Dr Ann Moen on the global influenza strategy

Influenza
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Dr Ann Moen, Chief of the WHO’s Influenza Preparedness & Response Unit (IPR), explains the importance of their latest strategy: the Global Influenza Strategy 2019-2030.

Influenza is a serious global health threat that impacts all countries: every year, there are an estimated one billion cases, three to five million severe cases, and 290,000-650,000 influenza-related respiratory deaths worldwide. In this interconnected world, the next influenza pandemic is a matter of when not if, and a severe pandemic is believed by many experts to be potentially the most devastating global health event with far reaching consequences. In fact, in the last 100 years, we have witnessed four pandemics that have resulted in significant morbidity and mortality, including the 1918 pandemic which killed an estimated 50 million people across the world and transformed public health as we know it.

In response to the ever-present threat of influenza, the World Health Organization (WHO) developed the Global Influenza Strategy 2019-2030 to serve as an overarching framework for WHO, countries and partners to strengthen our collective preparedness and response capacities and capabilities. We spoke to Dr Ann Moen, Chief of the WHO’s Influenza Preparedness & Response Unit (IPR), about their Global Influenza Strategy.

What is the work and role of the global influenza strategy?

The strategy presents a unifying vision and global goals and priorities for all of us to strive for through 2030. The strategy is not reinventing the wheel; rather, it builds upon several global assets so as not to duplicate efforts but rather enhance and advocate for those assets and provide a common path forward. For example, the Strategy builds upon the successes of the WHO Global Influenza Surveillance and Response System (GISRS), which is a WHO-coordinated system of over 150 institutions in more than 110 countries. GISRS represents the commitment of WHO Member States to global health for more than 70 years and serves as the foundation of surveillance, preparedness and response to influenza epidemics and pandemics. GISRS is a global mechanism of alert and response for seasonal, zoonotic and pandemic influenza.

The Strategy also builds upon the successes of the Pandemic Influenza Preparedness (PIP) Framework, a unique access and benefit-sharing system that aims to improve and strengthen systematic and timely sharing of influenza viruses with pandemic potential while at the same time ensuring all countries have equitable access to antiviral drugs, vaccines, and other pandemic-related supplies when the next influenza pandemic strikes. Additionally, through the PIP Framework’s annual Partnership Contribution, countries receive support to develop and expand their national capacities for pandemic influenza preparedness and response.

Can you give us an overview of the strategy, and its strategic objectives?

Our vision for 2030 is the attainment of the highest possible influenza prevention, control, and preparedness to safeguard the health of all people. In order to do that, we have outlined two high-level outcomes that are supported by four strategic objectives.

The high-level outcomes are:

  1. Better global tools: we want to see a focused, consensus-driven plan lead to greater research, innovation and availability of new and improved tools for the prevention, detection, control and treatment of influenza; and
  2. Stronger country capacities: we want every country to have a prioritised influenza programme that is evidence-based; is optimised to fit the country’s needs; and contributes to national and global preparedness, response, and health security.

The four strategic objectives are to:

1)         Promote research and innovation to address unmet public health needs;

2)         Strengthen global influenza surveillance, monitoring, and data utilisation;

3)         Expand seasonal influenza prevention and control policies and programmes to protect the vulnerable; and

4)         Strengthen pandemic preparedness and response for influenza to make the world safer.

What is the importance of these, and how will this be achieved?

There has been incredible progress made in influenza prevention, control, and preparedness since WHO’s last overarching influenza strategy was published in 2002, and especially since the 2009 H1N1 pandemic. However, there are two overarching sets of challenges that remain. These two overarching sets of challenges drove the development of the strategy and the specific distinction of the two high-level outcomes.

First, our current prevention and control tools, including antivirals and vaccines, have limitations. The seasonal influenza vaccine requires annual administration as it is formulated twice a year for the Northern and Southern hemispheres based on the circulating viruses. Vaccines can help prevent and manage the impact of influenza, but the vaccines are not 100% effective, and access, affordability and utilisation have been issues in many countries. Production of pandemic influenza vaccines is dependent on the identification of the virus causing the pandemic, and therefore, production of the vaccine could take a minimum of 5-6 months to produce once manufacturers have the virus. Antiviral drugs are the mainstay of influenza treatment, but they are most effective if administered early in infection. Additionally, they are costly, and the emergence of resistant influenza virus strains remains a problem across all available classes of antivirals.

Second, ongoing public health events continue to highlight that countries lack the core capacities to prevent, detect, and respond to infectious disease threats. With respect to influenza specifically, countries have drastically strengthened their capacities to conduct virological and epidemiological surveillance, but there are many low- and middle-income countries that do not have estimates for influenza disease and economic burden that drive evidence-based policymaking. Many countries lack a seasonal vaccination policy or programme, and the use of antivirals for influenza treatment each year is variable across all countries. And finally, regarding pandemic preparedness, many countries have not developed or updated their national influenza pandemic preparedness plans.

To achieve the high-level outcomes, WHO has identified a set of enablers:

Countries are at the centre

The primary aim of the strategy is to ensure that all countries see a measurable impact of their capacity-building activities. This ensures that the activities are dependent on country ownership, a country-level approach, and whole-of-government commitment and embedded in efforts to strengthen universal health coverage and implementation of the International Health Regulations (IHR) (2005).

Global influenza assets and strategies are strengthened and sustained

As previously mentioned, the strategy builds upon cross-cutting influenza assets and strategies, such as GISRS and the WHO Public Health Research Agenda for Influenza. It is vital that we continue to strengthen and sustain these assets because they bring together a wide network of partners and experts dedicated to developing a robust evidence base and building countries’ core capacities for influenza.

Countries, industry and civil society continue to support and implement the PIP Framework

The PIP Framework facilitates the sharing of influenza viruses with pandemic potential and ensures greater equity of access to vaccines, antiviral drugs, and other pandemic-related supplies. This framework significantly contributes to capacity building in countries through one of its benefit-sharing mechanisms, the Partnership Contribution, which is an annual cash contribution by industry partners that utilise GISRS.

Partnerships are strengthened and expanded

Through the years, WHO has built a strong network of partners dedicated to influenza prevention, control, and preparedness. However, successful implementation of the strategy and achievement of the high-level outcomes is contingent on the strengthening of the current partnerships and expanding to include new and innovative partners from additional sectors.

Value for money

Regarding WHO’s activities, we are committed to maximising the impact derived from every dollar spent and fostering an organisational culture driven by results and impact.

What would you say are going to be some of the main challenges this strategy will come up against, and how will these be overcome?

A primary challenge the strategy and its implementation activities will come up against is the issue of competing priorities within countries, and influenza may not necessarily be one of those priorities. As part of our activities, WHO will work with internal and external partners to document how influenza capacity building does have spillover benefits for broader health systems strengthening and preparedness for other infectious disease threats through the IHR (2005). Countries cannot build new systems in the face of an influenza pandemic or similar health emergency; overall preparedness can be realised only through building routine systems, and seasonal influenza is the perfect pathogen to test those routine systems.

Moreover, there will be the issue of sustainability; as capacities are built and strengthened, countries will need to identify resources to sustain these capacities as external sources of funding decrease. Ensuring a whole-of-government approach is incorporated throughout capacity-building for influenza prevention, control, and preparedness is important for sustainability as other sectors, primarily the ministries of finance, see the impact and spillover benefits of that capacity-building.

Finally, there will be the challenge of ensuring innovation translates to all countries. There are many national, regional, and global stakeholders that are innovating across the influenza enterprise, from surveillance to response. It will be critical that all countries have access to innovative strategies, tools, and products so that they may strengthen their national programmes. WHO is committed to monitoring this innovation and ensuring that the low- and middle-income country context is adequately captured.

By the end of strategy (which is proposed to be 2030), what do you hope its lasting impression will be? What effect do you hope it will have going forward after this time period ends?

We hope that the lasting impression is that seasonal, zoonotic, and pandemic influenza pose a real and significant burden for all countries, and that developing and strengthening national programmes for seasonal influenza will positively contribute to preparedness and response to pandemic influenza and other infectious disease threats. Additionally, we want to see countries utilising all the ‘tools in the toolbox’ to prevent and control influenza, including nonpharmaceutical and pharmaceutical interventions.

 

Dr Ann Moen

Chief Influenza Preparedness & Response Unit (IPR)

World Health Organization

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