Pandemic and Avian Influenza Vaccines: Global Collaboration for Prevention, Mitigation, and Intervention, A Strategic Initiative for Implementation via International Engagement Critical Analysis—A Systematic Review and Summary with Recommendations for Program Planning and Policy Development
Creators: name: Friend, Evan T.
Publisher: name: The University of North Carolina at Chapel Hill University Libraries
Year: 2007

description: The objective of this paper is to examine the potential for international collaboration in order to maximize prevention and mitigation efforts with respect to pandemic influenza preparedness and response. It is imperative that international leaders and experts become exquisitely engaged in efforts to prepare for this potentially devastating event. Successful mitigation of a pandemic depends upon incorporating the use of vaccines in a preemptive fashion. International organizations, backed by the political and economic will of the U.S., must take a more active role via the establishment of an effective partnership along with a true commitment toward sustaining these efforts over the next decade. If the generation of a novel virus strain occurs with the dramatic ability to efficiently infect the world population, sustained human-to-human transmissibility may progress to a worldwide pandemic, affecting populations on a truly global scale. The case-fatality rate for H5N1 in humans is still over 65% as of June 2007 . The H5N1 virus strain has not only evolved, but has already spread to over nine countries in Southeast Asia and East Asia. The ―Great Influenza‖ of 1918 was caused by the emergence of a pandemic strain of avian origin similar in process to the evolution of H5N1. Most experts consider vaccines to be the primary means to both prevent and mitigate the health consequences of pandemic influenza. Medical interventions, including vaccination and antiviral treatment prophylaxis, and non-pharmaceutical interventions may be utilized as mitigation strategies. Swift and targeted antiviral prophylaxis combined with prepandemic vaccination may achieve containment of a pandemic even if only moderate protection is provided by vaccination. An emergent strain may strike via multifocal outbreaks in various regions spread out over several countries, thus a global strategy is needed which incorporates prevention with vaccination as the cornerstone, to be utilized optimally both prior to and during pandemic onset. Vaccination represents the only medical intervention strategy which may be instituted proactively. An ideal approach involves a sequential ―two-step‖ strategy consisting of a ―universal‖ or crossprotective vaccine as a primer for prevention, followed by a subsequent strain-specific vaccine for mitigation during a pandemic. Production capacity may be improved through ―antigen-sparing‖ strategies which utilize immunogenic adjuvants. Even moderate levels of protection may prevent or decrease transmissibility, severe disease, and death. The ultimate prepandemic priming vaccine may be a bivalent product which would provide cross-protection against more than one clade of H5N1. ‗Coping capacity‘ for all nations would be bolstered by accelerated development of pandemic vaccines and expanded production capacity. Availability of a pandemic vaccine must become an absolute priority, resting squarely at the top of the international agenda. Nations need to have the opportunity to acquire sufficient pandemic vaccine supplies, and priorities must be established for global vaccine distribution. The Global Pandemic Vaccine Challenge is to define the most antigen-sparing formulation that guarantees the production of the largest number of doses of an economically viable pandemic vaccine. The most significant hurdles are organizational, logistical, and political. Vaccine efforts may be strengthened by a Multinational Pandemic Influenza Vaccine Master Program backed by U.S. leadership. A preferred policy initiative is one which supports a ―two-step‖ process involving the best possible prepandemic vaccine as a primer, whether it be mismatched but cross-protective or a true ―universal‖ vaccine, followed by only one dose of a ―strain-specific‖ vaccine with a more manageable temporal window after pandemic onset. The global population will need to find inspired leadership quickly in order to execute better pandemic influenza vaccine policy. Real leadership needs to be proactive, and mechanisms to achieve consensus among governments must be sought with the U.S. and other developed nations leading the way, in concert with international partners worldwide. ―Influenza Vaccines for the World‖ must become a shared vision among political and public health leaders alike, along with pressure from the international community to address issues of equity and transparency of the overall process. International coordination and distribution of vaccine resources are crucial for the effective implementation of pandemic vaccine policy. The public health principle of ―the greatest good for the greatest number‖ must always be kept in mind, as the utilization of a priming prepandemic vaccine as part of a comprehensive vaccine strategy can maximize the chances of successful prevention and mitigation of a pandemic through hopefully, a confluence of, as opposed to a conflict of, global interests.