The wave of human infections with the H7N9 avian influenza virus that began in China in September 2016 has again raised alarm about the threat of a pending influenza pandemic. The Pandemic Influenza Preparedness Framework has worked in innovative ways to prepare the world for such an event. As an additional capacity-building measure, WHO established a Global Action Plan for Influenza Vaccines in 2006 to address the projected serious shortfall of vaccine supplies during the next pandemic.
The plan, which was intended to operate for a decade, set out a three-pronged preparedness strategy: improve the use of seasonal vaccines, increase vaccine production capacity, especially in the developing world, and promote R&D for better vaccines and vaccine production technologies.
Its achievements have been significant. Studies over the past 10 years, documenting the burden of seasonal influenza, have encouraged 115 countries to put in place national policies for increasing the use of seasonal influenza vaccines, up from only 74 in 2006. Making good use of seasonal influenza vaccines not only protects health. It also provides the market incentive needed to increase production capacity and builds the delivery infrastructure that will be critically important during a pandemic.
In 2006, WHO estimated that global pandemic vaccine manufacturing capacity was around 1.5 billion doses per year, with all capacity concentrated in a few wealthy countries. A decade later, that capacity has more than quadrupled to reach 6.4 billion doses. An innovative technology transfer initiative brought the funding and technical support needed to establish 14 vaccine manufacturers in developing countries. Six of these countries have licensed locally produced influenza vaccines, of which three have been prequalified by WHO. Other countries are making steady progress towards this goal.
"The ideal product – a universal vaccine that protects, year after year, against both circulating seasonal strains and a pandemic strain – remains elusive."
Dr Chan, WHO Director-General
WHO has further worked to strengthen expertise in the national regulatory authorities of all 14 countries. Here, too, progress has been substantial. In 2006, only four of these countries had a functional regulatory authority. Now ten do.
This progress highlights the synergy between the Global Action Plan for Influenza Vaccines and the Pandemic Influenza Preparedness Framework, which has an investment stream for strengthening the capacity of national regulatory authorities.
Vaccines and their production technologies also improved. Numerous advances include adjuvanted pandemic vaccines that permit dose-sparing and conserve the use of antigen, live attenuated vaccines with improved production efficiency and significant operational advantages, tetravalent vaccines with broader strain coverage, and tissue-culture and recombinant vaccines that avoid the need for huge quantities of eggs in the production process and can thus be produced more quickly and efficiently. However, the ideal product – a universal vaccine that protects, year after year, against both circulating seasonal strains and a pandemic strain – remains elusive.
Nonetheless, all of these improvements have left the world vastly better prepared to respond quickly, and with benefits fairly shared, when the next influenza pandemic inevitably begins.