A LEADING virologist who helped develop New Zealand's influenza pandemic response has been accused of not properly disclosing his ties to drug companies.
Dr Lance Jennings has been promoted as an independent expert on influenza but has received payments, airfares and accommodation from drug companies including Roche, which manufactures Tamiflu, and GlaxoSmithKline (GSK), which makes Relenza, another anti-viral drug.
The criticism comes after similar concerns were raised by a British Medical Journal investigation, which found World Health Organisation advisers who wrote 2004 guidelines recommending stockpiling drugs in a pandemic had received payments from Roche and GSK for lecturing and consultancy work.
That advice led to governments around the world stockpiling billions of dollars' worth of anti-viral drugs – most now sitting in warehouses. New Zealand stockpiled 1.2 million Tamiflu doses from 2005, of which only 20,000 courses have been used.
WHO denies commercial interests played any part in its advice and says it has guidelines to deal with conflicts of interest. But it has been criticised for removing a requirement that there be a high mortality rate from its definition of a pandemic before declaring last year's worldwide one for swine flu.
Jennings, the Ministry of Health's leading influenza spokesman, and who has pushed vaccines as the best influenza protection, has links to numerous pharmaceutical companies. He says public-private relationships in the medical field are standard.
Given the limited expertise available, it is the only way new vaccines can be developed quickly, he says.
The Canterbury District Health Board clinical virologist is a member of two ministry advisory committees and was instrumental in establishing the National Influenza Immunisation Strategy Group. He is also a WHO adviser.
His drug company interests include chairing GSK's pandemic vaccines advisory board, membership of US company Quidel Corporation's infectious diseases advisory board, and he is also an adviser to Kimberly-Clark New Zealand, which produces Kleenex tissues.
In a media release in May promoting the Kleenex SneezeSafe schools programme, Jennings was described as a "leading virologist" but his links to Kimberly-Clark were not disclosed.
Jennings said in the release "we know from years of data captured by Kleenex tissues in New Zealand that the nation's standards of cold and flu hygiene are disappointingly low".
He has confirmed that Kimberly-Clark paid for flights and accommodation in Auckland for the promotion. He said he declared his conflicts of interests wherever appropriate, and sent the Sunday Star-Times a 2008 article he wrote for The Lancet medical journal, in which he disclosed he had received honoraria payments and travel assistance from GSK, Roche, Sanofi Pasteur (one of the suppliers of flu vaccine to New Zealand), Solvay, Baxter and Quidel. But in a New Zealand Medical Journal article last year on New Zealand's swine flu response, which included a link to the SneezeSafe website, Jennings listed "competing interests" as none.
Former clinical biochemistry lecturer Ron Law, now a health issues risk and policy adviser, said Jennings needed to be more open about his involvement with drug companies. "The problem for the whole pandemic saga was transparency. When we get these public health messages from so-called experts, who is it that is actually pulling the strings?
"When you've got billions of dollars' worth of commerce being promoted by officials who are advised by the advisers of the drug companies, you've got major conflicts of interest."
Law said Jennings was what was known in the industry as a "key opinion leader". "These people don't get there by chance; they are put there by the pharmaceutical companies."
Jennings confirmed he did work for the companies, and received travel and accommodation expenses, as well as payments for time spent preparing presentations. "It's usually about $1000-$1500. If you look at a lawyer or whatever receiving $300 or $400 an hour, that's peanuts really."
He said it was important conflicts were disclosed. "You've picked up aberrations where I should have declared something and didn't. By and large you can access information on me on the internet, it's pretty transparent."
Jennings said conflicts were bound to happen. "When you're a small country and you've got people wearing multiple hats – you've seen it with John Key our prime minister – what's important is to have that information in the public domain so the chairs of the particular committees can make decisions as to whether advice that is given by an individual... is biased or not."
Janice Wilson, a Ministry of Health deputy director-general, said the ministry would expect that experts would require travel to international conferences to maintain their expertise, networks and knowledge.
"There has been an understanding that Dr Jennings has received some assistance to attend international meetings, as is frequently the case with other experts operating at a similar level," she said.
Wilson said there were a limited number of people with Jennings' experience and expertise. New Zealand was too small to avoid all potential conflicts of interest. "One of the ways the Ministry of Health manages risks... is to ensure advice is thoroughly debated and peer-reviewed by several different people," she said.
Christchurch School of Medicine general practice professor Les Toop said drug companies had undue influence over governments and medical professionals and declaring conflicts of interest was important, although there were almost always conflicts in any field.
He questioned the efficacy of drugs such as Tamiflu. "If there is a scandal to this, it probably does rest somewhere in Europe in the WHO. Much is yet to be written, I'm sure, about what exactly happened when the definition of a pandemic was changed."
The Council of Europe has criticised the organisation's handling of the pandemic, saying it led to a waste of large sums of public money and unjustified scares about the health risks. Its report identified "grave shortcomings" in the transparency of decision-making around the outbreak, and concerns about pharmaceutical industry influence.
- Sunday Star Times