An unwelcome visitor during the holiday season has returned: influenza. As of December 11, 2019, six children have already fallen victim to the disease. And, as the Centers for Disease Control and Prevention (CDC) points out, “the flu season is just getting started.” It will only get worse before it gets better: Last year’s pediatric death total was 143.
With the spread of the virus comes the annual message stressing the importance of vaccination. Yet at the same time comes disappointment with the performance of current vaccines. They are good—but just aren’t good enough.
Influenza is a fickle virus. It regularly mutates, requiring adjustments to the vaccine’s formula every year. While only rarely do these unpredictable mutations turn the virus into an international killer on the scale of the 1918 influenza pandemic—which killed around 50 million people globally—the possibility of such a variant strain that could trigger a global pandemic looms each year.
The confusion of influenza with the many less serious, similarly symptomatic, infections that are commonly labeled “the flu” often contributes to complacency about the threat influenza poses. Make no mistake, influenza is a killer: In the U.S., the 2017 to 2018 season took an estimated 61,000 lives—more than the deaths from opioid overdoses that year.
Influenza extracts a heavy economic toll, costing the U.S. $361 billion each year, including health care costs, work missed, and lives lost, according to a recent report by the White House Council of Economic Advisors (CEA). Exacerbating this is the slow pace of manufacturing annual influenza vaccines combined with effectiveness rates that range from 10% to 60%. And these costs would increase considerably during a pandemic where the spread of the disease outpaces existing vaccine production technology. In the 2009 to 2010 pandemic, for instance, the CEA report estimates that combining an increased speed of production with a 30% improvement in vaccine effectiveness would have added around $953 billion in increased economic benefit from vaccination.
In its recent annual report, the Global Preparedness Monitoring Board (GPMB) gave a candid and urgent assessment, noting that governments have established “a cycle of panic and neglect when it comes to pandemics,” where there is a “ramp[ing] up efforts when there is a serious threat,” which is forgotten “when the threat subsides.”
To face down these threats, new, sustained investments—both financial and technical—are required. Modernizing the influenza vaccine manufacturing industry—and rapidly scaling up production of tailor-made vaccines to protect against newly-emergent influenza strains—is an important start. Current vaccine manufacturing remains largely based on 1940s technology, as our recent report from the Sabin-Aspen Vaccine Science & Policy Group highlights. But the stakes are too high to be satisfied with a response that begins only after a threat surfaces.
Eliminating the threat requires a universal influenza vaccine that provides effective, long-lasting protection against any future influenza virus strain.
The urgency and magnitude of the threat calls for an equally matched response—one that combines scientific, technical, and financial assets focused on the single-mission of developing a universal influenza vaccine.
In addition to current efforts by the National Institute of Allergy and Infectious Diseases (NIAID) to tackle the many foundational scientific challenges—such as a full understanding of how the human immune system protects against influenza and how to measure that protection—new private and public sector investments are essential to propel vaccine discovery beyond the current limitations. Efforts like the Gates Foundation and Flu Lab’s “Universal Influenza Vaccine Development Grand Challenge” call on the scientific community to find new, innovative strategies for vaccine development.
It is time for a bold vision and even bolder action. If the necessary investments are made now, the high costs that influenza will exact on the future would be radically diminished.
Dr. Harvey V. Fineberg and Dr. Shirley M. Tilghman are co-chairs of the Sabin-Aspen Vaccine Science & Policy Group.