As the H5N1 influenza virus poses a global threat, with outbreaks affecting various species across multiple continents, including the U.S., three worldwide experts in vaccines and public health emphasize the urgent need for comprehensive resources and support to develop a strong strategy to tackle both current and future pandemic influenza risks. They also suggest considering voluntary vaccinations for those who are at risk of exposure.
With the increasing global danger of H5N1 influenza outbreaks impacting a range of species and regions, including the U.S., three international specialists in vaccines and public health argue for the immediate need to enhance resources and support a solid strategy to manage this and potential future pandemic influenza threats, particularly recommending voluntary vaccinations for those currently facing exposure risks.
“At this pivotal moment, the choices we make regarding vaccine development, stockpiling, and distribution will determine our capability to respond to both present and future pandemic dangers,” say Jesse Goodman, MD, PhD; Rick A. Bright, PhD; and Nicole Lurie, MD, MSPH, in a JAMA Viewpoint published on September 4.
The ongoing H5N1 outbreak in North America has impacted poultry, cows, wild birds, and various mammals, with at least 13 human cases, mainly among those on dairy and poultry farms. No instances of human-to-human transmission have been documented.
“It is extremely alarming that this particular H5N1 strain has spread among mammals to an unprecedented degree,” states Goodman. “Although human infections have been relatively mild thus far, the potential for a pandemic is genuine due to the virus’s widespread presence near humans and its ability to mix with human influenza viruses or mutate to enable human transmission.”
Goodman serves as a professor of medicine at Georgetown University School of Medicine and was formerly the FDA Chief Scientist; Bright is a principal with Bright Global Health and was previously the Deputy Assistant Secretary for Preparedness and Response and the Director of the Biomedical Advanced Research and Development Authority (BARDA); Lurie is the executive director for Preparedness and Response at the Coalition for Epidemic Preparedness Innovations and was the former Assistant Secretary for Preparedness and Response at the U.S. Department of Health and Human Services.
In discussing vaccine strategies, Goodman and his team outline various immediate, medium, and long-term actions to minimize H5N1 risks: safeguarding exposed individuals and lowering pandemic risks; updating vaccine reserves and boosting production capacity; and preparing for future threats.
Short term
The authors highlight that the U.S. government is preparing 4.8 million doses of stored H5N8 vaccine, which may provide some cross-protection against the current H5N1 strains.
As a short-term measure, they suggest that “Provided there is adequate supporting data and regulatory approval, the available vaccine(s) should be offered voluntarily to those at exposure risk.” This includes farm workers who have close contact with animals.
Medium term
In the medium term, the authors emphasize the necessity of refreshing vaccine stockpiles with doses that are well-suited to the circulating viruses. The aim is for rapid immunization of at least 20 million individuals, especially crucial workforce members, in the event of a pandemic.
Furthermore, the public health team calls for actions to be taken now to prepare and enhance global pandemic influenza vaccine development and production capabilities. This includes evaluating mRNA vaccines, known for their quicker and more scalable manufacturing processes.
Long term
Looking further into the future, Goodman and his colleagues support investigating pre-pandemic immunization strategies. This could involve vaccinating high-risk groups during intervals between pandemics to cultivate population immunity against potential pandemic strains—a method that, despite being untested, could greatly lessen the effects of upcoming pandemics.
In conclusion, the authors urge elected officials, governments, global partners, and the private sector to tackle H5N1 and other pandemic influenza threats through a comprehensive health strategy aimed at both humans and animals, integrating pandemic vaccines, diagnostics, therapies, and non-pharmaceutical measures. They emphasize that the merging of health and agriculture interests—including the protection of workers, livestock, and economic stability—creates an opportunity to bridge existing gaps.
They finalize their statement by declaring, “The time for decisive action is not when a pandemic strikes, but now, while we have the chance.”
