PHA-Exchange> Science at WHO and UNICEF: The corrosion of trust

[Claudio Schuftan]

From: Vern Weitzel vern.weitzel at gmail.com

Lancet, Volume 370, Number 9592, 22 September 2007. The Lancet 2007;
370:1007. DOI:10.1016/S0140-6736(07)61451-2
Editorial

This week, The Lancet publishes two papers of critical interest to
child survival. Unfortunately, both have stirred concerns about
misuse of data by UN agencies. Here, we review the allegations and
try to draw lessons about the place of independent scientific inquiry
in the arena of global health policymaking.

Greg Fegan and colleagues report the success of an expanded
insecticide-treated bednet programme in Kenya. The full paper reveals
the strengths and limitations of the study, and provides important
estimates of uncertainty. No such statistical caution was expressed
in the WHO statement about these data, released on Aug 16. Indeed,
WHO claimed that this finding "ends the debate about how to deliver
long-lasting insecticidal nets". Yet communications between the
Kenyan research team and WHO suggest an ill-considered rush by WHO
against the advice of wiser scientific minds.

In early August, the Kenyan team and WHO exchanged views about the
results of this trial "on a confidential basis". The investigators
expected Ministry officials to disseminate their findings. But the
scientific team planned to remain silent until their data had
acquired the "legitimacy" of publication. They had WHO's agreement to
do the same. But WHO broke its promise. The agency released a
confident press statement without even having the courtesy to inform
the Kenyan scientists of their plans.

WHO officials have implied that waiting for peer-reviewed publication
of programmatic data is "obstructive". The conventions of scientific
communication get in the way of an important news story. To be sure,
the case for mass distribution of insecticide-treated bednets is
strengthening. Those who defend the selling of nets or their social
marketing have a weakening evidence base to draw on. But when the
data and their interpretation are more complex than a press release
can convey, the sensible approach is to wait. The agency statement
can then be read alongside fully reported research findings. WHO's
precipitate move to comment without reference to the full facts was
reckless.

In a separate collaboration between the new Institute for Health
Metrics and Evaluation, WHO, and Universities at Harvard and
Queensland, Chris Murray and colleagues report disappointing progress
in efforts to reduce child mortality. Although work to accelerate
child survival has been scaled up in recent years, it is too soon to
be sure of its success. Prior to receiving the paper by Murray and
colleagues, The Lancet had received signals from UNICEF that
competition in global monitoring of child survival risked damaging
valuable interagency collaboration. We consulted widely but the
private independent advice we received was overwhelmingly to publish.

Why? Because the work was seen as a useful additional accountability
tool not only for countries, but also for UN agencies. We sent
Murray's paper to UNICEF for its comments. We shared with them the
publication date.

In December each year UNICEF publishes its State of the World's
Children report. That publication regularly carries with it an
estimate of global child mortality. But on Sept 10—6 days after we
informed UNICEF of the publication date of the paper by Murray and
colleagues—and in a break with its usual practice, UNICEF contacted
selected journalists about "a major public health success". For the
first time UNICEF strongly publicised its claim that annual under-5
child deaths had fallen below 10 million.

Several journalists were puzzled. The sudden UNICEF contact was
unexpected. It was unusually dissociated from UNICEF's annual report.

There were no detailed data for journalists to examine in order to
interpret UNICEF's claim. UNICEF denies that it released the positive
9•7 million figure to pre-empt the more critical tone of the paper by
Murray and colleagues. But a senior UNICEF adviser did tell The
Lancet that Murray's work was "ethically troubling" and that "we
can't say that we were unhappy to have released our figure first".

Both of these examples show how UN agencies are willing to play fast
and loose with scientific findings in order to further their own
institutional interests. When those interests are the preventable
deaths of children, perhaps one should forgive their haste. Certainly
we share WHO's sense of urgency about translating research into
policy. And we support strongly UNICEF's view that scientists should
work together to improve systems for tracking child survival.

But the danger is that by appearing to manipulate science, breach
trust, resist competition, and reject accountability, WHO and UNICEF
are acting contrary to responsible scientific norms that one would
have expected UN technical agencies to uphold. Worse, they risk
inadvertently corroding their own long-term credibility.
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