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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine and National Academy of Medicine. 2022. Countering the Pandemic Threat Through Global Coordination on Vaccines: The Influenza Imperative. Washington, DC: The National Academies Press. doi: 10.17226/26284.
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Countering the Pandemic Threat
Through Global Coordination
on Vaccines

The Influenza Imperative

Peter Sands and Janelle Winters, Editors

Committee on Global Coordination, Partnerships, and Financing
Recommendations for Advancing Pandemic and Seasonal Influenza
Vaccine Preparedness and Response

Board on Global Health

Health and Medicine Division

A Consensus Study Report of

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and

NATIONAL ACADEMY OF MEDICINE

THE NATIONAL ACADEMIES PRESS
Washington, DC
www.nap.edu

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine and National Academy of Medicine. 2022. Countering the Pandemic Threat Through Global Coordination on Vaccines: The Influenza Imperative. Washington, DC: The National Academies Press. doi: 10.17226/26284.
×

THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW, Washington, DC 20001

This activity was supported by a contract between the National Academy of Sciences and the Office of Global Affairs with the U.S. Department of Health and Human Services. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.

International Standard Book Number-13: 978-0-309-08870-1
International Standard Book Number-10: 0-309-08870-4
Digital Object Identifier: https://doi.org/10.17226/26284
Library of Congress Catalog Number: 2021951345

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Copyright 2022 by the National Academy of Sciences. All rights reserved.

Printed in the United States of America

Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2022. Countering the pandemic threat through global coordination on vaccines: The influenza imperative. Washington, DC: The National Academies Press. https://doi.org/10.17226/26284.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine and National Academy of Medicine. 2022. Countering the Pandemic Threat Through Global Coordination on Vaccines: The Influenza Imperative. Washington, DC: The National Academies Press. doi: 10.17226/26284.
×

Image

The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Marcia McNutt is president.

The National Academy of Engineering was established in 1964 under the charter of the National Academy of Sciences to bring the practices of engineering to advising the nation. Members are elected by their peers for extraordinary contributions to engineering. Dr. John L. Anderson is president.

The National Academy of Medicine (formerly the Institute of Medicine) was established in 1970 under the charter of the National Academy of Sciences to advise the nation on medical and health issues. Members are elected by their peers for distinguished contributions to medicine and health. Dr. Victor J. Dzau is president.

The three Academies work together as the National Academies of Sciences, Engineering, and Medicine to provide independent, objective analysis and advice to the nation and conduct other activities to solve complex problems and inform public policy decisions. The National Academies also encourage education and research, recognize outstanding contributions to knowledge, and increase public understanding in matters of science, engineering, and medicine.

Learn more about the National Academies of Sciences, Engineering, and Medicine at www.nationalacademies.org.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine and National Academy of Medicine. 2022. Countering the Pandemic Threat Through Global Coordination on Vaccines: The Influenza Imperative. Washington, DC: The National Academies Press. doi: 10.17226/26284.
×

Image

Consensus Study Reports published by the National Academies of Sciences, Engineering, and Medicine document the evidence-based consensus on the study’s statement of task by an authoring committee of experts. Reports typically include findings, conclusions, and recommendations based on information gathered by the committee and the committee’s deliberations. Each report has been subjected to a rigorous and independent peer-review process, and it represents the position of the National Academies on the statement of task.

Proceedings published by the National Academies of Sciences, Engineering, and Medicine chronicle the presentations and discussions at a workshop, symposium, or other event convened by the National Academies. The statements and opinions contained in proceedings are those of the participants and are not endorsed by other participants, the planning committee, or the National Academies.

For information about other products and activities of the National Academies, please visit www.nationalacademies.org/about/whatwedo.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine and National Academy of Medicine. 2022. Countering the Pandemic Threat Through Global Coordination on Vaccines: The Influenza Imperative. Washington, DC: The National Academies Press. doi: 10.17226/26284.
×

COMMITTEE ON GLOBAL COORDINATION, PARTNERSHIPS, AND FINANCING RECOMMENDATIONS FOR ADVANCING PANDEMIC AND SEASONAL INFLUENZA VACCINE PREPAREDNESS AND RESPONSE

PETER SANDS (Chair), Executive Director, The Global Fund to Fight AIDS, Tuberculosis and Malaria

DEVI SRIDHAR (Vice Chair), Professor and Chair of Global Public Health, Usher Institute, University of Edinburgh

SALAH T. AL AWAIDY, Communicable Disease Advisor, Ministry of Health, Oman

WILLIAM AMPOFO, Associate Professor, Virology Department, Noguchi Memorial Institute for Medical Research, University of Ghana

PHYLLIS ARTHUR, Vice President, Infectious Diseases and Emerging Science Policy, Biotechnology Innovation Organization

CHRISTOPHER T. BAUCH, Professor of Applied Mathematics, University of Waterloo

GIAN LUCA BURCI, Professor of International Law, Graduate Institute of International and Development Studies

KEIJI FUKUDA, Director and Clinical Professor, School of Public Health, LKS Faculty of Medicine, The University of Hong Kong

BRUCE G. GELLIN, Chief, Global Public Health Strategy, The Rockefeller Foundation

AMANDA L. GLASSMAN, Executive Vice President and Senior Fellow, Center for Global Development

RICHARD J. HATCHETT, Chief Executive Officer, Coalition for Epidemic Preparedness Innovations

JOHN NKENGASONG, Director, Africa Centres for Disease Control and Prevention

CHARLES “OK” PANNENBORG, Chief Health Scientist and Director, World Bank (Retired)

ALEXANDRA L. PHELAN, Assistant Professor, Center for Global Health Science and Security, Georgetown University Medical Center, Adjunct Professor, Georgetown University Law Center

CHRISTOPHER SNYDER, Joel and Susan Hyatt Professor of Economics, Department of Economics, Dartmouth College

CHARLOTTE WELLER, Head of Prevention, Wellcome Trust

Study Staff

JANELLE WINTERS, Study Director

CLAIRE MOERDER, Research Associate (until June 2021)

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine and National Academy of Medicine. 2022. Countering the Pandemic Threat Through Global Coordination on Vaccines: The Influenza Imperative. Washington, DC: The National Academies Press. doi: 10.17226/26284.
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ERIKA JAUREGUI, Research Associate (from June to August 2021)

INEZ ADAMS, Research Associate (from June to August 2021)

TOCHI OGBU-MBADIUGHA, Senior Program Assistant (from April 2021)

EMILIE RYAN-CASTILLO, Senior Program Assistant

PATRICIA A. CUFF, Senior Program Officer, Board on Global Health

JULIE A. PAVLIN, Senior Director, Board on Global Health

FRANCES SHARPLES, Science Writer

ROGER YAT-NORK CHUNG, National Academy of Medicine International Health Policy Fellow

Consultant

ANNA NICHOLSON, Science Writer

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine and National Academy of Medicine. 2022. Countering the Pandemic Threat Through Global Coordination on Vaccines: The Influenza Imperative. Washington, DC: The National Academies Press. doi: 10.17226/26284.
×

Reviewers

This Consensus Study Report was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published report as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process.

We thank the following individuals for their review of this report:

Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations of this report, nor did they see the final draft before its release. The review of this report was overseen by GAIL CASSELL,

Page viii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine and National Academy of Medicine. 2022. Countering the Pandemic Threat Through Global Coordination on Vaccines: The Influenza Imperative. Washington, DC: The National Academies Press. doi: 10.17226/26284.
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Harvard University, and HELEN MILNER, Princeton University. They were responsible for making certain that an independent examination of this report was carried out in accordance with the standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the authoring committee and the National Academies.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine and National Academy of Medicine. 2022. Countering the Pandemic Threat Through Global Coordination on Vaccines: The Influenza Imperative. Washington, DC: The National Academies Press. doi: 10.17226/26284.
×

National Academy of Medicine

Advancing Pandemic and Seasonal Influenza Vaccine Preparedness and Response Series

This study, Countering the Pandemic Threat Through Global Coordination on Vaccines: The Influenza Imperative, provides recommendations on how to identify and overcome barriers to effective global coordination and sustainable financing for pandemic and seasonal influenza vaccines and vaccinations, drawing on successes and challenges from the global response to COVID-19. It is one of four studies conducted under the Advancing Pandemic and Seasonal Influenza Vaccine Preparedness and Response Initiative, which explores how the scientific and technological breakthroughs throughout the COVID-19 pandemic could inform and advance future pandemic and seasonal influenza vaccine preparedness and response efforts.

The three companion studies to this study examine how the lessons learned from COVID-19 around vaccine research and development, vaccine distribution and supply chain, and public health interventions and countermeasures could be best utilized to improve the development and distribution of future pandemic and seasonal influenza vaccines. Together, the four consensus studies present a path toward better preparedness in addressing pandemic and seasonal influenza.

Launched by the National Academy of Medicine with support from the Office of Global Affairs, U.S. Department of Health and Human Services, the Advancing Pandemic and Seasonal Influenza Vaccine Preparedness and Response Initiative acknowledges that influenza is here to stay. The unprecedented scope of this initiative allowed for international experts to look at this issue from multiple angles and provide recommendations that set out a pathway to more effective influenza vaccines worldwide. Driven by international cooperation, this independent initiative provides a platform to highlight why we need to act as a global community to better prepare for pandemic and seasonal influenza.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine and National Academy of Medicine. 2022. Countering the Pandemic Threat Through Global Coordination on Vaccines: The Influenza Imperative. Washington, DC: The National Academies Press. doi: 10.17226/26284.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine and National Academy of Medicine. 2022. Countering the Pandemic Threat Through Global Coordination on Vaccines: The Influenza Imperative. Washington, DC: The National Academies Press. doi: 10.17226/26284.
×

Acknowledgments

This study is timely, in terms of considering how to harness lessons and best prepare for a major future pandemic threat during a debilitating current pandemic. This timeliness created an intense study schedule for the committee members and staff. First and foremost, we would like to thank the members of the pandemic preparedness and response (PPR) community who took the time to speak to us, on top of incredibly busy schedules. Appendix B lists the names and affiliations of all speakers. This study would not have been possible without their intellectual contributions and candid perspectives on what has worked (and not worked) in pandemic preparedness for COVID-19, influenza, and other threats. We would also like to thank our sponsor, the Office of Global Affairs in the U.S. Department of Health and Human Services. We appreciate your dedication to advancing the pandemic influenza preparedness agenda. We are further indebted to members of the influenza PPR international committee, under the umbrella of the National Academy of Medicine, who guided the development of the four consensus studies. Finally, we thank members of the Health and Medicine Division, particularly Lauren Shern for providing study guidance and Leslie Sim and Taryn Young for coordinating the review process. Last, but certainly not least, we are grateful for the support of members of the “flu team” at the Board on Global Health, especially Kenisha Jefferson, Ellen Schenk, and Hoda Soltani.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine and National Academy of Medicine. 2022. Countering the Pandemic Threat Through Global Coordination on Vaccines: The Influenza Imperative. Washington, DC: The National Academies Press. doi: 10.17226/26284.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine and National Academy of Medicine. 2022. Countering the Pandemic Threat Through Global Coordination on Vaccines: The Influenza Imperative. Washington, DC: The National Academies Press. doi: 10.17226/26284.
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Preface

COVID-19 has taught the world a harsh lesson on the perils of being unprepared for a pandemic. More than 18 months since the World Health Organization (WHO) declared a public health emergency of international concern, governments across the world are still struggling to contain new waves of infection and death. The human and economic costs of this crisis are staggering, and it is far from over.

This reality underscores this report’s title, Countering the Pandemic Threat Through Global Coordination on Vaccines: The Influenza Imperative. COVID-19 has been terrible, but an influenza pandemic comparable to that of 1918–1919 could be even worse. The world cannot afford to be as unprepared for an influenza pandemic as we turned out to be for COVID-19. So, while the immediate priority must be to defeat COVID-19, we must also move decisively to strengthen our ability to protect people from future threats, pandemic influenza above all.

The seven recommendations in this report aim to provide this agenda for action. Underpinning the recommendations are four crosscutting themes. The first is simply the inadequacy of our current defenses: we have too many gaps, and too much is dependent on underfunded, often informal arrangements. Against the scale of the threat, we are woefully underprotected. We urgently need to strengthen our collective defenses against pandemic influenza and must do so in a way that is sustainable.

The second theme is the need to integrate the solutions for pandemic influenza into whatever broader solution global policy makers devise for pandemic preparedness and response (PPR) through the G7 or G20. It no longer makes sense to have purely influenza-specific mechanisms for critical

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine and National Academy of Medicine. 2022. Countering the Pandemic Threat Through Global Coordination on Vaccines: The Influenza Imperative. Washington, DC: The National Academies Press. doi: 10.17226/26284.
×

capabilities, such as disease surveillance, pathogen sharing, vaccine platform technologies, and vaccine deployment systems. The G7 and G20 debates around determining this broader set of solutions have been unfolding in parallel with the committee’s deliberations, posing a challenge in framing our recommendations: we want our proposals for pandemic influenza to fit the broader overarching solution for pandemic preparedness, without yet knowing precisely what this will look like.

The third theme is in slight tension with the second. We must integrate influenza PPR with the broader pandemic preparedness agenda, but we must avoid inadvertently weakening the existing influenza mechanisms. For all their limitations, current arrangements for global coordination, partnerships, and financing for pandemic influenza are typically much more established than the equivalents for other pathogens of pandemic potential. Moreover, influenza’s unique characteristics, such as its seasonality, create distinct challenges and opportunities that must be factored into the preparedness approach.

The fourth and final theme revolves around equity. Unless equity is embedded into the mechanisms for influenza PPR, frictions about inequitable access will corrode the collaboration and partnerships that are so vital to protecting us all. Moral, epidemiological, and practical perspectives all point to the need for an equitable approach to PPR.

The world might be lucky and not face an influenza pandemic for decades. But we might also be unlucky and find ourselves confronted by such a threat even before we surmount COVID-19. We cannot rely on luck. Too much is at stake. More effective global coordination, deeper partnerships, and scaled-up and sustained financing are essential to deliver reinforced protection against pandemic influenza. This committee, combining in its membership an extraordinary range of experience and expertise, aided by the superb staff of the National Academies, and informed by exceptional speakers bringing a wide spectrum of perspectives, has sought to explore these issues and lay out a set of actionable recommendations to address this imperative and make us all safer from the threat of pandemic influenza.

Peter Sands, Chair
Committee on Global Coordination, Partnerships, and Financing Recommendations for Advancing Pandemic and Seasonal Influenza Vaccine Preparedness and Response

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine and National Academy of Medicine. 2022. Countering the Pandemic Threat Through Global Coordination on Vaccines: The Influenza Imperative. Washington, DC: The National Academies Press. doi: 10.17226/26284.
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Page xviii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine and National Academy of Medicine. 2022. Countering the Pandemic Threat Through Global Coordination on Vaccines: The Influenza Imperative. Washington, DC: The National Academies Press. doi: 10.17226/26284.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine and National Academy of Medicine. 2022. Countering the Pandemic Threat Through Global Coordination on Vaccines: The Influenza Imperative. Washington, DC: The National Academies Press. doi: 10.17226/26284.
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Acronyms and Abbreviations

ABS access and benefit sharing
Africa CDC Africa Centres for Disease Control and Prevention
AMC advance market commitment
AU African Union
BARDA Biomedical Advanced Research and Development Authority
BMGF Bill & Melinda Gates Foundation
CBD Convention on Biological Diversity
CC WHO Collaborating Center
CDC U.S. Centers for Disease Control and Prevention
CEPI Coalition for Epidemic Preparedness Innovations
CIDRAP Center for Infectious Disease Research and Policy
COVAX COVID-19 Vaccines Global Access
CRS U.S. Congressional Research Service
CVV candidate vaccine virus
DARPA Defense Advanced Research Project Agency
EU European Union
FAO Food and Agriculture Organization of the United Nations
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine and National Academy of Medicine. 2022. Countering the Pandemic Threat Through Global Coordination on Vaccines: The Influenza Imperative. Washington, DC: The National Academies Press. doi: 10.17226/26284.
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FCTC Framework Convention on Tobacco Control
GAO U.S. Government Accountability Office
GAP WHO Global Vaccine Action Plan
GIP Global Influenza Program
GISN Global Influenza Surveillance Network
GISRS Global Influenza Surveillance and Response System
GLEWS Global Early Warning System for Major Animal Diseases
GloPID-R Global Research Collaboration for Infectious Disease Preparedness
GPMB Global Preparedness Monitoring Board
HERA Health Emergency Preparedness and Response Authority Incubator
HIC high-income country
HLIP G20 High-Level Independent Panel on Financing the Global Commons for Pandemic Preparedness and Response
IFC International Finance Corporation
IFPMA International Federation of Pharmaceutical Manufacturers & Associations
IHR International Health Regulations
IIV inactivated influenza vaccines
IMF International Monetary Fund
IP intellectual property
IPPPR Independent Panel for Pandemic Preparedness and Response
IVPP influenza viruses with pandemic potential
LAIV live attenuated influenza vaccine
LMIC low- and middle-income country
MERS Middle East respiratory syndrome
MIT Massachusetts Institute of Technology
mRNA messenger RNA
NGO nongovernmental organization
NIAID National Institute of Allergy and Infectious Diseases
NIC WHO National Influenza Centre
Page xxiii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine and National Academy of Medicine. 2022. Countering the Pandemic Threat Through Global Coordination on Vaccines: The Influenza Imperative. Washington, DC: The National Academies Press. doi: 10.17226/26284.
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OECD Organisation for Economic Co-operation and Development
OFFLU OIE/FAO Joint Network of Expertise on Animal Influenza
OIE World Organisation for Animal Health
OWS Operation Warp Speed
PHEIC Public Health Emergency of International Concern
PIP Pandemic Influenza Preparedness Framework
PPP G7/UK International Pandemic Preparedness Partnership
PPR pandemic preparedness and response
R&D research and development
REDISSE World Bank Regional Disease Surveillance Systems Enhancement Project in West Africa
SARS severe acute respiratory syndrome
SMTA-2 standard material transfer agreement 2
TAG technical advisory group
TWN Third World Network
UNICEF United Nations Children’s Fund
WHA World Health Assembly
WHO World Health Organization
WTO World Trade Organization
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine and National Academy of Medicine. 2022. Countering the Pandemic Threat Through Global Coordination on Vaccines: The Influenza Imperative. Washington, DC: The National Academies Press. doi: 10.17226/26284.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine and National Academy of Medicine. 2022. Countering the Pandemic Threat Through Global Coordination on Vaccines: The Influenza Imperative. Washington, DC: The National Academies Press. doi: 10.17226/26284.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine and National Academy of Medicine. 2022. Countering the Pandemic Threat Through Global Coordination on Vaccines: The Influenza Imperative. Washington, DC: The National Academies Press. doi: 10.17226/26284.
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The COVID-19 pandemic has laid bare the fragility of the global system of preparedness and response to pandemics and the fragmentation of our research and development ecosystem. The pandemic has provided a disruptive moment to advance new norms and frameworks for influenza. It also has demonstrated how innovative global public-private partnerships and coordination mechanisms can lead to rapid successes in viral vaccine research, manufacturing, and risk pooling.

Countering the Pandemic Threat Through Global Coordination on Vaccines identifies ways to strengthen pandemic and seasonal influenza global coordination, partnerships, and financing. This report presents seven overarching recommendations for how the urgent influenza threat should be conceptualized and prioritized within the global pandemic preparedness and response agenda in the future.

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