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Public health authorities and the biomedical research community are seeking new strategies to address global health threats, writes Jill Wechsler.
The 100th anniversary of the 1918 influenza pandemic that killed an estimated 50 million people is prompting public health authorities and the biomedical research community to seek new strategies to address global health threats. An immediate goal is to improve the effectiveness of seasonal flu vaccines, while advancing the development of a universal flu vaccine that can provide multi-year protection against multiple influenza strains.
In a major speech on April 27, 2018 in Boston, Bill Gates described how a lethal airborne flu virus could quickly spread around the world and kill 33 million people in six months. To avoid such a catastrophe, Gates announced the launch of a new “grand challenge” award by the Bill & Melinda Gates Foundation, along with Google co-founder Larry Page and his wife, to provide $12 million in grants to researchers discovering “game-changing” approaches for testing and developing a universal flu vaccine. He also cited the need for more effective antiviral therapies, rapid diagnostics, and advanced computer data systems to combat and prevent a pandemic.
The prospect of American scientists taking the lead in discovering new life-saving preventives may appeal to the White House, as seen in Gates’ comments on a private talk in March he had with President Donald Trump. Gates hopes that his message on how a global pandemic threatens the United States will counter administration moves to curb foreign aid, particularly for world health programs. This effort has support from Congress, where a group of leading Senators are developing bipartisan legislation to renew and improve the federal program for combating threats from bioterrorism and pandemics.
The National Institute of Allergy and Infectious Diseases (NIAID) at the National Institutes of Health (NIH) continues to play a key role in developing new vaccines for multiple diseases, including a universal flu preventive as outlined in a recent strategic plan. FDA commissioner Scott Gottlieb has voiced concerns about the limited effectiveness of the current seasonal flu vaccine, which speaks to the importance and challenges in developing a universal, multi-year preventive. At a Congressional hearing in March, Gottlieb emphasized the need to shift from the traditional egg-based method product method to cellular and recombinant protein products that appear to yield a vaccine that is more effective in protecting against dangerous flu viruses. Faster seasonal vaccine production systems would allow more time to analyze data on the viral strains most vital for a new vaccine to target. Several vaccine makers are making such changes, but the shift has been slow.
Efforts to prevent another flu pandemic also can build support for tackling multiple health threats around the world. This was highlighted at a conference this week marking the 50th anniversary of the NIH Fogarty International Center, which analyzes data on global infections and funds the training of biomedical research scientists and clinicians to combat disease in less-developed regions [see https://www.fic.nih.gov/About/50th-anniversary/Documents/fogarty-international-center-nih-at-50.pdf ]. At the conference, Anthony Fauci, director of NIAID recounted how the imperative to halt the lethal HIV/AIDS outbreak 40 years ago drove global health initiatives and led to the development of anti-retroviral medicines that transformed AIDS from a death sentence to a manageable disease, at least in the US. Fauci noted similar recent successes in combating the Ebola outbreak and Zika due to advances in global disease surveillance systems, local capacity building, and collaborative clinical research that can help deal with future pandemics.
In his recent speech, Gates expressed optimism about such advances, citing a growing pipeline of broadly neutralizing antibodies with potential to protect against a pandemic virus and of more rapid diagnostics that harness genetic engineering technology. He cited public-private initiatives, such as the Coalition for Epidemic Preparedness Innovations (CEPI), which supports research on new vaccines and therapies for killer pathogens such as Lassa fever and the Middle East respiratory syndrome, MERS, and the development of rapid response platforms able to quickly produce new vaccines for a range of infectious diseases.
To be prepared for a pandemic, Gates emphasized the need for a military-style mobilization plan with trained personnel ready to act. Such a program would include manufacturing and indemnification agreements with pharmaceutical companies to enable industry to move quickly in an emergency to produce needed treatments. “Our biopharmaceutical industry is the global leader in biomedical innovation,” Gates said, and should be instrumental in the US playing a “leadership role in creating the kind of pandemic preparedness and response system the world needs.” New vaccines, antibiotics, and rapid diagnostics will be critical in combating a flu pandemic and in addressing outbreaks of even more lethal pathogens at home and abroad.