"The reality is there is a huge amount of uncertainty [in a pandemic]. I think we did not convey the uncertainty. That was interpreted by many as a nontransparent process," Keiji Fukuda, the WHO's leading influenza expert, told a panel of experts convening this week for a post-pandemic analysis of the organization's response to H1N1.
The agency uses a six-stage system for "ranking" the outbreak of an illness based on geographic spread, rather than severity. When H1N1 was rated a pandemic, it fell into the same category as the much more deadly avian flu, which has killed 60 percent of those infected since 2003.
Critics have derided the system for overhyping the severity of H1N1, which, the WHO now acknowledges, was decidedly mild.
The WHO reaction also catalyzed a mass manufacturing of vaccines, which cost the U.S. government alone more than $1.6 billion. Worldwide, countries spent an estimated $4 billion on H1N1 vaccines, according to estimates from the World Bank.
Drug companies and health organizations initially advised two doses of vaccine to bolster immunity, but one was later found to be sufficient -- adding more fuel to the accusations of widespread misinformation and needless expenditures.
And while countries like the United States and England start discarding expired, unused vaccine doses, developing nations are crying foul at not receiving adequate supplies in the first place.
"It is not fair to have new vaccines and medicines and then they are so expensive that most poor people in developing countries can't access them," Kenya's delegate told the conference. "This is not a situation that should be tolerated at all."
Fukuda told the panel that the organization needs to come up with a better way to categorize the spread and severity of future influenza.
"Confusion about phases and level of severity remains a very vexing issue," he said.
But infectious disease specialist Dr. Neil Rau thinks the crux of the problem is the WHO, which got caught up in a flurry of self-made hype.
"They had focused so much on bird flu, on worst-case scenarios, that once the idea of a pandemic being declared was raised, there were now so many things written in that playbook, that they couldn't stop themselves," he told Canada's CTV News. "It was almost a spaceship had been launched: We just couldn't pull this back into orbit."
American health agencies are defending their own role in the global management of H1N1. "We were dealing with a very unusual situation. We had a pandemic. We had young people being killed," Anne Schuchat of the Centers for Disease Control and Prevention told The Washington Post in early April. "We wanted to make sure we had enough. We didn't want to be short. It was important to us to be able to protect the American people."
Results of the WHO review aren't expected until June of next year. Meanwhile, the agency still lists H1N1 as a pandemic. Though the illness is largely contained in the U.S., concerns persist about it spreading across the Southern Hemisphere.