GENEVA – The head of an expert group brought in to review the World Health Organization‘s response to the swine flu outbreak said Wednesday that some members of the panel would inevitably be biased because of their close links to the global body or national governments.

Harvey Fineberg, president of the Institute of Medicine in Washington, said the 29-member panel will try to deal with this problem by exposing conflicts of interest and — where appropriate — recusing members from specific discussions.

Faced with persistent criticism over its handling of the pandemic, WHO convened the panel Monday with instructions to conduct a “credible and independent review” of how the global body and national authorities responded to the outbreak. Critics say many panelists are trusted WHO advisers and government employees who could end up whitewashing any failures.

“We are actually still in the process of identifying all the possible sources of bias,” Fineberg told reporters in Geneva. “This is a committee that is composed of a lot of individuals who have done a lot of things in public health.”

At least ten panelists flown in by WHO are past or current advisers to the organization. Twenty four members of the panel are government employees.

All were selected by WHO Director-General Margaret Chan from among a roster of 200 experts proposed by the governments they are also meant to scrutinize.

“The WHO generally has a history of policy reviews and commissions reaching predetermined conclusions and this one looks like it fits that pattern,” said Philip Stevens of the London-based think tank International Policy Network.

Public anger is growing in many countries as vast stocks of unused vaccines, bought by governments at WHO’s recommendation, near their expiry date. Stevens said WHO’s repeated requests for money to help poor countries fight the pandemic also were questionable, but doubted they would be criticized.

“They were erroneously invoking the specter of the 1918 pandemic in which 50 million died around the world,” he said.

So far about 18,000 deaths from the A(H1N1) virus have been confirmed globally, out of millions of infections.

One issue that has received a lot of attention is WHO’s alert system for pandemic threat levels, or phases. Critics have complained that WHO was too quick to move to phase six — the highest level indicating a global outbreak.

“If most of these experts were part of the expert group that developed the WHO pandemic alert phase system, then this panel will simply be a whitewashing panel,” said James Chin, a retired professor of epidemiology at the University of California at Berkeley and former WHO official who fell out with the global body over its HIV and AIDS policies.

According to WHO documents, at least seven panelists contributed to the guidelines on pandemic phases.

Fineberg said the panel would examine the need to include severity along with geographical spread in future descriptions of disease outbreaks — something many health experts and governments have criticized WHO for failing to do with swine flu.

Michael Osterholm, a prominent expert on global flu outbreaks with the University of Minnesota, said much of the criticism directed at WHO and governments could be blamed on persistent public misunderstanding of the situation, due in part to poor communication by officials.

Osterholm said he was confident the review panel had the best technical experts for the task and their work would be carefully examined by others in the scientific community.

The experts’ initial findings will be presented to WHO member states in May. A final report will be published next year.

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[참고] 하비 파인버그(Harvey Fineberg)

Harvey Fineberg is President of the Institute of Medicine. He served as Provost of Harvard University from 1997 to 2001, following thirteen years as Dean of the Harvard School of Public Health. He has devoted most of his academic career to the fields of health policy and medical decision making. His past research has focused on the process of policy development and implementation, assessment of medical technology, evaluation and use of vaccines, and dissemination of medical innovations.

Dr. Fineberg helped found and served as president of the Society for Medical Decision Making and also served as consultant to the World Health Organization.

At the Institute of Medicine, he has chaired and served on a number of panels dealing with health policy issues, ranging from AIDS to new medical technology. He also served as a member of the Public Health Council of Massachusetts (1976-1979), as chairman of the Health Care Technology Study Section of the National Center for Health Services Research (1982-1985), and as president of the Association of Schools of Public Health (1995-1996).

Dr. Fineberg is co-author of the books Clinical Decision Analysis, Innovators in Physician Education, and The Epidemic that Never Was, also published under the title The Swine Flu Affair, an analysis of the controversial federal immunization program against swine flu in 1976. He has co-edited several books on such diverse topics as AIDS prevention, vaccine safety, and understanding risk in society. He has also authored numerous articles published in professional journals. In 1988, he received the Joseph W. Mountin Prize from the Centers for Disease Control and the Wade Hampton Frost Prize from the Epidemiology Section of the American Public Health Association. Dr. Fineberg earned an A.B. in 1967 from Harvard College, an M.D. in 1971 from Harvard Medical School, a Master of Public Policy from the Kennedy School of Government in 1972, and a Ph.D. in Government from Harvard’s Graduate School of Arts and Sciences in 1980.

Fineberg served his medical residency at Beth Israel Hospital, Boston, and was a fellow in Harvard’s Society of Fellows. He worked as a practicing physician at two Boston-area health centers from 1974 to 1984. He taught at the Kennedy School of Government from 1973 to 1981, and served on the faculty at the Harvard School of Public Health from 1973 to 1984, when he became the school’s dean.

Dr. Fineberg is married to Mary E. Wilson, a former associate professor at Harvard Medical School and Harvard School of Public Health.