Vaccine effectiveness numbers for this year’s flu season have yet to be released, but experts are already looking at flaws in the vaccination process, and how improvements can be made.
“We’ve become a little bit used to the idea that the flu vaccine is not a great vaccine,” Marc Lipsitch, DPhil, professor of epidemiology at the Harvard T.H. Chan School of Public Health in Boston, said during a forum Tuesday hosted by Harvard, Public Radio International’s The World, and WGBH.
“We have to target the right strains, and even when we get it right, it’s not always effective. And we don’t produce [flu vaccine] fast — we produce it in eggs, which is an old-fashioned way to produce vaccines,” Lipsitch stated.
In addition, the medical community faces significant challenges in upcoming flu seasons, according to the expert panel at the forum. Despite potential cuts to CDC funding, they said they hope for increases in vaccine development and influenza research.
As the universal flu vaccine may be years away, Lipsitch pointed to a number of short-term improvements to existing tools researchers have to develop vaccines. Specifically, he cited “a more scientific process” for choosing the strains in the vaccine, including “understanding the evolution of the virus and using computational tools to predict what flu strains are coming.”
“There is beginning to be a move from egg-based to a cell culture-based production system, which is in principle both faster and less likely to cause changes in the virus,” he added.
Panelist Yonatan Grad, MD, also of Harvard, said that a flu vaccine that can “elicit strong immune responses” continues to be one of the challenges.
“Understanding the types of influenza that individuals have seen” and how that impacts “their susceptibility to subsequent flu exposure will help us understand how to build a better vaccine,” he said.
Additional therapeutics for severe influenza are also needed.
“Right now, we’re focused on one class of antiviral drug, but we should be looking at combination therapies and other modalities, such as host-directed therapies,” said Timothy Uyeki, MD, of the CDC in Atlanta.
But bigger and better research requires funding, and several panelists expressed dismay at President Trump’s proposed budget that would cut funds to the CDC.
Lipsitch also pointed out that the CDC is going to reduce its presence overseas. Uyeki said that this could impact the U.S. involvement in the World Health Organization’s Global Influenza Surveillance and Response System.
Global researchers have used this system to “share data on viruses, including novel influenza A viruses of pandemic potential,” he explained. This data has been used to make recommendations for influenza vaccines, and these cooperative agreements have helped build influenza surveillance and response capacity, he added.
“We’re trying to understand the impact of influenza and improve surveillance. There have been a lot of improvements in the last 10 to 15 years, but we need to do much better. A lot of this takes a lot more funding,” Uyeki argued.
Lipsitch added another caution about “misplaced” research priorities, citing the recent reinstatement of federal funds for a type of experiment that artificially enhances flu viruses in the lab to understand how they become pandemic strains.
“This really puts us at risk of a dangerous accident without helping our flu preparedness,” he said.
There is some good news: Public initiatives continue to try to reduce the barriers to vaccination, noted Alfred DeMaria, MD, of the Massachusetts Department of Public Health. He cited pharmacy-based immunizations and a Massachusetts program where every patient is offered a flu shot at hospital discharge.
Nonetheless, DeMaria said public health officials spend a lot of time trying to “counter the myths that are out there” about vaccines. “You have to point out to people that if you don’t get a flu shot, it’s 100% ineffective,” he said.