Interesting perspectives from the Gates Foundation on a pandemic vaccine

The Bill and Melinda Gates Foundation is funding initiatives to support the development (and feasibility) of a vaccine for an influenza pandemic. Tadataka Yamada, the executive director at the foundation, recently co-authored a commentary in Nature, stating their perspective on feasibility:

"Several recent developments make this stockpile feasible. H5N1 vaccines with
adjuvants that reduce the required dose as much as fourfold have been developed
and one has been licensed for medical use. Furthermore, the manufacturing
capacity of 500 million doses is calculated on a requirement for three strains
of flu virus for standard vaccinations; in crisis mode, three times as much
monovalent pandemic flu vaccine could be produced. Together, these
considerations could increase global vaccine production capacity to 5 billion–6
billion doses over 12 months. Moreover, adjuvant-enhanced vaccines may provide
cross-protection against strains that have undergone up to seven years of
genetic drift3. If this is true, appropriate planning, manufacture and
stockpiling of currently effective vaccines might provide the basis for an
immediate response to an H5N1 outbreak."

In detailing how the support needed for vaccines to be a feasible option, they mention the importance of surveillance :

"We must build robust mechanisms; for surveillance of an outbreak of pandemic flu
and for delivering prevention and treatment, particularly vaccines, as quickly
and broadly as possible. There must be full integration of vaccine strategies
with other approaches, and we must coordinate research strategies for dealing
with zoonotic and human influenza infections"

It's very important to keep in mind the goals of our prevention efforts are certainly to prevent a pandemic but we can also hope to stall a pandemic as well, which are global efforts may have already done. Also, the work we do in H5N1 surveillance is just the beginning for emerging infectious disease surveillance systems.

For the full commentary see: http://www.nature.com/nature/journal/v454/n7201/full/454162a.html
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This is only a test

This is just a test, it's not real.

The State of Idaho is running a simulation from a blog, which you can find at:

http://sdhdtraining.wordpress.com/

So far they've posted one fake newscast showing a scenario where the world moves to Pandemic Alert Phase 5. So far, it's a good exercise - check it out.

A global look on avian influenza

Two things happen during the summer: generally, flu news tends to dip a bit and my blogging interns go off to do field work, so a little less posting happens to this blog.

It is a good time to step back and reflect, however. This latest article from Margret Chan "A Global Perspective on Avian Influenza" published Annals of the Academy of Medicine of Singapore
touches on an important point for me: the world has never before tried to prevent a pandemic (of any sorts) at this scale. I think it's very important that we remember just what it is we've set out to do in order that we don't get discouraged when it's not easy.

Abstract:

"Global public health security is both a collective aspiration and a mutual responsibility that demands cooperative action at all levels. The expansion of the current H5N1 avian influenza enzootic and its incursion into human health presents a real and significant threat of an influenza pandemic.

The world has for the first time an unprecedented opportunity for pandemic preparation. Current global efforts to tackle the H5N1 pandemic threat are centred around the framework of the International Health Regulations (2005) that requires countries to openly share disease intelligence including clinical samples, viruses and epidemiological information.

Present international initiatives also seek to establish more equitable allocation and sharing mechanisms for developing countries, of therapeutic resources, public health interventions and other broad-based support in the event of a pandemic.

To be sustainable, country preparatory efforts need to be integrated within wider national emergency preparedness frameworks and emphasise the strengthening of basic capacities in disease surveillance, outbreak response and health systems
that can respond to a range of public health emergencies.

Such capacity building represents permanent investments in health that will have enduring benefits beyond a pandemic. Preparations must also go beyond the health sector; greater promotion of intersectoral cooperation and an adoption of a whole-of-society approach to preparation is recommended.

Broad collaboration is vital in addressing the complex challenge posed by influenza to our collective security."

For more, read:

http://www.annals.edu.sg/PDF/37VolNo6Jun2008/V37N6p477.pdf

Ducks die in Southern Vietnam

The week of July 4th, around 1,000 ducks died in Southern Vietnam (Tra Vinh province). Reports indicate the ducks were not vaccinated and included this comment:

"Although Vietnam has been culling and vaccinating poultry for several years, H5N1 remains endemic in the area and is continuously reported in unvaccinated birds.However, recent reports from Hong Kong and Egypt raise concerns that the current vaccination approaches have limited utility, and the continuing reports of H5N1 in Vietnam may reflect these shortcomings."

It's true that number of countries are looking at the long term sustainability and efficacy of mass poultry vaccination. One alternative option being considered is improved surveillance now that the virus is considered endemic in some places.

http://www.recombinomics.com/News/07080801/H5N1_Vietnam_Persistence.html

Institute of Development Studies plans research on "policy and politics" of the global AI response

A research initiative supported by the Pro-Poor Livestock Policy Initiative will be examining the impacts of the the global HPAI response, the "winners and losers" and how this might impact disease control strategies in the future.

"Dr Anni McLeod, FAO Senior Officer (Livestock Policy), attended the recent planning workshop for this project at IDS. ‘This research comes at a particularly interesting time because the global focus is shifting from Avian Influenza as a single disease and an emergency, to thinking about how we might deal with zoonotic diseases in the future. That is going to require a very good understanding for the political economy in which the diseases are situated and the way that institutions work together to deal with them,’ she said.

‘We have got so much experience with Avian Influenza, there are so many narratives running through this on which we can draw, but there has been very little documentation of those narratives; most of the research that has been done doesn’t take that angle. This is quite a unique project coming at a really interesting time,’ Dr McLeod added.

The research will focus on both the international level, working with the key agencies involved in the global response, and the country level, engaging with four countries in SE Asia – Cambodia, Indonesia, Thailand and Vietnam. The overall analysis of the political economy of policy will reveal key challenges, obstacles and opportunities for responding to avian flu – and potentially other global epidemics. This project is part of a broader initiative of the STEPS Centre on ‘Global epidemics: pathways of disease and response’.

Working with collaborators in international agencies and national programmes, as well as funding agencies, the aim will be to develop a fresh and critical reflection on the current response to the HPAI challenge, asking questions about the distributional and sustainability consequences of the existing policy response"

http://www.ids.ac.uk/go/about-ids/news-and-commentary/july-2008-news/avian-flu

New Resource! Community-based Surveillance Case Study from CARE Vietnam

CARE Vietnam has been at the forefront of our avian and pandemic influenza programming and with them we’ve produced this case study concerning their community-based surveillance system and an outbreak of avian influenza that was caught by CARE trained and supported surveillance volunteers.

Other CARE country offices, including Laos, Indonesia, Cambodia and Myanmar, have also been working to pilot and strengthen community-based surveillance. We are excited about this innovative work that has ramifications for community-based surveillance of many disease, both animals and humans, and could significantly contribute to both current health systems and detection of emerging infectious diseases. We hope to be publishing further case studies on models of community based surveillance in the coming months.

Click here for the case study and check out our previously disseminated work at:

http://icarenews.care.org/avianflu.html