Scientists urge R&D for a universal flu vaccine
Residents of Brisbane, Australia, wear surgical masks in 1919 during the influenza epidemic.
State Library of Queensland
The 1918 influenza pandemic killed tens of millions worldwide and infected a third of the planet. On a smaller scale, the 2018 US flu hospitalization rate ranks highest since tracking began in 2005.
Enterprising reporters are exploiting the obvious news hook: horrendous flu pandemic centennial greeted by hospitals’ temporary parking-lot tents where doctors “triage the hordes of flu patients,” as the Los Angeles Times put it .
Enterprising commentators with scientific stature are capitalizing on something deeper. Expecting that many in the public will seriously engage a scientific argument about a public issue, they’re inviting readers to see how the profound biomedical connections between the story’s two threads prove the pressing need for a universal flu vaccine.
By conferring a high level of long-term or lifetime protection against all flu strains, a universal vaccine would leapfrog biomedicine’s inevitably faulty annual effort to predict—and to prepare a vaccine against—the coming flu season’s specific strain. Potentially even more importantly, it would also mostly neutralize what experts see as inevitable: the threat of another horrific 1918-scale world pandemic arising from a newly evolved strain.
Above the front-page fold on 3 February, the New York Times reported on this year’s consequences of that annual effort’s faultiness. The Times got its page A3 “Quotation of the day ” from this passage:
Dr. Luther V. Rhodes III, [a Pennsylvania] hospital’s chief epidemiologist, said he, too, was frustrated by the flaws of the vaccine, which is expected to be only about 30 percent effective this year.
“Even in a good year, it’s a C-plus, B-minus match, and even the high-test stuff for old people is a joke,” Dr. Rhodes said.
“Tell Tony Fauci to stop saying we need a universal flu vaccine and just do it,” he added, referring to the director of the National Institute of Allergy and Infectious Diseases [NIAID]. “We need a Kennedy-esque go-to-the-moon project.”
Anthony Fauci isn’t among science’s opinion commentators at Nature , Wired , and the New York Times who have called similarly for a Manhattan Project, but he has been exploiting this winter’s news hook all the same. Last month, with three colleagues, he pleaded in the New England Journal of Medicine for R&D on a universal vaccine. The headline’s verb echoes Rhodes’s frustration: “Chasing seasonal influenza.”
This month, with a NIAID colleague, Fauci pressed the need in a Scientific American article . “One approach,” the authors explain, “is to design a vaccine to generate antibody responses to parts of the virus that are common to all influenza strains and do not readily change by mutation.” NIAID’s website distills that approach:
Flu viruses are classified by two proteins on the outer surface of the virus: hemagglutinin (H) and neuraminidase (N). There are 18 different H subtypes and 11 different N subtypes, and viruses can be further broken down into different strains within those subtypes. For example, there are various strains of H1N1 influenza virus. The H protein (also called HA) enables the flu virus to enter a human cell. It is made up of a head and a stem. Seasonal flu vaccines fight infection by inducing antibodies that target the HA head. This region varies season to season, which is why flu vaccines must be updated each year. However, scientists discovered the stem typically remains unchanged, making it an ideal target for antibodies induced by a universal flu vaccine.
Similar distillations recur throughout the media coverage. A vivid, closely related two-minute animation in an Associated Press piece at Time simplifies two concepts central to Fauci’s message. Antigenic drift undermines body defenses’ recognition of flu strains, necessitating annual vaccine updates. But sometimes, as for the 1918 pandemic, there’s a “sudden major genetic change” for which most people have “little or no immunity.” That’s an antigenic shift.
The Scientific American article warns, “The remarkable capacity of influenza viruses to undergo antigenic drift or shift to overcome and escape human population immunity leaves us vulnerable to a public health disaster potentially as serious as the 1918 pandemic.”
In a New York Times op-ed last month, Michael Osterholm and a coauthor energetically amplified that warning. Osterholm is the widely consulted director of the University of Minnesota’s Center for Infectious Disease Research and Policy. The op-ed explains that with burgeoning human and animal populations, and with more than a billion people now annually crossing borders, the planet has become “a potent biologic mixing bowl and natural influenza virus mutation factory.”
“The virus will spread rapidly,” the op-ed warns. In the absence of a universal vaccine, a “1918-type influenza pandemic could cause ruin on the order of what the Black Death did to 14th-century Europe, but on a global scale. Like the Black Death, such a pandemic would alter the course of history.”
The Wall Street Journal in January carried a comparable appeal from Harvard’s Jonathan D. Quick. “A universal flu vaccine would be a triumph for humankind on a level with the smallpox or polio vaccines,” he declared. “Half a dozen major labs around the world are taking alternate approaches,” but “we need more public and private investment.”
Journalists have been investigating the progress of flu vaccine research. Back in October, Science News reported in some scientific detail on hopes for developing a “super shot,” quoting optimistic statements from the Emory Vaccine Center’s Walter Orenstein in Atlanta and from Fauci. Last month, Reuters reported that Vaccitech, a company founded by Oxford University scientists, has begun clinical trials for a universal flu vaccine. CNBC reported that a “handful of major pharmaceutical companies” are supporting research, including GlaxoSmithKline, Sanofi, and a division of Johnson & Johnson.
Will policymakers share in the alarm, responding, as Quick put it, “as if all the fury of a pandemic were bearing down upon us today”? A WSJ review of Quick’s book The End of Epidemics says it may be an uphill battle. “Why worry about the coming plague when a nuclear war seems so much nearer?” laments physician and author Meredith Wadman. “We humans, and our governments, respond largely to the tyranny of the urgent, no matter how deadly more-distant risks may be.”
Steven T. Corneliussen is Physics Today‘s media analyst. He has published op-eds in the Washington Post and other newspapers, has written for NASA’s history program, and was a science writer at a particle-accelerator laboratory.