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A strengthened effort to develop pandemic vaccines should be the primary focus of the U.S. government's national strategy for pandemic influenza, according to two leading professional societies representing infectious disease and infection control experts. Other strategies, such as quarantine and social distancing, can play an important back-up role to immunization.
That was the key recommendation in comments submitted to the White House this week by the Infectious Diseases Society of America (IDSA) and the Society for Healthcare Epidemiology of America (SHEA), in response to the Implementation Plan for the National Strategy for Pandemic Influenza, which the White House released in May.
Although the federal government's pandemic plan addresses vaccination, IDSA and SHEA believe a more comprehensive, international approach is needed for vaccine development, production, and delivery throughout the world. "The United States must take a leading role in fostering an international effort to develop vaccines against likely and eventual pandemic strains," said Martin J. Blaser, MD, president of IDSA. "We must do the legwork now so that we can produce and deploy those vaccines where we need them when a pandemic hits."
Scientists are already developing so called "pre-pandemic vaccines" against the H5N1 strain of avian flu that is currently circulating in Asia and other parts of the world. But influenza viruses are constantly mutating, and no one knows whether that strain will ultimately spark a pandemic, or whether another deadly strain will emerge.
According to IDSA and SHEA, new vaccine science and delivery approaches are urgently needed, and vaccine manufacturers must be involved in those efforts. "There is a critical need for rapid, transparent, and extensive exchange of scientific information among experts, and a novel systematic approach is needed to speed vaccine development," said the groups' comment letter.
"These challenges are surmountable," said Trish M. Perl, MD, MSc, president of SHEA. "We can build on our years of experience developing vaccines for regular seasonal flu. It won't be easy, but immunization is our best chance to significantly cut transmission and save lives."
In the race to develop effective vaccines, it will be essential that we have strong working relationships with countries around the worldespecially in Southeast Asiaso that novel influenza viruses can be detected early enough to develop effective vaccines against them. "Without timely identification and notification of the presence of an evolving viral strain, our efforts to produce a suitable pandemic vaccine will be compromised," said the IDSA/SHEA letter.
Although vaccines will be critical, they should not be the sole focus, because once a pandemic starts, it will take time to develop effective vaccines. "Whether or not a vaccine is available, all of the other efforts will make a difference," said Perl.
SHEA and IDSA applauded the White House plan for clearly designating the Department of Health and Human Services as the lead agency on health and medical response, and the Department of Homeland Security as overall coordinator of operations and resources. "But far more work remains to be doneat the federal, local, and state levelsso that there is clarity about who is in charge of what," said Blaser. "When everyone knows their battle stations, things go better."
More federal guidance is needed to foster a consistent, unified approach to pandemic preparedness and response so that local authorities do not send out conflicting messages that could impede nationwide coordination and shake public confidence. IDSA and SHEA called on federal officials to speedily fulfill their promise to deliver such guidance, and offered to help develop it.
IDSA and SHEA also called for regular drills to ensure that plans that look good on paper actually work in real life. So-called "community mitigation" approaches such as quarantine need to be based on mathematical modeling that is supported by field testing to validate and refine key assumptions. "It is analogous to developing new space shuttles," said Blaser. "You can have all the theory in the world, but then you have to test it, and then go back to the drawing board."
Specifically, IDSA and SHEA recommend that the Centers for Disease Control and Prevention (CDC) convene an expert consensus panel to evaluate the existing evidence related to community mitigation models and consider ways to strengthen modeling efforts.
The two groups also urged more funding for state, local, and global efforts. Although Congress has allocated significant resources for pandemic preparedness, most of the money has come in the form of one-time, emergency funding, and much of it has been offset by cuts in other federal bioterrorism and emergency preparedness funding.
"State and local health departments, hospitals, and other institutions need to be able to sustain their efforts for the long term," said Perl. "That means hiring and training staff, establishing surge capacity, integrating medical and public health systems, and doing a host of other things that require resources."
Source: Infectious Diseases Society of America (IDSA)