The next influenza pandemic is a case of when, rather than if. In the last major influenza pandemic in 2009, 201,200 people worldwide died.
The UK is now leading the world in how it prepares for such outbreaks, thanks to an innovative network of health research studies being kept in “hibernation”, ready to be activated the moment an outbreak strikes.
The approach is a more efficient alternative to the previous practice in the UK. It involved waiting for a pandemic to hit before instigating studies that then struggle to get up to speed quickly enough.
The new approach holds promise elsewhere in the world as well as for other health emergencies, including other infectious diseases and chemical, biological and radiation incidents.
Pandemic flu preparedness
We outline the development and benefits of the hibernated studies in an article published today.
This initiative followed the UK’s experience during the most recent flu pandemic, the 2009 A/H1N1 strain, commonly known as “swine flu”. It caused at least 3,700 deaths in the UK and 201,200 worldwide. It was a variant of the “Spanish flu” strain that killed over 50 million people globally in 1918.
In 2009, the National Institute of Health Research (NIHR) rapidly sponsored and activated studies to inform clinical and public health responses to the outbreak. Even with accelerated processes, some were completed too late to have a significant impact. Some studies suffered from inherent delays in calling for proposals and in assessing, funding and setting up subsequent projects, including obtaining relevant ethical and regulatory approvals.
Research ready to go when needed
Major research networks in other countries shared the experience. In 2012, the NHIR set up a suite of studies to be maintained in a state of readiness for activation in the event of another flu pandemic. The eight studies include key care and public health aspects of a flu pandemic, including surveillance, vaccination, triage and clinical management.
One study is to develop rapid turnaround flu phone surveys to monitor behaviour across the general population and identify ways to better communicate public health advice. Another is to advance real-time modelling of flu epidemics and provide a tool to monitor and predict the development of an ongoing pandemic.
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After seven years, these studies are now mature and, we believe, illustrate the value of the potential for rapid research, as well as clinical and public health response, in a future flu pandemic.
Hibernation has raised a number of issues, reflecting the need to keep stakeholders (including policy makers and those hosting the research) engaged and to keep studies up to date in terms of research regulations, scientific and social changes, and technological advances.
One of the network’s benefits is the spirit of cooperation. All too often researchers are in competition when trying to answer research questions in an emergency situation. The research response to the 2014 Ebola outbreak in West Africa was late and then inappropriately competitive. This resulted in several underpowered and unsuccessful studies. In contrast, the UK model allows for advance funding and planning of complementary studies, system testing and developing a collaborative network of researchers.
The challenge ahead is for commercially funded studies not to compete for scarce resources and to fit within this framework to ensure the highest quality studies are conducted most expediently. With this in mind, now might be the time for an international register of planned pandemic and emerging infection studies with agreements about collaboration.
Authors: Colin Simpson, Professor of Population Health, Victoria University of Wellington