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Preventing influenza pandemics- Read our series in Nature Research

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Ep 2. In the Age of Emerging Pandemics, Influenza is the Devil We Know

Pandemic expert Harvey Fineberg hopes COVID-19 is the wake-up call the world needs to prevent the next pandemic. How can we learn from COVID-19 in a future some have described as an “age of pandemics,” during which outbreaks will become increasingly frequent? We zero in on the pathogen we know best: influenza.

A Teachable Moment?

Scientists, health professionals, and policy-makers have warned about emerging infectious diseases for decades. Now, as the world yearns for a vaccine that can stem the destruction caused by COVID-19, experts who have long urged us to prepare against such threats recognize the current crisis as a “teachable moment.”  In conversation with the Influenzer Initiative, Harvey Fineberg, president of the Gordon and Betty Moore foundation and co-chair of the Sabin-Aspen Vaccine Science and Policy Group, expresses hope that today’s hard lessons fuel the resolve necessary to prevent the next pandemic. Fineberg also chairs the Standing Committee on Emerging Infectious Diseases and 21st Century Health Threats of the National Academies of Science, Engineering and Medicine, convened by request of the federal government in response to the coronavirus pandemic.

Our society is forced to manage COVID-19 as an emergency because we failed to acknowledge and mitigate the significant and well-characterized risk that such a pandemic would occur. We are learning by painful experience how an emerging microbial pathogen can disrupt and devastate our interconnected, interdependent world. How might we benefit from the lessons of COVID-19 in a future that some have described as an “age of pandemics,” during which infectious disease outbreaks will become increasingly frequent?

The infectious pathogen for which we can most effectively prepare is the one we know best: influenza.

First and foremost, there must be political will to focus the scientific expertise and financial resources brought to bear on COVID-19 on emerging infectious diseases that pose the greatest risk to public health. Clearly, vigilance is required to thwart another COVID-like Disease X, caused by an unknown pathogen with pandemic potential, but the infectious pathogen for which we can most effectively prepare is the one we know best: influenza, which the World Health Organization lists third among all global health threats.

Every year, seasonal flu causes an estimated 300,000 to 600,000 deaths worldwide—but when genetic shifts in the virus create a novel strain against which humans have little or no immunity, flu mortality rises steeply. In 1918, such a virus spread around the world, killing an estimated 50 million people (about 3 percent of the global population) in the course of 18 months; milder pandemics in 1957,1968, 1977, and 2009 took between 2 and 4.5 million lives, combined. It is only a matter of time—perhaps months, perhaps years—until the next influenza virus with pandemic potential emerges.

True preparation against pandemic influenza requires lifelong or multi-year protection against a broad spectrum of strains with a universal influenza vaccine (UIV). A UIV could prevent the tragic consequences of vaccine delay in the early stages of a global pandemic: suffering that even the monumental effort to produce a vaccine against SARS-CoV-2 could not avert. Moreover, a UIV could be incorporated into immunization schedules in many low- and middle-income countries that currently lack an influenza vaccination program, thereby reducing the burden of seasonal influenza.

We must prepare for the inevitable return of pandemic influenza by harnessing the momentum & resources brought to bear against COVID-19 to develop a universal influenza vaccine.

The Influenzer Initiative recognizes that the response to COVID-19 offers abundant positive lessons, as well as cautionary tales. Unprecedented focus, investment, and collaboration, combined with basic research and technological progress, have enabled the advancement of hundreds of vaccine candidates in record time. In order to characterize and amplify these successes, we are undertaking several projects to explore how the COVID-19 experience can inform the future of the vaccine ecosystem.  We aim to capture novel and optimized approaches currently being applied to vaccine development, to identify factors that enable—as well as hinder—progress toward safe and effective vaccines against SARS-CoV-2, and to assess the potential impact of this global endeavor on prospects for UIV development.

During this crisis, as we simultaneously mourn the destruction of lives and livelihoods and laud the speed and intensity of vaccine development, it’s important to recognize that the threat we fight today is not unique. We must prepare for the inevitable return of pandemic influenza by harnessing the momentum and resources brought to bear against COVID-19 to develop a UIV—and add it to the global health security repertoire before an influenza virus with pandemic potential emerges.

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