It's wrong and irresponsible to call H1N1 a 'fake' pandemic, WHO flu expert Dr. Keiji Fukuda says. (Anja Niedringhaus/Associated Press)

The World Health Organization's top flu expert has struck back at criticism about the agency's handling of the H1N1 pandemic, saying claims that the outbreak was a false alarm are scientifically wrong and irresponsible.

Dr. Keiji Fukuda also denied allegations that the global health organization overhyped the outbreak or was inappropriately influenced by the pharmaceutical industry in declaring the pandemic.

"At this point let's not play word games and let's not be indirect about this matter," he said from Geneva during a media conference Thursday. "The world is going through a real pandemic. The description of it as a fake is both wrong and irresponsible."

Fukuda also said dismissing the pandemic as a dud is "somewhat disrespectful" to the people who died or were severely sickened by the virus, as well as to those who have worked long hours on pandemic responses around the world. Those responses, he said, are the most concerted in the history of influenza and have averted infections and deaths.

"We don't know how much these efforts have helped to mitigate the overall effect of the pandemic, but we firmly believe that these efforts should not be discounted."

The WHO, which last spring was under fire for not declaring the H1N1 outbreak a pandemic sooner, has in recent weeks faced criticism fuelled by the fact that the pandemic has been milder than first anticipated.

Excess vaccine ordered

While the WHO persists in using the term "moderate" to describe its impact, to many untouched by H1N1-related deaths or serious illnesses, this event appears to be only modestly more disruptive than a regular flu season.

The perception has led to low uptake of H1N1 vaccine in many countries. A number of western European governments are trying to sell excess vaccine or are negotiating production cuts with suppliers because fewer than 10 per cent of their citizens have stepped forward to be vaccinated.

There have been allegations the WHO was in league with the pharmaceutical industry, declaring the pandemic to generate windfall profits for companies making vaccine and antiviral drugs.

The parliamentary assembly of the Council of Europe has announced it will hold a debate on the topic of "False pandemics, a threat to health" at the end of the month and has asked WHO officials to testify.

The Council of Europe, not to be confused with the European Union, has 47 member countries working through it to safeguard human rights and other protections of individuals, but it can make only non-binding recommendations.

Fukuda said the WHO is willing to participate in the council's discussion. And he said the organization will be undertaking a review of the pandemic response. Such a review is called for under the international health regulations the WHO oversees, and Fukuda said it will be made public.

Pandemic course uncertain

He cautioned against assuming the pandemic has run its course, saying it is too soon to make that determination. The path of the virus remains as impossible to predict now as it was when it first emerged, he said.

"From the very beginning, the WHO has gone out of its way to let everybody know that the future course of the pandemic was uncertain, that we did not have a crystal ball and could not tell you at the beginning which way it was going to go. This remains as true today as it was back then," said Fukuda, who is the WHO's special adviser on pandemic influenza.

He said the inability to predict the course of the outbreak forced the WHO and national governments to adopt what is known as the precautionary principle — planning for the worst but hoping for the best.

"Given this reality, there is no health authority, including WHO, which can afford to sit back before making decisions. Actions have to be taken because we have to provide support to countries and other institutions working to reduce the impact of the situation," Fukuda said, pointing to the size of vaccine orders as one decision that had to be made before it became apparent that one dose per person was sufficient for protection.

He noted that if the pattern of the disease changes and demand for vaccine rises again, countries now being castigated for buying too much vaccine may be criticized for not buying enough.