What H1N1 Tells Us

Here’s the answer: The current H1N1 flu pandemic tells us we need a better, faster way to make flu vaccines.

Monday, Oct. 5 was an important day in the influenza world: It was the day the new H1N1 vaccine rolled out, it conincidently was the CDC‘s official start to the new U.S. flu season (even though H1N1 infections have been on the upswing since mid-August),  and it was nearly 6 months since pandemic H1N1 flu first appeared on the U.S. surveillance radar last April.

electron micrograph of influenza virus/courtesy Frderick Murphy;CDC public health image library

electron micrograph of influenza virus/courtesy Frderick Murphy;CDC public health image library

Despite a remarkable full-court press by the Department of Health and Human Services, the CDC, and others it took almost 6 months to move from the realization that here was a looming problem and possible public-health nightmare to having the first vaccine spray hit a person’s nose yesterday. The delay was long enough to force the CDC’s director, Dr. Thomas R. Frieden, to ask without prompting during a press conference today whether the vaccine arrived too late. In his next breath, Dr. Frieden said no, “it’s too soon to say it’s too late.”

But at least some say it’s been too long. In an insightful editorial released by the BMJ late today, two flu vaccine experts said: “The current H1N1 pandemic illustrates the shortcomings in our capactiy to design and produce vaccines on the scale needed …Vaccinated people may be protected only after the peak of the pandemic has passed …Vaccines and vaccine production need to improve.”

The answer, they went on, may lie in new, cell-based production platforms for flu vaccines, and using flu-protein subunits. In principle, they said, producing protein-subunit vaccines for flu should be “relatively fast and easy,” and it would also ax the need for eggs. They even held out hope for a “universal flu vaccine” that might eliminate the need for making a new vaccine for every novel flu strain that comes along.

Although anything can happen with flu, right now the H1N1 pandemic seems caused by a flu strain that is relatively tame, a fortuitous roll of the dice for us. The 2009 pandemic experience is turning into a fairly benign dress rehearsal for the killer pandemic that’s somewhere down the road. This time around, it allowed the public-health pandemic machine to flex its muscles and show its flaws.  For all our sakes one hopes that lessons have been learned, vaccine-production systems improve, and the next time the machine is called on it will work a whole lot faster.

To read my coverage of Dr. Thomas Frieden’s press briefing on Oct. 6 go here. To read my coverage of the BMJ editorial, go here.

—Mitchel Zoler, Oct. 6, 11:30 PM, Wynnewood, PA (on Twitter @mitchelzoler)

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Filed under Family Medicine, Infectious Diseases, Internal Medicine, Primary care

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