Ruminations

Proactively Anticipating the Next Influenza Pandemic

"We have to do better and by better, we mean a universal flu vaccine. A vaccine that is going to protect you against essentially all, or most, strains of flu."
"It's folly to predict [what a potential next pandemic might result in]. We just need to be prepared."
Dr. Anthony Fauci, U.S. National Institutes of Health

"We've made some serious inroads into understanding how we can better protect ourselves. Now we have to put that into fruition."
"Say a pandemic came along and you didn't have time to make vaccine. You'd want something to block infection if possible."
Ian Wilson, flu biologist, The Scripps Research Institute, La Jolla, California

"[The Chinese H7N9 bird flu] worries me a lot. For a virus like influenza that is a master at adapting and mutating and evolving to meet new circumstances, it's crucially important to understand how these processes occur in nature."
"How does an avian virus become adapted to a mammal?"
Dr. Jeffery Taubenberger, pathologist, NIH

Biologist Jason Plyler prepares to test how immune cells react to possible flu vaccines at the Vaccine Research Center at the National Institutes of Health, Tuesday, Dec. 19, 2017, in Bethesda, Md. As scientists mark the 100th anniversary of the 'Spanish' influenza pandemic, labs are hunting better vaccines. (Carolyn Kaster/Associated Press)

To Dr. Taubenberger, the 1918 influenza outbreak represents the mother of all pandemics. Little wonder he would designate it in that category. That pandemic turned out to be one of the world's most catastrophic outbreaks of a disease which at that time had no antidote, no vaccine tailored by science to overcome its dread symptoms and even more dreadful conclusion. That year, influenza was responsible for the deaths of tens of millions of people across the globe.

Its trajectory from onset to final morbidity was swift. Its victims felt no symptoms of adverse health in the morning and by the time night fell they were dead, their faces turned a ghastly blue and they coughed up blood before they left this mortal coil to join the bodies of others for whom there were insufficient coffins to service funerals. And that 1918 outbreak of almost instant death consumes the minds of present-day scientists hoping they may succeed through research in overcoming the threat of another deadly outbreak.

There were no defences back then, a century ago, and though there are some now, in yearly-produced formulae of serum to inoculate against the upcoming strain of influenza, the formulae represent informed guesswork more than positive certainty as to the strain that will evolve and the efficacy of the vaccine produced on the basis of knowledge about the strain before its appearance. Invariably when the strain is finally identified the vaccine meant to inoculate against it fails to fully reflect a defence against the type of virus presenting.

Dr. Taubenberger led the team working for the military as a pathologist that succeeded in identifying and reconstructing the 1918 virus that was so globally deadly, and now extinct. With the use of traces unearthed in autopsy samples from First World War soldiers along with samples taken from an individual felled by the 1918 virus, discovered buried in the Alaskan permafrost of the flu that turned the world into a killing zone (paraphrasing John M. Barry's The Great Influenza: The Story of the Deadliest Pandemic in History), the molecular structure of the virus was identified.

There is a good degree of confidence among historians that the pandemic began in early 1918 in Kansas; a year later, in winter of 1919 the virus had succeeded in infecting one third of the entire global population, destroying the lives of an estimated 50 million people. The latter-day AIDS epidemic in comparison, has taken 35 million lives over a forty-year period. Since there is no known way to predict what strain of the flu virus might be capable of triggering another pandemic, science badly needs a defence.

Medical laboratories are on the hunt for a proposed super-shot capable of eliminating the annual fall vaccination, to produce one that might require only one shot in five or ten years. Even more ambitious would be a vaccine to be taken once in a lifetime as a childhood immunization. Dr. Fauci has focused on a universal flu vaccine for NIH's National Institute of Allergy and Infectious Diseases, as a primary priority. Scientists are attempting to dissect how the virus is disguised so the immune system fails to detect its presence.

The problem with the flu vaccines as they are produced today is that they are never more effective than at a 60 percent level at most, and fall in efficacy to 19 percent when new viral strains erupt and the vaccine fails to match the viral composition. Once a new flu strain comes into being it consumes months of research to tailor a new, appropriate vaccine, and in the interval another strain entirely can be manifested. Animal flu strains that have the potential to become the next human threat is one focus of Dr. Fauci's search.

The foremost concern at the present time relates to a lethal bird flu that leaped species from poultry to infect over 1,500 people in China in the last four years. That strain produced a mutation rendering millions of just-in-case vaccine doses in storage in an American stockpile fairly useless. There were three additional flu pandemics that arose since the 1918 event. The second in 1957, another in 1968 and a final one to date, occurring in 2009 which spread widely but turned out to be minimally deadly in comparison to the original.

In 2009 a discovery was made that there are occasions when people produce a limited number of antibodies in response to the circulating virus invading their bodies targeting the virus elements that don't mutate. "These antibodies were much broader than anything we've seen" heretofore capable of blocking multiple subtypes of flu, according to The Scripps Research Institute's Dr. Ian Wilson. Leading scientists to attempt various methodologies in hopes of spurring production of those antibodies, among other strategies.