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“Science” of Pandemic Influenza
Stephen C. Schoenbaum, MD, MPH
Executive Vice President for Programs
June 15, 2006
www.cmwf.org
Limitations of Our Knowledge
• Direct or inferential virologic
knowledge only about 1889, 1918, 1957,
1968, 1977
– Direct virus isolation only for the latter 3
– Virus reconstruction for 1918
– Direct pandemic experience with only
H1,2,3; N1,2
• i.e., 3/16 hemagglutinin types; 2/9
neuraminidase types
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Avian Flu (H5N1)
• Emerging pandemic among birds
– A unique observation (I believe); hence difficult to
estimate the probability of its being a prelude to a
human pandemic
• Some, but few, instances of spread to
humans
– Hopeful, but not an absolute protection
– Has occurred with other strains (e.g., H7)
• Possibly a few instances of spread between
humans
– Again, a concern; but this has occurred with other
strains without causing a pandemic (e.g., Hsw1N1
=H1N1 at Fort Dix, NJ in 1976
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Policy-Relevant Information About
Pandemics
• Pandemics occur irregularly over time
– It is likely there will be another some time
• Pandemics vary in “size”
– All are important; but not all have the impact of
1918
• Disproportionate effect on younger people
than interpandemic epidemics
– Policies for control need to be population-wide
• Can/do cause societal disruption
– Need contingency plans for vital societal
functions
• Usually associated with a second, even third,
wave
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Policy Options for Preventing or
Ameliorating Pandemic Spread
• Global surveillance for novel strains
– Occurring
– Leading to control of influenza in flocks of
birds
– Hard to know if this can have an impact on
prevention or amelioration of pandemic
spread
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Policy Options for Preventing or
Ameliorating Pandemic Spread
• Developing methods for crash production
of vaccines once a pandemic has been
detected
• Stockpiling prototype vaccines for each of
the influenza A hemagglutinins
• Prior immunization with prototypes of the
influenza A hemagglutinins
• Immediate production/use of vaccines to
ameliorate second/third waves
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Policy Options for Preventing or
Ameliorating Pandemic Spread
• Stockpiling antivirals and using them with
emergence of a new strain
• Increasing routine use of antivirals
• Research to develop new antivirals
• Increased/repeat pneumococcal vaccination at time
of emergence of a new influenza A strain
• Statins - ?other novel/general methods of reducing
the lethality of bacteremia or of viral infections
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Policy Options for Preventing or
Ameliorating Pandemic Spread
• “Social Distancing”
– 1968: school closures (Xmas vacation)
– 1918: Quarantine of Australia
– Bottom line: could buy “some” time
• Ability to enhance ICU/treatment capacity
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Respirators – how many are really needed?
Cross-trained staff – will they show up?
Antibiotics – can we deal with resistance?
Bottom line guess: could probably handle a 1957size pandemic
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