Q&A: Pandemic flu – Preparing for the next unknown
While much attention has been focused on the Ebola outbreak that has claimed over 2,000 lives across West Africa, there are other, more easily spread infectious diseases lurking – like pandemic influenza virus. In fact, influenza is responsible for some of the deadliest pandemics of the 20th century. The 1918 “Spanish flu” killed more people than World War I and the “swine flu” or H1N1 pandemic of 2009, killed up to 575,000 people globally.We checked in with Gerald Parker, D.V.M., Ph.D., vice president for public health preparedness and response at the Texas A&M Health Science Center, to find out more about pandemic influenza, its implications for society, and actions the public health community can take to mitigate damage and save lives.
Q: What is a pandemic?
A: Pandemics are global outbreaks of disease that can cause serious illness in a wide geographic area, affecting an exceptionally high proportion of the population.
Q: What’s the difference between seasonal influenza and pandemic influenza?
A: Influenza, or flu, is a contagious respiratory illness caused by influenza viruses, which can cause mild to severe illness, and even death. Between 1976 and 2006, estimates of flu-associated deaths in the United States range from a low of about 3,000 to a high of about 49,000 people every year. The best way to prevent the flu is to get a flu vaccine every year.
Influenza viruses are constantly changing genetically. Seasonal flu outbreaks, which peak annually in January or February, are caused by common influenza viruses that have accumulated small variations. Even though these viruses may change slightly from one flu season to another, many people have developed some immunity. Because similar viruses have circulated previously, a vaccine is more readily available and more likely to provide some protective immunity.
On the other hand, influenza pandemics are rare, only occurring three times in the 20th Century and are caused by the emergence of a virus that is brand new or radically different from flu viruses that circulated previously- – often emerging from an animal population. Because humans have little to no immunity to a new virus, and there is no readily-available vaccine, influenza pandemics often result in significantly more severe illness and death. Because of this, development of both the capability and capacity to rapidly manufacture pandemic influenza vaccines are critical components of pandemic preparedness.
Q: When will the next influenza pandemic occur?
A. Unfortunately, no one can predict when a pandemic might occur. However, influenza pandemics are known to have occurred several times each century since the Middle Ages and into the 21st century. In the 20th century, we saw outbreaks in 1918, 1957 and 1968. We have already experienced the first influenza pandemic of the 21st century in 2009 with H1N1.
Q: Will the seasonal vaccine protect against pandemic influenza?
A. Seasonal influenza vaccines refer to vaccines that are updated yearly and that protect against currently circulating influenza viruses. As such, the seasonal vaccine will likely not protect against newly emerging pandemic flu outbreaks. However, seasonal vaccines are still vitally important as they are the best way to prevent seasonal flu, and the current flu vaccine now combats the previous 2009 H1N1 pandemic strain.
Q: Is there a pandemic influenza vaccine?
A: Influenza vaccines are designed to protect against specific viruses that have already been identified, so a pandemic vaccine cannot be produced until a new influenza virus emerges and starts to cause a significant number of human illnesses. A virus that would cause a pandemic could be very different from the seasonal flu viruses for which there is already vaccine.
Q: How quickly could one be produced, if needed?
A: The 2009 H1N1 influenza pandemic brought to light some key areas in need of improvement on a national scale: dated, slow vaccine technology and too much reliance on foreign factories. As H1N1 reached a peak in June 2009, with all 50 states in the U.S., the District of Columbia, Puerto Rico, and the U.S. Virgin Islands reporting cases of infection, the federal government implemented an emergency flu vaccine manufacturing campaign to combat the 2009 H1N1 pandemic flu virus. Vaccines were widely distributed for use in the fall of 2009.
After the experience of the 2009 pandemic, new strategies and plans were put in place to develop the capabilities and capacities to more effectively address the need for highly flexible, adaptive domestic manufacturing technologies.
Today, although we cannot predict the next strain of pandemic flu or other infectious disease threats that may emerge, we are developing the capability to quickly respond, thanks, in part, to three government-funded biodefense centers established through unique public-private partnerships. These centers are aimed at building manufacturing capacity for pandemic flu vaccines, creating core advanced development capabilities to support the national medical countermeasure stockpile for the United States, and standing at the ready with a near-immediate response to the next national public health threat.
The Centers for Innovation in Advanced Development and Manufacturing (CIADM) allow for immediate outbreak control measures, with the Texas A&M CIADM developing a capacity to supply 50 million vaccine doses within four months of receipt of a pandemic influenza strain, with the first doses available in 12 weeks.
Q: What would a government response to a pandemic outbreak look like?
A: Preparing for pandemic influenza requires global influenza virus biosurveillance in close collaboration with the World Health Organization, early detection of flu cases, effective immunization and treatment programs, the ability to address large numbers of patients in all continuums of care, and lastly, effective public health measures and communications to our citizens.
Q: What can citizens do to prepare for a possible pandemic?
A. One of the most important things you can do is to help prevent spread of the disease by practicing simple, but important habits that reduce the spread of germs:
- Avoid close contact with those that are sick. On the flip side, if you are sick, limit contact with others.
- If you are sick, stay home for at least 24 hours after your fever is gone without using medications to reduce fever.
- Cover your nose and mouth with a tissue when coughing or sneezing.
- Wash your hands with soap and water often.
- Clean and disinfect surfaces and objects that may be contaminated with germs.
It’s not a matter of if a flu pandemic will happen, but when. Although we can’t predict when the next flu pandemic will happen, we can be ready to respond with highly flexible manufacturing capabilities to produce pandemic vaccine doses to populations in need. Additionally, through simple disease prevention habits, you can help slow the spread of illness to help save lives.
Dr. Gerald Parker, vice president for public health preparedness and response at the Texas A&M Health Science Center and principal investigator at the Texas A&M Center for Innovation in Advanced Development and Manufacturing. Dr. Parker previously served as Deputy Assistant Secretary of Defense in Washington, D.C., leading chemical and biological defense; and former Commanding Officer of the U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID) at Fort Detrick, M