As of this week, the Centers for Disease Control and Prevention reports there’s widespread seasonal flu activity in every state in the continental U.S. Though calling seasonal flu an epidemic — as it’s currently dubbed — isn’t uncommon, the reach of the current outbreak exceeds what the CDC has seen in more than a dozen years of tracking seasonal flu.
Influenza, a contagious respiratory illness that can cause symptoms like body aches and a scratchy throat, can be mild to severe. For those who are most vulnerable — like older adults and individuals who have a compromised immune system — there’s an even graver concern: Though its familiarity may lead some to ignore the threat, in less common cases, flu can even cause death.
Virus strains differ, affecting year-to-year efforts to control the flu. But beyond seasonal flu, there’s another threat that looms on the horizon, for which some experts say we’re especially ill-prepared: a flu pandemic, or a global outbreak of a new influenza virus.
The most devastating flu pandemic occurred in 1918 and 1919 when the Spanish flu killed between 50 million to 100 million people worldwide. Not all the details about that pandemic’s spread (including the exact number of deaths it caused) are clear. But experts expect today that a flu pandemic would involve a novel animal flu strain that is able to infect people, and then, through a genetic mutation or other changes to the strain, become readily transmissible from person to person. “That’s the most likely pathway, and that’s what we’ve seen in the past,” says Dr. Tom Inglesby, director of the Johns Hopkins Center for Health Security, part of the Bloomberg School of Public Health, in Baltimore.
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Along those lines, one flu strain that public health experts are keeping an especially close eye on is a bird flu virus in China called H7N9. Though there’s only been limited person-to-person transmission to date, the strain has a case fatality rate of about 40 percent, which is “pretty stunning,” Ingelsby says, compared to a fatality rate of 2 and 1/2 percent for the flu strain involved in the 1918-19 pandemic. “It has not caused sustained transmission,” he reiterates. “But one can easily imagine that if there was sustained transmission in a community or broadly of a virus that had anything even close — even 10 times less or even 50 times less case fatality rate — you would have a global pandemic of extraordinary scale.”
The question is, would the U.S. be ready to take on such a global threat? Many experts say the answer, at present, is absolutely not.
“No, we’re not prepared for the next flu pandemic. There have been many important efforts that have gotten us a little bit prepared in various ways. But overall we would face a lot of very, very serious problems across the country, because our vaccine production process takes time,” Inglesby says. “If all goes well, it takes five or six months to get the vaccine through all the necessary steps of making sure it works and that it’s safe. And then it has to be made in high quantities.”
In a recent New York Times Op-Ed, Michael T. Osterholm of the Center for Infectious Disease Research and Policy at the University of Minnesota and writer and documentary filmmaker Mark Olshaker — who co-authored “Deadliest Enemy: Our War Against Killer Germs” — also assert we’re not ready for a pandemic. Given the century of medical progress since the 1918-19 pandemic, they write, “one might conclude that we are far better prepared today to deal with such a worldwide catastrophe. Unfortunately, the opposite is true.”
Certainly, some strides have been made, says Dr. Michael Jackson, an associate investigator at the Kaiser Permanente Washington Health Research Institute in Seattle. As part of his role at Kaiser Permanente, Jackson is the principal investigator for the United States Influenza Vaccine Effectiveness Network, a project which provides ongoing evaluations of the U.S. influenza vaccination program.
For one thing, he points out, global surveillance of flu has improved, including enhanced sharing of invaluable information between countries. “So there’s a greater likelihood of being able to pick up a new potential pandemic virus early on when it’s first getting started,” Jackson says.
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But the time it still takes to develop a new flu vaccine and the question of how many flu patients the U.S. health system could handle loom large. “If a pandemic virus happens to come from something we already have an eye on like the H7N9 viruses that are circulating in China right now, and where there’s already some preliminary vaccine development that’s been done, I think we’d be in better shape than having something that just shows up new and unexpected,” Jackson says.
The CDC noted in an email that “The United States is certainly more prepared for the next pandemic than we were five or 10 years ago. Since the last influenza pandemic occurred in 2009, we have experienced some particularly severe flu seasons and seen the emergence of H7N9 in China.”
As for criticism the nation’s not ready for the next flu pandemic, the agency added, “Preparedness isn’t a goal you set, achieve, and then you’re finished. Being prepared is a work in progress — each flu season we go through offers us a chance to learn more about the flu virus and how and where it may spread, every time there are shortages of vaccines or antivirals offers us a chance to strengthen relationships with manufacturers and work out issues in the supply chain, and each new vaccine, diagnostic test, or treatment offers us new ways to prevent, test, and treat the ever-changing threat.” The CDC says it and other U.S. Health and Human Services agencies continue to work to increase the capacity for a global pandemic response, also working with international partners in this effort.
“Influenza pandemic preparedness can only be attained through the continued development and maintenance of a robust global influenza surveillance and detection network,” the agency added.
Still, many experts contend that there are not nearly enough resources — financial or otherwise — being allocated for pandemic preparedness. There’s also the tricky business of getting people to sit up and take notice of the threat.
In a world where the word “epidemic” has become commonplace — attached to a growing number of serious health concerns ranging from opioid deaths to obesity — the first major hurdle is “getting the public to believe that the threat exists,” says Leslie E. Gerwin, associate director of the Program in Law and Public Affairs at Princeton University, and an adjunct professor of public health, law and policy at Cardozo Law School in New York City. The second problem: “Is there willingness to accept government recommendations — or even government mandates that would mitigate that risk?” On the one hand, it would make sense to do everything necessary to prevent the spread of a potentially fatal disease; on the other hand, experts note that how far the government is allowed to go to impose, say, quarantines, raises questions about restrictions on personal freedoms.
Taking it all in, orchestrating an organized response in the face of a flu pandemic would be quite a feat — and the difficulty of doing so is all the more reason many public health experts see developing a universal flu vaccine that could protect against many different flu strains as a goal of paramount importance. “The only real solution is a universal vaccine that effectively attacks all influenza A strains, with reliable protection lasting for years, like other modern vaccines,” write Osterholm and Olshaker in the NYT Op-Ed.
“I think that that is a widely held view, that the ultimate solution to this problem is a universal flu vaccine,” Inglesby says. “I think there’s disagreement about the level of effort that is going towards that goal now.” But he says he agrees with the point made in the Op-Ed that much more effort needs to be put into doing just that.
For the public, who aren’t involved in pandemic preparedness efforts, clinicians and public health experts say that whether it’s seasonal flu or a pandemic, it’s key to follow best practices: Get vaccinated (if and when that’s available), get treatment when sick, try to avoid others who are sick and wash your hands regularly to avoid the spread of the virus.
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What’s more, it’s critical to listen to public health advice, including on a local level. Even so, modern factors — like international travel on a massive scale that makes it easier for viruses to spread quickly around the globe today, plus limited capacity to treat a surge of patients — present formidable challenges in the event of a future pandemic. So experts reiterate that as with so many things related to health, the best medicine for a pandemic is likely prevention — in this case, on a global scale.
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Are We Prepared for the Next Flu Pandemic? originally appeared on usnews.com
