Armed with 1940s-vintage flu vaccine technology and supported by only anemic funding for developing truly revolutionary vaccines, the world is woefully unprepared for the next influenza pandemic, and the Trump administration is ignoring the problem, two experts wrote in a New York Times op-ed piece yesterday.

"There is no apparent effort to make [next-generation flu] vaccines a priority in the current administration. Its national security strategy published last month cites Ebola and SARS as potential bioterrorism and pandemic threats, yet makes no mention of the risk of pandemic influenza nor any aspect of critical vaccine research and development," write infectious disease expert Michael Osterholm, PhD, MPH, and his book coauthor Mark Olshaker.

Osterholm is director of the University of Minnesota's Center for Infectious Disease Research and Policy (CIDRAP), which publishes CIDRAP News. He and Olshaker last year wrote Deadliest Enemy: Our War Against Killer Germs, which details the most pressing public health threats and includes a nine-point action plan.

The urgency expressed in the commentary was echoed by other experts.

'Worst-case scenario'

In their op-ed piece, Osterholm and Olshaker point out that the infamous "Spanish flu" pandemic of 1918-19 killed 50 million to 100 million people worldwide—at a time when the globe held only a quarter of the population it now houses.

In addition, the current flu season demonstrates how disruptive even everyday seasonal flu can be.

"The next few weeks," the two write, "will highlight how ill prepared we are for even 'ordinary' flu. A worldwide influenza pandemic is literally the worst-case scenario in public health."

Amesh Adalja, MD, senior scholar with the Center for Health Security at the Johns Hopkins Bloomberg School of Public Health, concurs.

"The difficulties currently being experienced in handling a predictable rougher-than-usual flu season should be a wake-up call to all that we will be greatly underprepared for the infectious disease emergencies we are certain to face in the years ahead," he told CIDRAP News.

Antiquated weaponry

Outdated flu vaccines lie at the heart of the problem.

"Our current vaccines are based on 1940s research. Deploying them against a severe global pandemic would be equivalent to trying to stop an advancing battle tank with a single rifle," Osterholm and Olshaker write. "Limited global manufacturing capacity combined with the five to six months it takes to make these vaccines mean many people would never even have a chance to be vaccinated.

"The only real solution is a universal vaccine that effectively attacks all influenza A strains, with reliable protection lasting for years, like other modern vaccines."

A universal vaccine targets the "conserved" portion of influenza viruses, the parts that vary little from strain to strain. Such a vaccine would protect against not only the four strains commonly circulating during flu season in any given year but also any strains—such as H7N9 avian flu, which has caused mounting cases in China in recent years—that cause a future pandemic.

"I don't think anything else is more important for public health than developing a universal influenza vaccine," said John Barry, author of The Great Influenza, a definitive account of the 1918-19 pandemic that was said to be instrumental in building momentum for US preparedness efforts during the George W. Bush administration.

"The threat of a pandemic virus aside, a vaccine targeting conserved portions of the virus would very likely be far more effective than current seasonal vaccines, saving hundreds of thousands of lives a year," Barry says. "It makes no sense that it has not been a higher priority in past decades."

Adalja adds, "The pressing need for a universal flu vaccine, as expertly argued in the op-ed, is becoming more critical as the threat of H7N9 looms. Facing such challenges with technology that is obsolete and suboptimally effective is a recipe for disaster."

In Deadliest Enemy, Osterholm and Olshaker paint a fictitious yet chilling scenario of what an H7N9 flu pandemic could look like and how the disease would spread rapidly among today's highly mobile global population.

Lack of funding commitment

In their op-ed piece, the pair details the bleak reality of current US funding efforts.

"Although the National Institutes of Health has publicly declared developing a vaccine a priority, it has only about $32 million this year specifically for such research. The Biomedical Advanced Research and Development Authority, the other federal agency responsible for developing and making available new vaccines for emergency response, has in fiscal year 2017 only a single project for $43 million supporting game-changing influenza vaccines."

But together those funds total less than 8% of what the US government spends each year on developing an effective HIV vaccine, which is still a long way off.

"By contrast," Osterholm and Olshaker write, "the search for an H.I.V. vaccine—still a scientific long shot—receives $1 billion annually (which it should). We estimate that international governments, vaccine manufacturers and the philanthropic community must make a similar commitment to influenza vaccine research if the kind of vaccine we need is to developed in the next 10 years."

They note that eradicating smallpox in the 1970s was arguably public health's greatest accomplishment, adding, "We have the tools to potentially accomplish this with influenza, and with the stakes as high as they are, isn't it worth a Manhattan Project-scale effort to defend ourselves?"

See also:

Jan 8 New York Times commentary

Mar 14, 2017, CIDRAP News story "Osterholm plays detective, general in 'Deadliest Enemy' book"

Oct 15, 2012, CIDRAP report on game-changing flu vaccines