The very word ‘pandemic’ conjures images of global disease and death. Educational campaigns highlighting the centennial of the 1918 Influenza pandemic are a jarring reminder that more than 50 million people died due to a previously unknown influenza strain against which very few people had immunity. However, few people today understand that every year over one billion people worldwide are infected by seasonal influenza viruses resulting in as many as 650,000 deaths. This global threat requires a global response.
On Monday, March 11th the World Health Organization (WHO) released the Global Influenza Strategy 2019-2030. The Strategy signifies a holistic effort to strengthen national capacities to detect, prevent, and respond to seasonal and pandemic influenzas on a global scale, and to capitalize on recent influenza preparedness gains. The new strategy strengthens our work with WHO to fight influenza and prevent or slow any worldwide outbreak of the viral disease. This plan leverages expertise from across HHS, including the U.S. Food and Drug Administration, the National Institutes of Health, the Office of the Assistant Secretary for Preparedness and Response, Centers for Disease Control and Prevention and the Office of Global Affairs. Our proven domestic preparedness efforts coupled with a more seamless and global commitment will help quickly combat the most dangerous and persistent infectious disease threats.
Last year in the U.S., there were 49 million influenza infections, 960,000 hospitalizations, and 79,000 deaths, despite the availability of a seasonal vaccine. Influenza vaccination prevented approximately seven million illnesses, and 8,000 deaths during the 2017-2018 U.S. flu season. The yearly occurrence of seasonal influenza oftentimes means that this disease is not taken seriously, but complacency should never undermine our vigilance in prevention efforts. Continued innovation in our domestic medical countermeasures, surveillance and response capabilities as well as increased public awareness about the importance of vaccines are essential in the fight against seasonal influenza and another global pandemic.
The launch of the WHO Strategy builds upon its nearly 80-year history in seasonal and pandemic influenza preparedness. It sets forth a vision aimed at providing nations, industry, and civil society with a framework allowing better global influenza surveillance, disease prevention and control. It sharpens countries’ preparedness efforts, and promotes basic and applied research that will produce better diagnostics, antivirals, and vaccines.
In an increasingly mobile society, this global strategy is more important than ever. Pathogens do not respect borders; all it takes is a plane ticket to transport these invisible germs around the world in hours. The US must lead by example, our domestic disease prevention efforts are a model for the rest of the world. International collaboration is the only way to prevent mobile viruses from quickly spreading.
The U.S. Centers for Disease Control and Prevention (CDC) is one of the six premier WHO Influenza Collaborating Centers monitoring the evolution and emergence of influenza viruses. CDC provides data and recommendations for diagnostics, vaccines, antiviral drugs, and risk assessment that directly inform our global preparedness in addition to preparing candidate vaccine viruses for use in vaccine production. CDC also works with more than 50 nations to enhance their capacity to detect, prevent and respond to both seasonal and pandemic influenza. These collaborations lead to sharing information between nations, including knowledge of outbreaks of novel virus detections, and lead to earlier prevention and control at home and abroad. Combating influenza is not done in a vacuum; all nations must work together.
In 2006, WHO created the Global Action Plan for influenza vaccines (GAP). With the technical expertise of HHS’s Biomedical Advanced Research and Development Authority (BARDA), the plan introduced influenza vaccine manufacturing to areas of the world where none or very few vaccines existed. One of the program’s many success stories is the Institute of Vaccines and Medical Biologicals (IVAC) in Vietnam. Just this year, IVAC licensed its first seasonal trivalent influenza vaccine. Vietnam now has the ability to provide influenza vaccines to the people of Vietnam and help the global community with surveillance and manufacturing. The 15 companies, from 13 low and middle income countries, supported by BARDA and WHO in this program expanded their pandemic influenza vaccine production capacity from less than 1 million doses in 2006 to over 600 million doses in 2018. Since its creation, GAP has contributed to an increased global vaccine capacity from an estimated 500 million doses in 2006, to a predicted ability to produce over six billion doses for the next influenza pandemic. This is a major global preparedness milestone. Domestically, ASPR/BARDA is also working with industry to improve seasonal and pandemic influenza vaccines by utilizing new technology to improve production methods that reduce the time needed to produce and administer vaccines in response to a pandemic.
HHS has other major initiatives dedicated to understanding and improving influenza preparedness, surveillance, and response. The National Institutes of Health’s (NIH) National Institute of Allergy and Infectious Disease is involved with innovative work investigating universal influenza vaccines and next generation diagnostics, antiviral agents and other research that provides valuable information about the influenza virus and host response. Much of this research is generated by NIAID’s network of Centers for Excellence for Influenza Research and Surveillance (CEIRS).
The Food and Drug Administration (FDA) is an Essential Regulatory Laboratory within the WHO system and works directly with key partner nations to strengthen regulatory systems that support influenza vaccine manufacturing capacity through WHO’s GAP program. In collaboration with other Essential Regulatory Laboratories in the United Kingdom, Australia, and Japan, FDA contributes to a range of activities each year for the production of influenza vaccines, including strain selection for seasonal and pandemic influenza vaccines, preparing virus stocks, and calibrating vaccine reagents.
HHS will continue to work every day to prevent and contain the threat of disease. We are a committed partner in the WHO Global Influenza Strategy. We collaborate with academia and the private sector to advance influenza preparedness. Influenza is an international problem that necessitates global collaboration and an infrastructure ready for worldwide response. We are proud that HHS is working hand in hand with WHO to lead global efforts to prevent the next pandemic.
Garrett Grigsby is the Director of the HHS Office of Global Affairs and Dr. Robert Kadlec is the Assistant Secretary of Preparedness and Response.