An influenza pandemic like the pandemic of 1918 could be even worse than COVID-19 has been, and the world is not ready to deal with it, the National Academy of Medicine said in a series of reports released Wednesday.
Work needs to begin now to start developing next-generation vaccines, and to build up capacity in low- and middle-income countries so they can make their own vaccines without relying on wealthy nations to make them available, the reports recommended. And governments need to figure out how to make sure companies have the incentives to work on these vaccines without knowing whether they'll ever be used or needed.
COVID-19 has been terrible, the Academy, an independent body that advises the U.S. federal government on matters of medicine and health, said in the first of the the reports.
"Yet, from an epidemiological perspective, COVID-19 does not represent a 'worst-case' pandemic scenario, such as the 1918-19 influenza, which resulted in at least 50 million deaths worldwide," the report reads.
Flu kills anywhere between 290,000 and 650,000 people a year in a normal year, according to WHO. COVID-19 has killed 5.1 millon people globally. The next influenza pandemic could kill 33 million people, the Academy said.
It's hard to predict when a new flu pandemic might hit — but it's certain one will come.
"Influenza pandemics have occurred repeatedly, and experts worry that the risk for an influenza pandemic may be even higher during the COVID-19 era due to changes in global and regional conditions affecting humans, animals, and their contact patterns. While it is difficult to predict when it will occur, a major influenza pandemic is more a matter of 'when' than 'if,' " it added.
One major recommendation: a global "moonshot" to develop a universal flu vaccine that would protect people against current and future flu strains. Current flu vaccines must be reformulated regularly, tweaked every year, and do not protect against emerging new strains that might cause pandemics.
And this needs to be done as a matter of global coordination.
"We have too many gaps, and too much is dependent on underfunded, often informal arrangements," one of the reports reads. "Against the scale of the threat, we are woefully underprotected. We urgently need to strengthen our collective defenses against pandemic influenza and must do so in a way that is sustainable."
One report recommends having 4 billion to 8 billion doses of influenza vaccine ready to go just in case.
"Preparedness has to be an ongoing commitment — it can't be year to year, or crisis to crisis," Dr. Victor Dzau, president of the National Academy of Medicine, said in a statement. "COVID-19 has enabled the emergence of new capabilities, technologies, collaboration, and policies that could also be deployed before and during the next influenza pandemic. It's critical to invest in science, strengthen health systems, and ensure trust in order to protect people from the health, social, and economic consequences of seasonal and pandemic influenza."
One report specifically recommends that the National Institute of Allergy and Infectious Diseases, the Biomedical Advanced Research and Development Authority, the Department of Defense and other agencies invest in research now on new and better flu vaccines. "This will allow selection of the candidates most fit for purpose to be brought to authorization and sufficient production and distribution to optimize the control of influenza across diverse settings and phases of pandemics and epidemics," the report read.
"The World Health Organization should advocate and coordinate with multilateral stakeholders (e.g., the Coalition for Epidemic Preparedness Innovations), governments, funding agencies, the vaccine industry, and philanthropic organizations to build global capacity for robust and internationally comparable preclinical, clinical, and immunological assessments of influenza vaccine candidates, including novel candidates that use innovative structures, targets, and delivery systems to potentially broaden or improve protection," it added.
One of the reports notes that the COVID-19 pandemic has shown that face masks and physical distancing contributed to the dramatic reduction of influenza activity globally. "Face masks would be simple and cost-effective during the next influenza pandemic, and public health agencies should mandate their use, when justified by the severity and incidence of influenza," the Academy said in a statement.