A more severe flu pandemic is as inevitable as “death and taxes”

BMJ 2010; 340 doi: (Published 25 June 2010) Cite this as: BMJ 2010;340:c3410
  1. Jo Carlowe
  1. 1London

    The next flu pandemic could be more severe than the H1N1 pandemic of 2009, health experts have warned.

    Maria Zambon, director of the Health Protection Agency’s Centre for Infections, borrowed from Benjamin Franklin when she suggested that the emergence of new pandemics was as certain in this world as “death and taxes.”

    Professor Zambon was summing up the Health Protection Agency’s Pandemic Influenza Conference held in London on 21 and 22 June, which explored the world’s response to a 21st century pandemic.

    Earlier in the conference Nancy Cox, director of the Influenza Division of the US National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, had said that she expected the H1N1 virus to change within the next year.

    Gordon Duff, chairman of the UK Scientific Advisory Group for Emergencies, said all the agencies involved needed to remain vigilant.

    “We really need to be in observational mode with every tool that is available,” he said. Among the “tools” he listed were bioepidemiological surveillance; quick assay development; virology to monitor changes in viral genome, sensitivity to antivirals, and to ascertain the best vaccine seeds; and good community surveillance and hospital data collection.

    The experts acknowledged that as challenging as the 2009 pandemic had been—it could have been a lot worse.

    Angus Nicoll, influenza coordinator for the European Centre for Disease Prevention and Control, said from a European perspective there were many positive features about the 2009 pandemic including immediate virus sharing to enable rapid test and vaccine development and learning from experiences in North America and the southern hemisphere.

    “Europe managed the pandemic moderately well but we were very lucky in what we had and yet we should have done better, probably,” he said, warning that next time an acute health threat may be “far less forgiving.”

    Professor Nicoll called for greater flexibility in the system and better sharing between countries. Others highlighted the importance of allowing for planning at a more local level given regional variations in the spread and severity of the pandemic.

    In addition the conference was told of new approaches, such as the use of antibody treatment, but old ideas were not ruled out. For example, the experts revisited the concept of original antigenic sin—the idea that the body has the propensity to preferentially use immunological memory based on previous illnesses.

    “Ideas get recycled having gone into a black hole for 30 to 40 years,” said Professor Zambon. “This latest pandemic will cause us to look at original antigenic sin,” she said noting that it was time to think out of the box particularly during this age of “financial austerity.”


    Cite this as: BMJ 2010;340:c3410

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