At first blush, the World Health Organization’s Pandemic Influenza Preparedness Framework
has all the right elements. It calls for sharing influenza viruses, surveillance, stockpiles of medicines and vaccines, tiered pricing, technology transfers, and a sustainable financing mechanism.
Yet this solid framework rests on shaky footing. The reason? It lacks two cornerstones of a solid foundation: a research strategy ready for launch immediately upon an outbreak, and funding for that research. Without such research on a novel virus, there is no way to know if the stockpiled medicine and vaccine will be relevant, much less effective.
The Past Can Help Us Learn for the Future
Examples of this knowledge to practice gap—and its profound consequences —abound. In the 2009-2011 H1N1 pandemic, it took six months to set up a research program, which missed the first wave of the outbreak entirely. Zika and Ebola each took about a year, and by the time the Ebola research plan was ready, the outbreak had burned itself out.
Influenza seasons typically last only two to four months in a community, and pandemic influenza usually exhibits a quickly escalating epidemic curve in an environment with little or no pre-existing immunity. This means it is critical that study preparation and implementation be fast, nimble, and flexible.
Clinical Coordination to Track the Next Flu Pandemic
The Centers for Disease Control and Prevention moved to address at least part of this problem. In 2013, it awarded a contract to Abt Associates to prepare the United States for influenza research that can begin three days after an outbreak. Under the five-year, $51.6 million Epidemiology of Novel Influenza Virus Infection and Evaluation of Antiviral and Vaccine Effectiveness
contract, Abt is establishing the research infrastructure necessary to conduct epidemiologic studies of emerging influenza virus infections, including H7N9, better known as bird flu. These studies will help assess novel flu infections and evaluate the effectiveness of antivirals and vaccines developed to prevent and treat the disease.
Incorporating Rapid Cycle Evaluation into Decision-Making
The pandemic influenza research platform actively identifies and enrolls patients with possible pandemic influenza infection. To help understand the data across different sites, we collect clinical specimens and medical information in a standardized way throughout the pandemic from a set of research hospitals and institutions. The information is collected in real time to inform public health officials about testing and treatment practices, as well as clinical characteristics and outcomes of laboratory-confirmed pandemic hospitalized patients. These findings help inform the response and rapidly adjust how we make decisions in emergency situations.
In addition, the information collected helps estimate laboratory-confirmed pandemic influenza incidence and estimates the effectiveness of antiviral treatment and pandemic vaccines, using observational study designs. By using this research platform, federal, state, local and other public health officials can now ask new research questions that might not have been obvious or possible at the time of the outbreak.
Additionally, this research platform allows expansion of the protocol so it may also apply to other emerging infections such as Zika.
What Can Other Countries and Organizations Do?
Based on experience in conducting research during a pandemic and preparing for research in future ones, Abt recently made the following recommendations to the World Health Assembly in May:
For pandemics, countries should have in place research strategies, including platforms, study protocols, data management systems, the identification and commitment of clinical sites, and internal review board approvals.
International donors should fund programs to help developing countries create the required plans and provide training on influenza surveillance skills, such as epidemiology, laboratory and data management.
International donors should fund more projects that investigate the burden and vaccine effectiveness on vulnerable groups.
Countries that have established data management systems and other tools for sharing should make them available to countries unable to develop their own.
National governments or international donors should establish a standing pool of funding to jumpstart pandemic research.
With these steps in mind, we stand the best chance of responding quickly and effectively to the next great pandemic, because we know it’s not a matter of if, but when.