Questionable parenting practices? Yeah. But our dinner conversations are amazing and spark the level of curiosity and appreciation in public health that I wish more people had, especially right now.

About three weeks ago, my kids saw that I was a little worried about something. Instead of telling them outright, I turned to our old game and asked them to tell me what they thought was the scariest disease.

Most people would go for Ebola because of its Hollywood-level freak out potential. Cholera is very scary as well, and an awful way to die. But my kids know by now that there’s one blue ribbon winner in my book when it comes to very scary diseases: Influenza.

Not garden-variety seasonal influenza. No, I’m talking about pandemic level influenza, like the 1918 pandemic flu that killed an estimated 50 million people and sickened a fifth of the world’s population.

This strain of influenza is the stuff of nightmares. A disease that spreads so rapidly that 2-3 healthy people could get infected by one sick person. A disease so deadly that it turns our own immune system against us, tricking it into a massive overreaction called a cytokine storm that either kills us or lays waste to our natural defenses so that that infections like bacterial pneumonia just waltz right into our bodies.

It’s why in 1918 the healthiest people often died the fastest: as in showing up for work in the morning and dead by night kind of fast. In places like Baltimore, Philadelphia, Seattle and countless corners of the world, the Great Influenza killed so quickly and debilitated people so widely that basic services broke down. In scenes reminiscent of Medieval times during the Bubonic Plague, when families were asked to bring out their dead, there were instances of bodies being stacked in the streets of America’s major cities.

And just like Bubonic Plague, where victims near death displayed the tell-tale, malodourous rash of “Ring around the Rosie” children’s song fame, care providers in 1918-19 watched as patients who were near death turned blue from oxygen failing to get through disease-ravaged lungs.

Here’s another little-known twist: Most people refer to the 1918-19 pandemic as the Spanish Influenza, assuming that was where it originated. But that’s not the case. Because of World War I, most of northern Europe was in a news blackout and didn’t report that thousands of soldiers engaged in fighting there were falling sick. Spain was the first European country to report on the emergence of the new disease, earning the unfortunate label as the epicenter for the pandemic.

There is general consensus among global health experts and historians that the true origin of the Spanish Influenza was likely thousands of miles away from Spain. It’s one of the many inconvenient truths that was glossed over in the midst of all the finger pointing and xenophobia directed to China during Covid-19: The deadliest plague in modern human history started just over a century ago not in a lab or a crowded urban tenement, but on a pig farm in the middle of Kansas, USA.

Which is why I’m watching the pigs now.

On October 29, the U.S. Department of Agriculture detected the first known transmission of H5N1 avian influenza to pigs on a small backyard farm in Oregon where poultry had been infected and euthanized recently. While certainly not a reason to panic, this milestone was alarming enough that I couldn’t disguise my concern during family dinner three weeks ago.

There are several reasons why we should all be keeping an eye on where H5N1 goes next.

First, think of pigs like a Vitamix for whirling around zoononic (animal) and human strains of influenza and spilling out the perfect pandemic-level smoothie. Because we share so much in common with pigs, genetically speaking, and because pork is such an integral part of the global diet, the potential for this animal species to serve as an efficient transmitter of deadly influenza strains is particularly high. This is worrisome, because H5N1 is very deadly to humans, carrying with it a 50+ percent fatality rate (compared to a roughly 1 percent case fatality ratio for Covid-19 among U.S. patients).

Second, if Americans are angry now about the price of eggs – which strangely no presidential candidate connected to mass chicken culls from H5N1 – just wait for the economic and food supply impact of broader infections among pig herds.

But most importantly, America’s public health system has been slow to track H5N1, ignoring important lessons from Covid-19 and downplaying the potential threat that could be on the horizon. There are broad concerns that surveillance has lagged and impacted flocks and herds are being undercounted. U.S. media attention has focused on the safety of the nation’s milk supply, which is interesting since pasteurization kills all viruses and bacteria (something to note for all of you raw milk drinkers out there). And there seems to be inexplicable foot dragging with our efforts to conduct and broadly share regular genetic sequencing of different H5N1 samples to understand how the virus may be mutating into a more virulent pathogen.

Instead of focusing on the infrastructure we have in place to detect a potential spillover of H5N1 to humans, we are poised to cut funding and resources needed to effectively track and contain outbreaks before they spread.

While pandemic fatigue is real and we can’t dismiss its influence on U.S. politics, economics or popular culture right now, we also cannot afford to leave our front door open when a virus with pandemic intentions is creeping around our yard.

Now is the time to review and publicly discuss the lessons learned from Covid-19 on surveillance, health system strengthening, rapid reporting and effective intra—government and public communications. We have more advanced technologies and biosecurity measures that we can leverage, as well as incentives to ensure livestock operators are not collateral damage in our war against disease. Lastly, we can’t afford to weaken routine immunization policies when they may be our first line of defense against a novel pathogen that overwhelms our health systems again.

By combining proactive policies with strong communication strategies, including more effective ways to engage and educate the media, we can effectively prevent and manage the threat posed by H5N1 and other pandemic influenza viruses, safeguarding public health and minimizing economic disruptions.

The question is whether there is enough political will remaining after Covid to keep our guard up against pandemic threats, either homegrown in the U.S. or originating in a far-off hot zone. The answer is what keeps me up at night.

The post Watching the Pigs appeared first on Medika Life.

Even a peep of news about a new flu pandemic is enough to set scientists clucking about eggs.

They worried about them in 2005, and in 2009, and they’re worrying now. That’s because millions of fertilized hen eggs are still the main ingredient in making vaccines that, hopefully, will protect people against the outbreak of a new flu strain.

“It’s almost comical to be using a 1940s technology for a 21^st-century pandemic,” said Rick Bright, who led the Health and Human Services Department’s Biomedical Advanced Research and Development Authority (BARDA) during the Trump administration.

It’s not so funny, he said, when the currently stockpiled formulation against the H5N1 bird flu virus requires two shots and a whopping 90 micrograms of antigen, yet provides just middling immunity. “For the U.S. alone, it would take hens laying 900,000 eggs every single day for nine months,” Bright said.

And that’s only if the chickens don’t get infected.

The spread of an avian flu virus has decimated flocks of birds (and killed barn cats and other mammals). Cattle in at least nine states and at least three people in the U.S. have been infected, enough to bring public health attention once again to the potential for a global pandemic.

As of May 30, the only confirmed human cases of infection were dairy workers in Texas and Michigan, who experienced eye irritation. Two quickly recovered, while the third developed respiratory symptoms and was being treated with an antiviral drug at home. The virus’s spread into multiple species over a vast geographic area, however, raises the threat that further mutations could create a virus that spreads from human to human through airborne transmission.

If they do, prevention starts with the egg.

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To make raw material for an influenza vaccine, virus is grown in millions of fertilized eggs. Sometimes it doesn’t grow well, or it mutates to a degree that the vaccine product stimulates antibodies that don’t neutralize the virus — or the wild virus mutates to an extent that the vaccine doesn’t work against it. And there’s always the frightening prospect that wild birds could carry the virus into the henhouses needed in vaccine production.

“Once those roosters and hens go down, you have no vaccine,” Bright said.

Since 2009, when an H1N1 swine flu pandemic swept around the world before vaccine production could get off the ground, researchers and governments have been looking for alternatives. Billions of dollars have been invested into vaccines produced in mammalian and insect cell lines that don’t pose the same risks as egg-based shots.

“Everyone knows the cell-based vaccines are better, more immunogenic, and offer better production,” said Amesh Adalja, an infectious disease specialist at Johns Hopkins University’s Center for Health Security. “But they are handicapped because of the clout of egg-based manufacturing.”

The companies that make the cell-based influenza vaccines, CSL Seqirus and Sanofi, also have billions invested in egg-based production lines that they aren’t eager to replace. And it’s hard to blame them, said Nicole Lurie, HHS’ assistant secretary for preparedness and response under President Barack Obama who is now an executive director of CEPI, the global epidemic-fighting nonprofit.

“Most vaccine companies that responded to an epidemic — Ebola, Zika, covid — ended up losing a lot of money on it,” Lurie said.

Exceptions were the mRNA vaccines created for covid, although even Pfizer and Moderna have had to destroy hundreds of millions of doses of unwanted vaccine as public interest waned.

Pfizer and Moderna are testing seasonal influenza vaccines made with mRNA, and the government is soliciting bids for mRNA pandemic flu vaccines, said David Boucher, director of infectious disease preparedness at HHS’ Administration for Strategic Preparedness and Response.

Bright, whose agency invested a billion dollars in a cell-based flu vaccine factory in Holly Springs, North Carolina, said there’s “no way in hell we can fight an H5N1 pandemic with an egg-based vaccine.” But for now, there’s little choice.

BARDA has stockpiled hundreds of thousands of doses of an H5N1-strain vaccine that stimulates the creation of antibodies that appear to neutralize the virus now circulating. It could produce millions more doses of the vaccine within weeks and up to 100 million doses in five months, Boucher told KFF Health News.

But the vaccines currently in the national stockpile are not a perfect match for the strain in question. Even with two shots containing six times as much vaccine substance as typical flu shots, the stockpiled vaccines were only partly effective against strains of the virus that circulated when those vaccines were made, Adalja said.

However, BARDA is currently supporting two clinical trials with a candidate vaccine virus that “is a good match for what we’ve found in cows,” Boucher said.

Flu vaccine makers are just starting to prepare this fall’s shots but, eventually, the federal government could request production be switched to a pandemic-targeted strain.

“We don’t have the capacity to do both,” Adalja said.

For now, ASPR has a stockpile of bulk pandemic vaccine and has identified manufacturing sites where 4.8 million doses could be bottled and finished without stopping production of seasonal flu vaccine, ASPR chief Dawn O’Connell said on May 22. U.S. officials began trying to diversify away from egg-based vaccines in 2005, when avian flu first gripped the world, and with added vigor after the 2009 fiasco. But “with the resources we have available, we get the best bang for our buck and best value to U.S. taxpayers when we leverage the seasonal infrastructure, and that’s still mostly egg-based,” Boucher said.

Flu vaccine companies “have a system that works well right now to accomplish their objectives in manufacturing the seasonal vaccine,” he said. And without a financial incentive, “we are going to be here with eggs for a while, I think.”

Arthur Allen: aallen@kff.org, @ArthurAllen202

The post The Chicken and Egg Problem of Fighting Another Flu Pandemic appeared first on Medika Life.