Wednesday, September 28, 2011

Fourth International Influenza Conference highlights gap between vaccination recommendations and practice

septembre 28 2011
The Fourth International Influenza Conference in Malta underlined the need to forge closer links between science and policy, and to address the ongoing dichotomy between the recognised need to vaccinate at-risk groups and the reluctance of individuals - including health professionals - to comply with WHO and EU recommendations.

EPHA was invited to attend the Fourth International Influenza Conference in Malta, which brought together leading scientists, academics, policy makers and industry representatives active in influenza research, vaccination, pandemic preparedness and health threats from communicable diseases.

The three-day conference was organised by EPHA member - the European Scientific Working Group on Influenza (ESWI).

As a follow-up to the discussion that took place at the First European Influenza Summit held in Brussels earlier this year, and EPHA’s ongoing work on health threats and pandemic preparedness - EPHA to the European Commission consultation on health security in the EU, and the EPHA briefing on health threats from communicable diseases, including well-prepared health systems) - the conference allowed for deeper insights and reflection on vaccination, its history and current uses, as well as on pandemic surveillance, health risk management and risk communication.

ESWI Chair Dr Ab Osterhaus opened the conference by reminding participants of the timeliness to discuss issues related to vaccination and pandemic preparedness in the light of the ongoing ’’lessons learnt from H1N1’’ evaluation, and the likelihood that another pandemic will strike European health systems in the future.

European Commissioner for Health and Consumer Policy, John Dalli sent a video message in which he stressed the urgent need for improved and equitable access of vaccines at EU level. Notably, he announced that the European Commission would present a foundation for a Joint Procurement Mechanism at the end of 2011 so that EU citizens are better protected from cross-border health threats in the future. He also said that the Commission is making an increased effort to work with the Member States and the ECDC to promote vaccination coverage, especially amongst health care workers and people at risk.

To illustrate, Dr Ron Fouchier (Erasmus MC, Netherlands) demonstrated in his keynote speech how the avian H5N1 (’’bird flu’’) virus has evolved substantially as a result of genetic variation, which had led to an increase in disease and death in Indonesia and other countries. The ability of viruses to reassort and undergo antigenic drift (the continuous process of genetic and antigenic change among flu strains) also means that the WHO needs to continuously update its database of vaccines stacks.

EPHA also participated in the new ’’science policy interface’’ made up of seven interactive sessions in which leading scientists presented the latest available data ’translated’ into policy terms by the moderators. Please find some highlights below :

- SP 1 : ’’Why should influenza be a public health priority ?’’

Dr Ab Osterhaus named migrating birds as the source of most influenza A viruses, with an ever-expanding host range (e.g. dogs, horses, etc.) over the years. He also explained how international air traffic routes had compounded the worldwide spread of the H1N1 pandemic. He asked participants to ’’expect the unexpected’’ as influenza viruses could reassort and co-circulate with seasonal flu, in the process changing their virulence and acquiring antiviral resistance. He said it was not a question of whether there would be another pandemic but of when it would happen.

Dr Caroline Brown, Programme Manager at the WHO Regional Office for Europe elaborated on the WHO recommendations to protect at-risk patients (especially health care workers, pregnant women, and those aged 6-months+ with underlying chronic conditions) and presented the preliminary results of a survey on pandemic vaccination policies and coverage in WHO MS. The survey uncovered some common reasons for refusing to vaccinate, such as doubts over vaccine safety and pandemic severity, lack of health workers’ confidence in vaccine efficiency, and sketchy risk communication. The WHO would therefore place increased emphasis on targeted campaigns for risk groups, availability of vaccination, and improved communication to the public, which also included working with the media.

- SP 2 : ’’Misconceptions in Influenza’’

This session served to discuss the widespread public confusion over influenza given that many other respiratory illnesses displayed similar symptoms. As a result of this, a lot of people are reluctant to take vaccines, either because they believe that they do not not work or out of fear that they will get (instead of combat) seasonal flu as a side effect. Furthermore, many people do not view the flu as a severe enough disease to worry about, especially those not belonging to at-risk groups. The session also compared the different approaches to health worker vaccination in the USA and in Europe (e.g., the policy of HCW vaccination or mandatory use of face masks in the States). The panel of international flu experts admitted that vaccines are never perfect and need to be constantly improved, however the evidence was clear that fewer lives are lost as a result of vaccination.

- SP 5 : ’’Will there be another flu pandemic ? Should we be prepared ?’’

Dr Sylvie Briand from the WHO informed the participants of the lessons learnt from the 2009 H1N1 crisis for improving pandemic preparedness. She argued that overall, a broader multi-hazard approach was needed given that some actions were common to all crises (e.g., risk communication). The response to a pandemic has to be 1) sized to the threat, 2) flexible over time, and 3), preparatory efforts have to be maintained over time so that gaps do not occur, especially in economically challenging times. Given that it takes 4-6 weeks to produce a flu vaccine, it is crucial to strengthen the health system response, including the use of antivirals for which the WHO has developed new guidance. She also underscored the need to improve access to vaccines and antivirals as per the Pandemic Influenza Preparedness Framework adopted in May 2011 at the 64th World Health Assembly.

John Ryan, head of DG SANCO’s health threats unit at the European Commission traced the EU’s increased involvement in coordination measures in pandemic preparedness since the 1990s, including the Early Warning and Response System set up in 1998, and the 2005 EU pandemic preparedness plan which took into account the WHO’s revision of pandemic phases and the creation of the ECDC. The EU had a role to play in monitoring and assessment (mainly through the ECDC, which prepared risk assessments), but also in prevention and mitigation. While Member States decided their health system responses at national level, the EU provided preparedness coordination (e.g. health system response plans, hospital emergency plans). Regarding communication, the EU also had public communication plans for each phase and level, and it provided media briefing materials, and strategically deployed the ECDC and the Council’s Health Security Committee. The 2008 Council Conclusions re : upgrading pandemic preparedness planning were followed in 2010 by a call for the inclusion of the joint procurement of vaccines, which was in the process of becoming a realilty, something that had already been achieved in Asia . Ryan stressed that the 2011 Health security initiative included pandemic preparedness so that it would become obligatory at Member State level and the EU can match the legal framework of the WhO International Health Regulations (IHR).

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