By the summer of 2009, shortly after the H1N1 flu pandemic had first emerged, there was a waiting list for the first several million doses of the forthcoming new flu vaccine. At the head of the line, naturally, were the world's richest nations. "Again we see the advantage of affluence," said Margaret Chan, the head of the World Health Organization (WHO), at a news conference on July 14. "Again we see access denied by an inability to pay." Describing H1N1 as "entirely new and highly contagious," Chan scolded rich countries at the time for hoarding the "lion's share" of the global H1N1-vaccine supply.
Six months later, Chan's admonitions seem prescient. Rich countries' hoards have become massive surpluses, and many nations are now trying frantically to cancel pending orders of vaccines or transfer them to poorer nations. France, which had ordered enough of the vaccine to inoculate its entire population of 60 million, has so far used only 5 million doses and now wants to cancel 50 million doses and sell millions more. Similarly, the Netherlands has a 19 milliondose order for sale to other countries, while Germany is in talks with drug manufacturers to halve its order of 50 million doses and sell off millions of others. Switzerland, Spain and Britain are also considering giving away or selling the millions of doses of the vaccine they have received or have on order. The U.S., which has so far distributed 160 million of the 251 million doses it purchased to doctors, hospitals and other health care providers across the country, has yet to make a decision on whether it will have an overflow and what it will do with any surplus.
The excess in many countries occurred partly because health officials initially thought the vaccine would require two doses instead of one, and many countries signed contracts with manufacturers under that assumption; it turned out that a single dose was enough to build immunity. But the main reason for the surplus is simply that demand for the vaccine fell far short of what was originally expected. Now, after governments have spent billions of dollars on vaccines that were not needed France alone spent $1.25 billion some politicians and health professionals are looking to hold someone accountable.
"WHO advised us falsely. They raised a false alarm," says Dr. Wolfgang Wodarg, who served in Germany's parliament until September, faulting the U.N.'s global health agency for relying on an inadequate definition of a pandemic.
Wodarg notes that the agency declared the H1N1 pandemic based only on the new virus' transmissibility and did not take into consideration the severity of the strain. Wodarg blames the WHO for raising the alarm over a virus with little destructive potential, leading countries to embark on expensive mass-vaccination programs. He has organized a public parliamentary hearing on behalf of the Strasbourg-based human-rights group Council of Europe, titled "The Handling of the H1N1 Pandemic: More Transparency Needed?" The hearing, scheduled for Jan. 26, will explore the question of whether the WHO and governments overreacted to the threat of H1N1.
Keiji Fukuda, the WHO's special adviser on pandemic influenza, who will head a delegation to the Strasbourg hearing, counters that the WHO's definition of influenza pandemics has always been based on transmissibility and has never had anything to do with the lethality of a virus; it was no different with H1N1. In response to accusations of overreaction to what has amounted to a mild disease, Fukuda says that once the 2009 H1N1 pandemic had been declared, "WHO consistently made it clear that it could not predict the future course of the pandemic but consistently provided sober, balanced and scientifically supported information and guidance."
Fukuda says also that claims that H1N1 is a mild pandemic are wrongheaded. "There have been over 14,000 deaths that have been laboratory-confirmed, many in young, previously healthy people. Who is going to tell their families that the virus is mild?" Fukuda wrote to TIME in an e-mail.
Indeed, it is not difficult to imagine an alternate scenario in which critics would now be accusing the agency of failing to warn countries properly of the H1N1 threat. Hugh Pennington, a microbiologist at the University of Aberdeen who has advised the British government on past public-health crises, says the WHO was obligated to raise the alarm as soon as H1N1's spread matched the medically accepted definition for a pandemic. He points out also that early news reports from Mexico and the U.S., where the virus first emerged, suggested a highly lethal disease.