HONG KONG - A year after the first cases of the A/H1N1 influenza surfaced in Mexico and the U.S., the World Health Organization is facing accusations that it overreacted to the threat and pushed too hard for a rapidly available vaccine.

More than anything else, WHO Director-General Margaret Chan wanted to avoid a muted response or even appearing to do too little, said the man who coordinated the health organization's public relations efforts.

Speaking at Hong Kong's Foreign Correspondents' Club this week, Thomas Abraham, now director of the Public Health Media Project at the University of Hong Kong, explained how "a particular set of circumstances elevated this pandemic influenza into a massive global threat."

"Within the WHO there is a lot of skepticism that we went too far," he said.

Perhaps more than anyone else, Chan herself knew how important it was to be seen as reacting with the right measures and at the right tempo. Chan was in charge of Hong Kong's response during the outbreak of Severe Acute Respiratory Syndrome, which rapidly spread across the globe in 2003.

She had been the subject of severe criticism for not taking more rapid and decisive action then.

"SARS demonstrated what a significantly lethal virus could do in a globalized world," said Abraham.

He said public health professionals generally believe that Hong Kong's response to the 2003 outbreak was well handled, but the public perception is very different.

"Diseases are about public health and medicines, but they are also about politics. Perhaps, above all, they are about politics," said Abraham. "The way a disease is perceived in society is as important as the reality of the disease."

When it came to the spread of swine flu, he said, no one country wanted to be the one with enough cases to push up the situation into a Level 6 pandemic, simply due to politics. This, said Abraham, led to skewed reporting of cases around the globe and a difficult situation for the WHO, which moved to declare a full pandemic based on global numbers rather than on numbers from a single country.

But then, after much hoopla, an unprecedented push to develop vaccines and a massive education effort, "a pussycat came out, not a tiger."

It was the pharmaceutical companies that developed and shipped out vaccines and antiviral medicines that benefited most, Abraham said.

However, he dismissed charges that both the disease and the response had been an orchestrated effort. Over the past few weeks media around the world have reported on accusations - not backed by evidence - that big pharmaceutical outfits were somehow behind the spreading fear of the virus.

"I don't think this is a credible charge," he said, while noting that there are too many checks and balances in place within the WHO to prevent such a situation.

In the end, he said, a lot of effort went into producing a vaccine that some sections of the populace did not want (Also see "Nearly Half Of Hong Kong Healthcare Workers Would Refuse Swine Flu Vaccine" - Scrip, 27 August, 2009.). Yet he was quick to dispel fears that vaccines could have serious harmful effects on those who take them.

Health authorities around the world have been giving out jabs for months and "had the vaccine not worked we would have heard about it by now," he said.

He noted that government leaders have not done a particularly good job of communicating the reality of the vaccines and that reports of serious side effects have not been backed by credible scientific evidence.

"If something had gone seriously wrong, we would have known about it."

He said Hong Kong did a good job in containing the pandemic early on but is failing in terms of the vaccination campaign. If the virus gets worse in the months ahead, "it is going to have serious consequences."

Ultimately, there may yet be bigger challenges. The next one may appear during the Chinese New Year holiday this month, when hundreds of millions of people will clog the country's transportation arteries and come into close contact as they travel across the country to visit family and friends.

- Alfred Romann (pharmasia@elsevier.com)

Did The World Health Organization Overreact To The Threat Of A/H1N1?

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