By Clément Paule
Passage au crible n°12
The PACE (Parliamentary Assembly of the Council of Europe) should begin an investigation into the threat of false pandemics end of January 2010. In a motion voted on December 18, 2009, the Health Committee of this institution accuses the pharmaceutical industry and WHO (World Health Organization) experts of potential collusion. In this case, this inquiry should evaluate the management of the H1N1 flu pandemic and more specifically the recommendation for a global immunization campaign. This controversy seems to be reinforced by the last epidemiological reports confirming a strong decline of the virus activities in many countries, especially in the United States and in the main parts of Europe and Asia. Main pharmaceutical laboratories – or big pharma – are under suspicion of having participated in the setting-up of a psychosis allowing them to sell insufficiently-tested products; moreover, these companies seem to benefit massively from the national policies of vaccination. Thus, on January 15, 2010, the firm GSK (GlaxoSmithKline) that had been extensively marketing the vaccine Pandemrix™ announced a 945-million-euro revenue for the last quarter of 2009.
> Historical background
> Theoretical framework
> Analysis
> References
Since its outbreak in spring 2009, the H1N1 virus is suspected to have caused more than 14 000 casualties in 209 States. The transnational struggle against the flu pandemic shifted rapidly towards immunization measures recommended by the SAGE (Strategic Advisory Group of Experts on Immunization). National preventive strategies were nevertheless diverse and heterogeneous. Some states like France, Canada or Switzerland decided to target a high rate of immunized population – more than 75% – whereas a low-profile policy was chosen by Germany or the United States. Only 5% of the Chinese population – around 65 million people – had been vaccinated at the beginning of 2010. At that stage, vaccination campaigns were beginning in Vietnam and Saudi Arabia. But Poland took a unique stance by refusing from November 2009 onwards the purchase pharmaceutical products which it estimated unreliable. The fact that many states could not access immediately the vaccine market should be noted. In fact, extensive orderings by Northern countries – more than 1 billion vaccines in September 2009 – had been prioritized.
Then, the immunization scheme started changing during November 2009 with the reduction to one shot instead of the two initially planned. This dramatically disrupted national policies and created surplus. The situation worsened with the populations’ reluctance regarding the vaccine that was injected to date to only 8% of the French – 5 million – almost half a million of Moroccans and less than 4 millions of British. 62 million Americans followed the recommendations of WHO, in spite of the 1976 precedent during which the suspicion of an outbreak of flu epidemic caused a large-scale vaccination campaign.
1. The precautionary principle. Included in the Rio Declaration on Environment and Development in June 1992, this norm aims to meet the uncertainty provoked by health or environment risks. It was written down in the French Constitution in 2005 after the infected blood scandal and the mad-cow disease crisis, and was invoked to justify massive preventive campaigns against the H1N1 virus.
2. Socio-technical controversies. Proposed by Michel Callon, Pierre Lascoumes and Yannick Barthe, this concept tries to reconstruct the struggles concerning the definition of hardly-governable situations. The pandemic management take place in a context of uncertainty in which a scientific authority discourse is challenged by other expertise.
The WHO leadership in the struggle against the H1N1 virus showed the normative power of this international institution and its ability to define the contents of local preventive policies. However, the legitimacy of this health organization was weakened when its Director-General recognized on January 18, 2010 an excess of prudence towards the pandemic which she justified by public health imperatives. This resort to the precautionary principle opened a policy window – according to the concept of John Kingdon – for many dissenting actors claiming alternate or even profane expertise. It should be noted that from the beginning some physicians have taken a skeptical stance towards vaccination campaign in spite of the advices of the SAGE. For instance, one of them evoked in July 2009 the financial and industrial interests likely to overestimate the threat of flu viruses. But WHO have also been the target of conspiracy theories which blamed the institution for having purely and simply created the pandemics. Austrian journalist Jane Burgermeister notably pressed charges against the health organization and the laboratory Baxter in June 2009, accusing them of bioterrorism and attempt of genocide.
Up to then without any media coverage, these denunciations were reinforced by the failures of immunization campaigns often depicted as disproportionate – 13 millions of doses ordered by the Swiss government for 7.7 million citizens – considering an actually moderate pandemic. Thus, the fifteen experts of SAGE soon were at the center of collusion suspicions with the pharmaceutical industry well-known for its lobbying capacities. WHO officials were forced to several public justifications under the pressure of member-States: such as India or Vietnam. The health organization tried furthermore to provide guarantees of transparency and in the same time – in spite of the confidentiality of the debates – to detail safeguards which are supposed to avoid conflicts of interest involving SAGE experts. It seems nevertheless that those scientists have partly lost their legitimacy as they have been getting out of the monopoly of the authority discourse they had been maintaining on their specialty. The latter configuration of knowledge – conceived in its absolute form as a real ideology by Jürgen Habermas – appears disputed by that kind of overt accusations and by a sort of passive resistance expressed by the low rates of people willing to be immunized despite the SAGE recommendations.
The proliferation and growing audience of alternative discourses in the form of multiple and rival expertise are going together with the weakening of the vertical system of decision and information. Such a process reminds other examples of socio-technical controversies, like the infamous infected blood scandal or the mad-cow crisis, which involved both scientific uncertainty and divergent actors’ strategies. However, a specificity of the present case relies in a particular side effect of the precautionary principle. It can be observed in the way governments stood up for their management of pandemic risk. The French Health Minister answered thus to her detractors by the invocation of the precautionary principle. According to François Ewald, this norm would lead to overestimate risk but it seems to be a necessary justification for decision-makers, especially in a context of uncertainty. Indeed, the political costs of a potential catastrophe would make stakeholders systematically picturing the worst. Therefore public policies would be more and more depending of a blurred responsibility shared by both governments and their specialized advisers, this pattern carrying the risk of a global delegitimization. The failure of an official expertise suffering from lack of transparency would then add to health risks the social threat of an easily exploitable market of anxiety.
Abécassis Philippe, Coutinet Nathalie, « Caractéristiques du marché des médicaments et stratégies des firmes pharmaceutiques », Horizons stratégiques, (7), 2008, pp. 111-139.
Hamdouch Abdelilah, Depret Marc-Hubert, La Nouvelle économie industrielle de la pharmacie : structures industrielles, dynamique d’innovation et stratégies commerciales, Paris, Elsevier, 2001.
Juès Jean-Paul, L’Industrie pharmaceutique, Paris, PUF, 1998. Coll. Que sais-je ?
Pignarre Philippe, Le Grand secret de l’industrie pharmaceutique, Paris, La Découverte, 2003.
PwC (PricewaterhouseCoopers), Pharma 2020 : the Vision – Which Path will you Take ?, 2007, consulté le 14/01/2010 sur le site de PwC : http://www.pwc.com/gx/en/pharma-life-sciences/pharma-2020/pharma-2020-vision-path.jhtml
