Create International Stockpiles of Antiviral Drugs and Vaccines8

A dedicated supply of vaccines and antiviral drugs is necessary for a rapid response to the first cases of a potential pandemic influenza strain (e.g., through ring immunization and/or targeted antiviral prophylaxis). This plan would probably require a smaller investment, and possibly offers greater benefit in relation to cost, than the aforementioned strategy of compensating farmers for preemptive culling of poultry or livestock in areas affected by avian influenza. However, this strategy is unlikely to work unless an international agreement to create such stockpiles is in place when the next pandemic arrives; otherwise, stockpiles and production of vaccines and antiviral drugs are expected to be nationalized. Additionally, these antiviral stockpiles need to be placed in geographically high-volume points of care (e.g., outpatient clinics, emergency rooms, occupational health sites, student health facilities, nursing homes, pharmacies) for rapid access to therapy that does not rely on a visit to a physician for an effective pandemic response. If stockpiles of vaccines are to be developed and relied upon, it is clear that the range of factors contributing to the recent crises in seasonal influenza production and deployment will need to be overcome.

Establish Protocols for Research During a Pandemic9

When the next influenza pandemic emerges, it will be essential to gain a greater understanding of the clinical, epidemiological, and biological nature of influenza—but this will only be possible if research protocols and the laboratory networks to pursue them are established before a pandemic strikes. As Klaus Stöhr of WHO observed, “We have to invest more into planning research, into having protocols ready, and having networks of scientists in place and eager to contribute before the next pandemic virus emerges.” For example, protocols to estimate vaccine efficacy could be implemented immediately upon the commencement of immunization in response to a pandemic, and could even be conducted during the annual flu season.

Goals for Research

Determine the Molecular Basis of Influenza Pathogenesis10

Much remains to be understood about the molecular basis of influenza pathogenesis, host immune response, immune protection, immune enhance-


Brown (2004); Gellin (2004); Hosbach (2004); Longini (2004a); Stohr (2004).


Grundy (2004); see Hayden in Chapter 3.


Taubenberger (2004); Webster (2004a).

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