By the mid-twentieth century, cases of disease were mostly (99.9%) non-serious or asymptomatic cases (sub-clinical infections) in developed countries, and these cases were fundamental to producing long-term herd immunity in the population.
Yet the definition of a pandemic was changed in 2005, when the board that established the new International Health Regulations (IHR) stipulated that the WHO Director-General (DG) was to appoint an Emergency Committee (EC) for advice on matters relating to global pandemics of disease. It was stated in the IHR that membership of this committee was not to be made public and therefore conflicts of interest would not be declared or publicized [1]. Further, the composition of the board with respect to stakeholder representation would also be unknown to the public. This anonymous committee was given the power to make decisions about vaccination policies in global pandemics without consultation with the Strategic Advisory Group of Experts (SAGE), the principal advisory group within the WHO for the development of policies related to vaccines and immunization strategy [3].
The SAGE board comprises 15 members who sign a declaration of interests they have with professional activities that might conflict with their advisory function for the WHO. This is done with the purpose of excluding representatives with conflicts from the decision-making process. The establishment of the Emergency Committee did not require any declaration of COI or stakeholder representation in decisions to declare a global pandemic.
In 2009, some experts noted from an early stage that the new sub-type of influenza virus (swine-flu) was causing less harm than other strains of the virus in previous years [1][4]. In this regard the definition of a pandemic is of great significance. Further, some scientists became concerned when WHO raised the pandemic to level 6 when the influenza virus was causing mild symptoms in most cases of the disease. It was noted that the WHO Emergency Committee changed the definition of a pandemic just prior to calling the level 6 pandemic [1]. It would not have been possible to call a pandemic if the definition of the pandemic had not been changed.
Whilst the WHO claims that the definition was finalized in February 2009, as part of the current pandemic preparedness plans, the fact remains that after 10 years of PPP (Pandemic Preparedness Plans), the change in definition made it possible to call a pandemic [5]. There was a lot of time and money invested in planning for a pandemic. The important change to the definition that occurred in May 2009, was the removal of the need to show how severe the impact of the virus would be on the population.
The Arbitrary Changes made to the Definition of a Pandemic in 2009
1. Before 4th May 2009: “An influenza pandemic may occur when a new influenza virus appears against which the human population has no immunity, resulting in epidemics worldwide with enormous numbers of deaths and illness. With the increase in global transport, as well as urbanization and overcrowded conditions, epidemics due to the new influenza virus are likely to quickly take hold around the world” [1].
2. After 4th May 2009: “A disease epidemic occurs when there are more cases of that disease than normal. A pandemic is a worldwide epidemic of a disease. An influenza pandemic may occur when a new influenza virus appears against which the human population has no immunity …. Pandemics can be either mild or severe in the illness and death they cause, and the severity of a pandemic can change over the course of the pandemic.” [1]
Pandemic planning requires that all stakeholders agree on a common definition of what an influenza pandemic represents. The Parliamentary Assembly of the European Council (PA) believes that the changes made to the pandemic definition were highly inappropriate at a time when a major influenza infection was occurring [1]. These changes affected disease descriptions and indicators, and they were made in a non-transparent manner. It also meant that because of the PPP’s that locked governments into prescribed actions when a pandemic was called, authorities were constrained in their actions – even when the evidence did not match the actions they were required to implement [5]. Once the pandemic was declared governments had no choice but to buy up the required vaccines according to quantities and prices set in the PPP’s.