question of if, but rather when, a new pandemic will arrive, the sooner the lessons of outbreaks such as that in 2009-10 can be learned, the better.