100 years after the influenza pandemic — are we prepared for another epidemic?

100 years after the influenza pandemic — are we prepared for another epidemic?
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One hundred years ago this month, Private Albert Gitchell, a company cook at Camp Funston-Fort Riley Kansas, woke up with a high fever, chills, aches, pains and a sore throat. He staggered down to the military camp’s infirmary and was admitted.

Within three weeks, 1,100 soldiers at Fort Riley were struck down and hospitalized with the same symptoms — the first clearly identified record of the catastrophic 1918 Influenza pandemic; one that would go on to claim the lives of up to 50 million people worldwide and infect a third of the world’s population.

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Now 100 years later, our capacity to protect ourselves is vastly improved but we are still remarkably vulnerable to an outbreak of a deadly virus. While our scientific understanding of epidemic-causing pathogens has grown significantly (in 1918, scientists had yet to isolate the influenza virus) it won’t be enough, as has been shown again and again in the epidemics since the Spanish flu.

 

For example, the Ebola virus was discovered in 1976, but the experience we gained with the virus over nearly 40 years was not sufficient to prevent the deaths of over 11,000 people during the devastating West Africa Ebola outbreak of 2014 and 2015.

The world was woefully underprepared for Ebola in 2014. It was the inadequacy of the world’s response that led directly to the creation of the Coalition for Epidemic Preparedness Innovations (CEPI), an innovative partnership between public, private, philanthropic and civil organizations, founded last year by Norway, India, the Bill & Melinda Gates Foundation, Wellcome and the World Economic Forum.

Our goal is to finance and coordinate vaccine development to protect ourselves from future epidemics. It offers a new approach to the age-old problem of emerging infectious diseases: an approach that is systematic, coordinated and global; one that leverages the scale and expertise of both public and private sectors to improve the world’s response to the threat of epidemics.

The reason we need this now more than ever is that pathogens are spreading faster and emerging more frequently than ever before due to ecological changes, urbanization and increased mobility. Every emerging infectious disease is just a plane ride away, as we saw when Ebola arrived in Dallas in 2014. This threat affects us all.

In 1918, the pandemic impacted every continent and the world became “a vast incubator of disease.” Today, a virulent respiratory virus spreading as fast as influenza could reach all major global capitals within 60 days. 

A recent GAO report notes that the U.S. Army has estimated, “that if a severe infectious disease pandemic were to occur today, the number of U.S. fatalities could be almost twice the total number of battlefield fatalities in all of America’s wars since the American revolution in 1776.”

I know from my time as deputy director and chief medical officer of Biomedical Advanced Research and Development Authority (BARDA) at the U.S. Department of Health and Human Services and leading medical countermeasure development programs at the National Institutes of Health, how seriously this country takes its commitment to planning for and responding to epidemics. 

But it’s urgent that, collectively, we do a better job than we have in the past of preparing for emerging infectious diseases. We know this is challenging. The research and development (R&D) required is complex and lengthy, the market potential for needed products is limited, and testing vaccines against such threats is complicated given how sporadic and unpredictable outbreaks are. For example, Ebola was not known to have occurred in West Africa before the 2014 and 2015 outbreak.

Our role is to fill the gap when market forces fail to drive needed vaccine development for priority threats. It does this in two ways. First, by moving vaccine candidates from preclinical studies through to proof of concept and safety in humans, we will be in a much better position to test the effectiveness of these vaccines at scale should an epidemic threaten.

We will have small investigational stockpiles ready for use in an outbreak. This is what we call a “just-in-case “ approach to better preparedness. Second, we will also fund the development of new platform technologies for the rapid development of vaccines against new and unknown pathogens, for a faster response.

We have moved fast since its founding last year. It has already made its first major investment to advance vaccine development and manufacturing on two infectious diseases, Lassa fever and MERS, which are among our highest priorities. This could not be more relevant given the ongoing Lassa fever outbreak in Nigeria, which is believed to have infected nearly a thousand people this year.

We cannot prevent pathogens from emerging, but we can prevent the devastation they can cause, through better preparedness and a faster response. To be most effective, however, we need to work together. U.S. citizens will benefit from the world’s collective efforts to prepare against pandemics because, as we learn again and again, dangerous pathogens do not respect borders.

Richard Hatchett M.D. is the CEO of the Coalition for Epidemic Preparedness Innovations (CEPI) and former acting director and chief medical officer for the Biomedical Advanced Research and Development Authority at the U.S. Department of Health and Human Services.