Countering the Pandemic Threat Through Global Coordination on Vaccines The Influenza Imperative (2022) / Chapter Skim
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. Although the true burden of influenza is unknown, an estimated 1 billion people are infected by seasonal influenza annually and in virtually 1 See Johns Hopkins Coronavirus Resource Center, https://coronavirus.jhu.edu.
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Influenza pandemics are a serious threat, and, because of their respiratory mode of transmission and short incubation period, they are capable of spreading rapidly around the world and causing high illness and death. Yet, the public and policy makers are mainly only familiar with seasonal influenza and, paradoxically, often dismiss all influenza and a range of minor illnesses with similar symptoms as "just the flu." To place the threat of pandemic influenza in context, if COVID-19 had the same case fatality rate as the 1918–1919 influenza, the total U.S.
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The committee's deliberations were based on a single premise: starting with the first human detection of a novel influenza virus with pandemic potential, how can the global health community move as quickly as possible to develop and produce safe and effective vaccines and equitably immunize as many people as possible worldwide? The committee acknowledges that a universal influenza vaccine would be a complete game changer, by ensuring advance preparation rather than reactive development.
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However, the committee recognizes that overcoming these challenges, or at least mitigating their consequences for global health, is a prerequisite for success, for both the broader PPR agenda and the specific influenza vaccine recommendations that this committee put forward. The committee adopted the basic assumption that a geopolitical context can be established in which one can speak meaningfully of a global community able to take at least some degree of coordinated collective action, since much of what is proposed in the recommendations requires this as a foundation.
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KEY FINDINGS AND RECOMMENDATIONS Governance and Coordination: Aligned Pandemic Preparedness and Response for Respiratory Pathogens with Pandemic Potential Among infectious diseases with pandemic potential, influenza stands out because its technical and policy systems, including for surveillance, the vaccine strain selection process, relations between the public and private sectors, and related access and benefit system (pertaining to pandemic influenza) are global and -- at least compared to other pathogens -- relatively well coordinated through WHO.
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to develop, in consultation with vaccine manufacturers, a framework for improved global coordination of vaccine development, production, and deployment for respiratory pathogens with pandemic potential that includes defined roles, responsibilities, and accountability mechanisms. Surveillance: Stable Financing for Integrated, Modern, Timely Respiratory Virus Surveillance for Pathogens with Pandemic Potential Without stable financing of a modern, integrated surveillance system for respiratory pathogens with pandemic potential, we will continue to fight pandemics in the dark.
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, and an integrated approach to risk assessments would benefit from the efficiencies of shared platforms and approaches. Strengthening and broadening global influenza surveillance to support a broader approach to respiratory virus surveillance will require substantially greater and sustained multilateral investments in country, regional, and global surveillance.
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Pathogen Sharing: Limitations and Potential of the PIP Framework and Nagoya Protocol The timely sharing of influenza viruses is essential for developing lifesaving seasonal influenza vaccines, identifying antiviral drug resistance and potential pandemic virus strains, and providing early warning for outbreaks. The PIP Framework supports a critical WHO global surveillance system needed for influenza and establishes a multilateral agreement that places access and benefit sharing (ABS)
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A similar delay in sharing genetic sequence data is also possible, due to the uncertainty about whether it falls under the PIP Framework and Nagoya Protocol. The rapid ramp-up of genomic surveillance for SARS-CoV-2 variants and the use of such data for vaccine development underscores the urgency of ensuring rapid access and sharing of genetic sequence data during pandemic situations.
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This establishes a necessity of innovation for influenza vaccines to shorten manufacturing time lines, increase global manufacturing capacity, and improve effectiveness. The goal in the next 3–5 years would be to progressively pursue development and assessment of new
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: that it only focused on U.S. needs and did not account for global needs or engage with a broader set of global stakeholders and partners.3 Recommendation 4: The Global Health Threats Board or similar gov ernance structure created by the G7/G20 PPR agenda, should negotiate to extend the mandates of the Coalition for Epidemic Preparedness Innovations (CEPI)
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should name a global coordination body to specifically coordinate global and regional government– industry partnerships for influenza vaccines. CEPI is the existing multilateral global coordination vehicle for R&D, has access principles built in, and is a possible organization to assume this role.
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Successfully developing a universal influenza vaccine will require galvanizing intense and sustained effort across multiple partners toward a hugely ambitious goal, hence the committee's use of the expression "moonshot." This endeavor could be expanded to encompass a similar quest for a more broadly protective vaccine against coronaviruses with pandemic potential; that would be a substantial step toward reducing the societal disruption caused by pandemics and the current global inequities related to vaccine availability and distribution. Partnerships, such as CEPI, that involve governments and private, philanthropic, and civil society organizations could be incentivized to lead or coordinate the push for a universal influenza vaccine; for CEPI, an expanded mandate -- accompanied by funding -- would be needed for it to assume the leadership needed to create push mechanisms and foster pre-competitive scientific research.
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, and regional governance structures, including but not limited to the Organisation for Economic Co operation and Development, G20, World Bank/International Monetary Fund, regional development banks, the World Trade Organization, European Union, and African Union. This funding should be separately and individually supported by trade and global financing institutions of the United States, China, and the European Union, such as the European Investment Bank and Asian Infrastructure Investment Bank.
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Manufacturing Scale-Up and Supporting Geographically Distributed Hubs for Influenza Vaccine Manufacturing and Supply Chain Capacity Regional or "geographically distributed" manufacturing hubs offer promise in helping counter vaccine nationalism and promoting equitable access through self-sufficiency. However, distributing manufacturing does not offer a full solution for addressing issues of vaccine equity, and it should be balanced with increasing the overall scale of global vaccine production capacity that can be applied to producing pandemic vaccines.
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Recommendation 6: The Global Health Threats Board or similar governance structure created by the G7/G20 pandemic preparedness response agenda should initiate a long-term (10–20+ years) multilateral partnership to track emerging technologies that may be targets for technology transfer for vaccines for influenza; promote industry partnerships with geographically distributed hubs; and provide technical training.
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should be given funding explicitly allocated for introducing and deploying next-generation seasonal influenza vaccines to underpin scaled-up manufacturing capacity. The World Health Organization regional offices should urgently work with countries to do more extensive assessments of their readiness to reach appropriate populations, including adults and high-risk groups, to enable work plans by 2023, which include the following: a.
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For optimal effectiveness, efficiency, sustainability, and impact, "countering the pandemic threat of influenza" should be reframed to "countering the pandemic threat of influenza within a wider respiratory pathogen" PPR framework. This move toward an integrated framework for respiratory pathogens with pandemic potential can only occur with large, dedicated financial investments, particularly targeting LMICs.
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2021. Global production capacity of seasonal and pandemic influenza vaccines in 2019.
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