Senior Specialist in influenza, co-author of the “Human Virology”, world-renowned scientist, Professor John Oxford, arrived at the SPbSRIVS FMBA to give a lecture to the employees. The lecture by Dr. John Oxford was dedicated to virology and partly its history, with a focus on the Spanish influenza of 1918.
A century ago, Russia, as well as the rest of the world, was gripped by an influenza pandemic. In 1918-1919, as much as 30% of the global population was infected with the Spanish influenza. About 50 million people, or 2.7% of the population at the time, died, which made that epidemic one of the largest disasters in human history. This explains our vision of the influenza virus as a major threat, explains Professor Oxford in his lecture. “This is why you work here and why this facility was built.” The age group most affected by the influenza virus was rather small and limited to men and women aged 27-29.
Until now, scientists have been trying to find out why the influenza killed people in this particular age group. Scientists are still unsure why this particular group of people was affected. However, when asked this question by the audience, the professor suggested the following: “According to the first theory, before the age of 27, the immune system is not so strong, and after 29 it already begins to weaken. It appears that at the age of 27-29 we are best protected against viruses. In fact, it’s even too good and can overreact. In other words, a “storm” of deadly chemical processes can occur. According to another theory, elderly people, who are usually more prone to death from influenza, had already experienced a influenza pandemic and developed good immunity. This age group made only 1% of the deaths.” Since 1919, scientists have been collecting clinical samples such as pieces of the lungs of the influenza fatalities, now scattered in museums around the world. Actually, Professor Oxford has been investigating these samples with a view to recreating the virus using the polymerase chain reaction.
Professor Oxford believes that, despite the name “Spanish influenza”, the disease originated not from Spain, nor even from China, as some scientists supposed, but from the Western Front during the First World War, among French, German and British soldiers. In theory, pandemic influenza was spread by migrating wild geese. However, it appeared that wild geese transmitted the virus to domestic geese, and they, in turn, infected people. The professor suggests that the epidemic originated from France, in one of locations where pâté de foie gras was produced. Finally, the virus reached the United States. It might have been brought by American volunteer doctors who helped at the front.
In his lecture, John Oxford pointed out the superhuman effort the scientists had to make to obtain samples: “They did not have the capabilities that modern molecular genetics and virology provide. Still, they believed that someone in the future – that is, you – would analyze these samples and be able to explain why 50 million people died. What did they end up with? They managed to create a vaccine. Your challenge now is to prevent a future pandemic. Scientists of that generation had no chance of preventing it because they had no vaccines. And that's why you should be proud to work on influenza prevention.”
On the same day, the staff had a lecture by Bram Palache, an expert on the influenza vaccine availability. Dr. Bram Palache is a Founding Member of the International influenza Vaccine Supply (IVS) Group at IFPMA, Board Member of the European influenza Working Group, and the Founder of FluPal Consultancy. Bram Palache visited the production facility of our Institute and highly commended our commitment to the Good Manufacturing Practice principles (GMP). After a tour around the plant, the guest from the Netherlands gave a lecture to the employees. The lecture spotlighted several important industry-specific topics. In particular, the professor stated that influenza, a preventable worldwide disease, is not being prevented as effectively as possible. Dr. Palache finds such a situation alarming as it affects both the public health system and the possibilities to control a future pandemic. In his presentation, Dr. Palache delved into the contradictions in the use of vaccines.
To summarize, we come to the following conclusions: We have been facing a worldwide infectious disease. We have an effective vaccine to prevent it (Dr. Palache pointed out that WHO recommendations for the use of vaccines are based on evidence-based medicine). We have recommendations for using the vaccine. However, we are not using our capabilities to the full. To date, not enough people are vaccinated against the seasonal influenza. The expert believes that it is the healthcare professionals who can decisively contribute to solving this problem. This situation partly results from lack of awareness among the patients as many doctors still fail to duly encourage them to get vaccinated. “With the current demand for seasonal vaccines, we won't have enough manufacturing capacities to start producing the adequate amount of pandemic vaccine when needed.” Due to its specifics (the accuracy of predicting circulating strains of the virus), the effectiveness of influenza vaccine varies from year to year and ranges from 10% to 70%. Dr. Palache proposed to imagine that the vaccine is only 10% effective (in fact, it is many times higher).
This poses the question: whether it is worth making a vaccine that is only 10% effective. And yet, the research shows that even with this effectiveness, we can save 7,000 lives out of 1 million people vaccinated against the influenza. Dr. Palache concludes that, even in the worst year, when forecasts for dominance of strains did not come true, vaccination is necessary. Suffice it to say that the effectiveness of the vaccine is still not zero. The benefits of vaccination are underestimated if we assess the effectiveness in percentage terms only. It is necessary to take into account the number of deaths that we have prevented. At the workshop, the staff also learned about how WHO decides when to start production of a pandemic vaccine and discussed the Nagoya Protocol with Dr. Palache. He shared misgivings about the benefits for vaccine manufacturers. Sometimes, instead of immediately sending pathogens to manufacturers around the world following the WHO forecast, countries that have the right pathogens and have ratified the Nagoya Protocol have to spend their limited time on negotiating. This decelerates production. “The protocol mechanism is good for biodiversity, but it is disastrous for vaccine manufacturers. At the moment, there is a heated discussion of this protocol between the WHO and manufacturers. Incidents of delayed vaccine deliveries have already been reported because of this protocol. ” Dr. Palache expressed concern that the WHO could come to a compromise solution in order not to disrupt the timelines of national vaccination calendars and thus opt for the faster available strains, rather than those most likely to be relevant in the new epidemiological season.
