INFLUENZA RESEARCH 2010: PANDEMIC RESPONSE AND FUTURE DIRECTIONS
1 Great George Street, Westminster, London, UK
Thursday June 24th 2010
MEETING NOTE
PREPARED BY DAVID EVANS AND TOM SUTHERLAND
REVIEWED BY FREDERICK HAYDEN
1. On 24 June 2010, the Wellcome Trust Influenza Research Team held a satellite workshop
meeting at the Pacific Health Summit 2010 to review the team’s activities and those of its
partners in the context of the 2009 H1N1 pandemic and to discuss implementation of the
recently posted World Health Organization Public Health Research Agenda for Influenza. As
many of the team’s activities have been conducted in collaboration with organisations in the
UK and other countries, the meeting also provided an opportunity to hear from the
colleagues working in these partners of the Trust, particularly from those in the World Health
Organization.
2. Jimmy Whitworth, Head of International Activities at the Trust opened the meeting and gave
an overview of the format of the day (Agenda attached at Annex A). The main sessions,
covered in further detail below, were as follows:
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
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Session 1 – Pandemic influenza research in the UK
Session 2 – WHO: pandemic influenza vaccines
Session 3 – WHO Research Agenda for Influenza
Panel discussion: taking forward global influenza research
SESSION 1: PANDEMIC INFLUENZA RESEARCH IN THE UK
3. This session was opened by Fred Hayden, Influenza Research Coordinator at the Trust, who
provided details of the major activities the Influenza Research Team has been involved with
since autumn 2008. The audience then had an opportunity to hear about three specific
research projects developed rapidly in response to the influenza H1N1 pandemic and in part
supported by the Trust.
Influenza activities and UK funders’ response to pandemic H1N1
Professor Frederick Hayden (Wellcome Trust)

Fred Hayden provided context of the Trust’s involvement in UK pandemic influenza
research projects. In response to the H1N1 pandemic, the Trust and other UK partners
convened meetings of the clinical research community (May 2009) and veterinary
research community (June 2009) to develop new or enhanced research responses to the
pandemic. Based on recommendations from these meetings, the three principal UK
studies covered in further detail in the other presentations in this session, were:


The Mechanisms of Severe Acute Influenza Consortium (MOSAIC) – a wide
ranging study of influenza pathogenesis in patients hospitalised with severe H1N1
disease during the pandemic (MRC and Wellcome Trust)
FluWatch – a large community-based cohort study examining epidemiology,
severity, treatment and vaccination strategies of influenza (MRC and Wellcome
Trust)
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

The Combating Swine Influenza initiative (COSI) – a study to monitor and
compare the evolution, transmission, infection dynamics and immunopathology of
H1N1 in pigs and humans (BBSRC and Wellcome Trust)
The Trust also invited influenza-related proposals from its Major Overseas Programmes
(MOPs) in Africa and Asia in response to the pandemic. Studies that have been funded
include:

Studies of severe pneumonia and respiratory viruses at hospital and community
levels in Kenya (James Nokes).

Hospital-based surveillance for influenza in an African population with a high burden
of HIV, malaria and malnutrition in Malawi (Rob Heyderman).

A range of clinical research on serious human, including pandemic H1N1, and avian
influenza and other infectious diseases of public health importance in the South East
Asian region (through the South East Asian Infectious Disease Clinical Research
Network).
Fred Hayden provided an overview of the Trust’s efforts in collaborating with the World
Health Organization, both on developing the WHO Public Health Research Agenda for
Influenza1, on a range of influenza vaccine-related activities2 and on meetings related to
clinical aspects and management of pandemic H1N1 patients3 to set the scene for later
presentations (see Annex B for a summary of recent meetings involving WHO and the
Trust).
A summary of the full range of activities can be found at
www.wellcome.ac.uk/influenza.
Mechanisms of Severe Acute Influenza Consortium (MOSAIC)
Professor Peter Openshaw (Imperial College London)

Professor Openshaw provided an overview of the MOSAIC study, a multi-centre project
involving a large network of collaborators designed to investigate severe influenza
disease in hospitalised patients. The grant was awarded in November 2009, and built on
the existing work of the Centre for Respiratory Infection at Imperial College London to
study pathogenesis of respiratory viral diseases and to enhance pandemic preparedness
and response.

The MOSAIC study comprises eight separate work packages run from a number of UK
centres, with the core administrative element of the project run out of the Centre for
Respiratory Infection at Imperial College. In total, the project involves around 45
investigators in 8 major research centres in England and Scotland. The project aims to
obtain samples from 500 hospitalised adults and children to investigate virology,
bacteriology, host genetics, cellular immunology and immune mediators.

Professor Openshaw discussed the difficulties of launching a timely study in response to
the pandemic.
One of the primary causes for delay was securing Research and
Development (R&D) approval at the various hospitals involved. Each hospital required
submission of different forms, requesting different information and went through different
processes to award R&D approval. This caused major delays, and in one instance it
took 8 months to secure R&D approval from a participating hospital. This information
has been collated in a report (Cross and Openshaw, evidence provided to the review of
the regulation and governance of medical research) to the Academy of Medical Sciences
1
http://www.who.int/csr/disease/influenza/2010_04_29_global_influenza_research_agenda_version_01_en.pdf
http://www.who.int/csr/disease/influenza/inforesources/en/index.html
3 http://www.who.int/csr/resources/publications/swineflu/clinical_management_h1n1.pdf
2
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in 2010. The key message of this report is that regulation and governance needs to be
harmonised and streamlined at the simplest of the currently diverse standards and that
reciprocity of approval should be recognised between hospitals so repeated applications
are not necessary. Despite these hurdles the project has managed to recruit a small
cohort from the second wave of the pandemic. This has allowed MOSAIC’s clinical
protocols to be tested and has allowed the infrastructure to respond to the next outbreak
wave to be developed. Over 2000 samples have been collected and stored. It was
noted that the LabCollector system used for this had been essential and allowed
samples to be easily catalogued for later analyses. It was also noted that of the 85
patients enrolled, only around 30% were H1N1 positive. There were 2 fatalities among
the patients recruited to the study.
Investigators are currently analysing the initial samples collected before the next wave of
subjects is anticipated to be recruited during the 2010-11 influenza season.
FluWatch surveillance programme
Dr Andrew Hayward (UCL)

Dr Hayward provided an overview of the FluWatch study, a national household cohort
study to examine community-based influenza transmission and immunity. The study
was set up in 2006 with MRC funding, and expanded in 2009 in light of the pandemic
with funding from MRC and the Trust.

The FluWatch study has recruited around 4300 subjects during the 2009/10 influenza
season. Subjects are recruited as whole households, and followed up weekly by onlineor telephone-based surveys to detect respiratory symptoms. Participants also maintain a
detailed diary. Self-collected nasal swabs and temperature readings are submitted
during periods of illness for detection of influenza virus infection, and additional samples
are taken to analyse influenza-specific serology and T cell immune responses before
and after infection in a subset of patients.

One of the main findings of the study is that the rate of influenza-like illness (ILI) and
confirmed influenza infection based on RT-PCR appears to be much higher in the
community than data from GP-based surveillance would indicate, both during seasonal
and pandemic influenza periods. Infection rates as measured by serology were
substantially higher than clinical attack rates during the pandemic, an observation
suggesting that many infections were asymptomatic or minimally symptomatic. In
addition, the study found that levels of vaccination were very low in target groups with a
high proportion of vaccination occurring around or after the winter peak of influenza; that
most oseltamivir prescriptions in the cohort were to those who did not have virological
evidence of H1N1 infection when tested, and that only about 5% of those with ILI during
the fall wave of the pandemic received antiviral treatment.

Dr Hayward also touched on the barriers to rapid roll-out of large scale national
community studies during a pandemic. As with the MOSAIC study, R&D approval
caused delays, with applications taking over a month to be approved. He concluded that
the current research governance system introduces severe delays to studies recruiting
through primary care. They also faced other recruitment problems. One of the barriers to
recruitment was competition from industry trials that were able to offer remuneration for
participation.The original aim was to scale up recruitment to 10,000 household members,
but ultimately a total of 4283 was achieved. However, this still represented the largest
study of its type to date.
Pandemic H1N1 and swine: the Combating Swine Influenza (COSI) initiative
Dr Ian Brown (Veterinary Laboratories Agency)
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
Dr Brown gave an overview of the COSI initiative, which comprises two linked grants.
Firstly, a ‘model’ or experimental inoculation grant conducted at the Veterinary
Laboratories Agency is investigating transmission, infection dynamics and
immunopathology of pandemic H1N1 2009 virus in pigs, in part to assess comparability
to human infections. Secondly, a ‘population’ grant conducted at the University of
Cambridge is examining the epidemiological and evolutionary characteristics of
pandemic H1N1 influenza virus in pigs and the associated occupational risks.

Dr Brown presented a range of initial results from both studies. Initial results from the
‘model’ grant suggest that following viral infection, shedding is influenced by age, with
older swine showing shorter shedding periods with less overall virus replication. The
study has also looked at prior-immunity, which appears to affect transmission.
Experiments to examine the cellular immune responses to GSK and Baxter vaccines are
underway, with a clear difference between the immune responses to the two vaccines
already apparent.

The ‘population’ grant component seeks to investigate outbreaks of influenza in pigs, pig
farmers and veterinarians; quantify farm level infection dynamics; and conduct whole
virus sequencing of virus samples from outbreaks. Cohort studies for non-pandemic and
pandemic viruses have also been used to determine incidence on pig farms and risk
factors for endemic infection. Mathematical modelling and analysis of data at the
population and ‘within host’ levels are used to predict possible transmission and
understand mechanisms of disease in pigs, respectively. Early results have shown that
the pandemic virus caused frequent infections in pig populations in the UK (~30% farm
level incidence), with a clustering of prior H1N1 infection in northern England. In
addition, H1N1 seroprevalence in veterinarians exposed to pigs was found to be much
higher than in the non-pig exposed population. Whole genome sequencing on the
Sanger Illumina platform of 60 archived swine viruses has to date found no evidence of a
recent pandemic precursor (although only the N and M genes have been analysed so
far).

The first session concluded with an opportunity for the audience to ask questions on
each of the presentations. The following areas were among those covered in the Q&A
session:

Animal Human interface. Surveillance and reporting requirements for influenza in
animal populations, particularly the differences in reporting standards for poultry and
swine, and the importance of these differences on research, surveillance and our
understanding of the human/animal interface were discussed. Angus Nicholl
commented that the EU has only one example of enzoonotic swine influenza
crossing to humans. Nancy Cox reported significantly higher numbers of zoonotic
cases in the US and attributed the difference primarily to the fact that cases of swine
influenza in humans are notifiable in the US but not in the EU.

Delays in clinical research. The regulatory hurdles that need to be overcome to
conducting research in a pandemic setting, in particular the difficulties in obtaining
R&D approval in individual hospitals in the UK were noted. The UK Academy of
Medical Sciences is looking at this issue; Prof Openshaw presented details of his
submission to the consultation. In other countries, specifically the US, delays in
initiating clinical studies during the pandemic were often related to the current
requirement for obtaining ethical approval at each participating centre and the lack of
existing networks to undertake studies. A possible solution, of pre-approval of
projects (ethics and other regulatory requirements) and pre–positioning of protocols
at qualified sites was suggested to alleviate the problem of delays in the event of a
pandemic. Another suggestion was to set up a network to study severe acute
respiratory infection, which would be valuable in itself, but also could be scaled up to
provide a research platform during a future pandemic.
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SESSION 2: WHO: PANDEMIC INFLUENZA VACCINES
Pandemic plans and H1N1 vaccine experience: production, access, distribution and
effectiveness Dr Marie-Paule Kieny (IVR, WHO)

Dr Kieny provided an update of the WHO pandemic vaccine response. In 2006, WHO
published the Global Action Plan1, highlighting the main strategies for the WHO to work
with others to increase access to pandemic influenza vaccine in developing countries.
The strategy aimed to increase the use of seasonal influenza vaccines, enhance overall
production capacity, and stimulate research and development of new technologies.
Since 2006, WHO has pursued a range of related activities, including a global survey of
seasonal influenza vaccine use and an analysis of the parameters for the establishment
of a H5N1 influenza vaccine stockpile.

Dr Kieny reported that globally, there are more than 35 manufacturers of influenza
vaccines, 10 in China alone. She highlighted the technology transfer development
project grants awarded to manufacturers in 11 developing countrie , who have played a
part in making global influenza vaccine production more equitable. WHO has also
signed a royalty-free, sub-licensable licence with Nobilon-Schering-Plough-Merck on
Live Attenuated Influenza Vaccine (LAIV) technology, and to date sublicenses have been
provided to 3 developing country manufacturers. Of note, the Serum Institute of India
received a license for their pandemic LAIV in June 2010. Based on capital expenditure
to date compared to the number of forecasted annual doses produced, it was noted that
the average cost per vaccine dose from these manufacturers was around US$ 3.3, with
cell culture-based inactivated influenza vaccines significantly higher than egg-based
LAIV.

Moving to the WHO H1N1 pandemic response, Dr. Kieny noted that four priorities in the
H1N1 pandemic response plan relate to vaccines: facilitating rapid development and
manufacture of pandemic vaccine; providing guidance on the use of pandemic vaccine;
monitoring vaccine safety; and increased vaccine access for low and middle income
countries. One problem was that the production capacity of pandemic influenza
vaccines as of January 2010 was lower than expected at around 1.3 billion doses, partly
due to poor egg yields. This highlights the ongoing fragility of global production capacity.
In terms of vaccine safety, there have been no new signals with around 350 million
pandemic H1N1 doses administered. Dr Kieny presented preliminary results from an
ECDC study (I-MOVE) which indicates that vaccine effectiveness was ≥70%. There
were limitations to the study such as wide 95% confidence intervals due to the small
numbers of people vaccinated. The small numbers also meant that stratification by
brand and age group was not possible. The study does indicate that the response was
generally good and comparable to effectiveness of the seasonal vaccine.

Finally, Dr Kieny provided details of the WHO Pandemic Influenza A (H1N1) vaccine
deployment initiative, which aims to help 97 developing countries to protect against
severe disease from H1N1 by coordinating the distribution of 200 million doses of
donated H1N1 vaccine. Issues arising from the deployment initiative have included
concluding donation agreements with donor partners, issues around indemnification from
liability requested by manufacturers, country readiness and regulatory constraints. Prior
to receiving vaccine, WHO has requested countries to develop acceptable vaccine
deployment plans. These have been completed and finalised by 73 countries to date, a
process that should greatly facilitate country planning and response to the next
pandemic. WHO has also produced framework legal agreements to facilitate the
process. To date, ca. 37 million doses have been delivered, with around 39 million
1
http://www.who.int/vaccines-documents/DocsPDF06/863.pdf
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doses expected to be delivered in the coming months. The initiative has allowed WHO
to gain significant experience on crafting global agreements that address the liability
concerns of the donor companies or governments and recipient countries.

The following areas were among those covered in the Q&A session:

Uptake of vaccines within countries. It was noted that most countries which received
donated vaccines used vaccines in targeted risk groups like pregnant women, health
care workers and children. However, uptake overall has been low. Further work to
assess how the donated vaccines were used and whether they were delivered
effectively (who received vaccine, how quickly etc) needs to be undertaken. At
global level uptake of pandemic vaccine was quite variable across countries. The
majority of countries had planned to vaccinate pregnant women, health care workers
and children. However, more data are needed to help countries establish what their
at-risk populations actually are, in order to inform planning and vaccine delivery.

Next steps needed to build on the momentum of the WHO GAP activities.
Continuing the technology transfer programme and building demand for seasonal
influenza vaccines were seen as priorities for improving the sustainability of vaccine
production capacity. It was noted that strategies for building demand in resourcelimited settings need particular attention with respect to understanding burden of
influenza disease in the context of other healthcare priorities and the key target
populations (e.g., pregnant women, healthcare workers).
SESSION 3: WHO RESEARCH AGENDA FOR INFLUENZA
WHO Public Health Research Agenda for Influenza: development and implementation.
Dr John Tam (GIP WHO).
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
Dr Tam, Global Influenza Programme, provided an overview of progress and recent
developments on the WHO Public Health Research Agenda for influenza 1. The main
goal of the research agenda is to help support the development of evidence needed to
strengthen public health guidance and actions essential for limiting the impact of
influenza in all its forms, pandemic, zoonotic and seasonal influenza. In response to
calls for WHO coordination of influenza research in 2002 and 2006, the agenda
developed from WHO meetings starting in 2008 and was posted publicly for the first
time in April 2010.

WHO held a 4-day consultation on the research agenda in November 2009 to discuss,
review and prioritise research topics based on public health needs. The consultation
process distilled the number of research questions to approximately 250 and prioritised
them into the five topic streams, each of which contain a number of broad, overarching
research recommendations: (1) reducing the risk of emergence of pandemic influenza;
(2) limiting the spread of influenza; (3) minimising the impact of influenza; (4) optimising
the treatment of patients; and (5) development and application of modern public health
tools.

The WHO is now looking towards further refinement and implementation of the influenza
research agenda. Planned next steps include developing regional-level research
agendas for influenza that take into account regional and local needs. As a first step, a
consultation process is planned for each of the WHO regions during the current year;
that for Africa was conducted in June 2010. In addition, GIP plan to host workshops on
cross-cutting topics including surveillance, modelling, diagnostics, and risk
communication, the latter covered in a workshop held in Geneva in May 2010.
http://www.who.int/csr/disease/influenza/2010_04_29_global_influenza_research_agenda_version_01_en.pdf
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
The following areas were among those covered in the Q&A session:
 The implementation and monitoring process for the Agenda, as well as its integration
with other activities, remains under discussion. A core progress monitoring group is
envisioned to regularly assess new developments and modify the Agenda
accordingly.

The importance of advocacy building to ensure awareness of the WHO Public Health
Research Agenda for Influenza. It was seen as important that researchers within
different global regions come up with their own proposals.

Building a body of evidence on behavioural research was seen by some as essential
to all of the research streams, and therefore needs to be incorporated throughout the
agenda. Similarly other tools like modelling and diagnostics were viewed as
fundamental for many specific research topics. Monitoring published research was
viewed as important, although it was also viewed as important to monitor ‘in progress’
research to minimise unwanted duplication in efforts to address research gaps. Dr
Tam explained that WHO has early plans to develop monitoring centres around the
world to track and monitor research. A web-based method of tracking research
efforts was also seen as a possible way forward.
PANEL DISCUSSION: TAKING FORWARD GLOBAL INFLUENZA RESEARCH
Panel members:
Professor Fred Hayden (Wellcome Trust) – Chair
Dr Nancy Cox (US CDC)
Professor David Salisbury (UK Department of Health)
Dr Norbert Hehme (IFPMA)
Professor Malik Peiris (University of Hong Kong).
Dr Suwit Wibulpolprasert (Ministry of Public Health, Thailand)
Dr Marie-Paule Kieny (IVR, WHO)
Dr Linda Lambert (US NIH)
Dr John Tam (GIP, WHO)
Dr Douglas Holtzman (BMGF)

The panel session covered a broad range of topics, including:
 Clinical research needs. It was noted that we need to invest in conducting
epidemiologic, pathogenesis, and intervention studies in the inter-pandemic period,
both in the community and in those hospitalized with more severe illness. Such
initiatives would serve to not only build this research capacity as a platform for
response to new threats but also to understand the impact of annual outbreaks of
influenza and other respiratory pathogens and test measures to mitigate their impact.
In addition, such projects need to involve the next generation of clinical investigators,
particularly in less resourced countries, to develop a new cadre of researchers.
Initiatives like the South East Asia Infectious Disease Clinical Research Network
were seen as valuable models in this regard.

Surveillance and operational research at the human/animal interface and clinical
studies on patient management, particularly those with severe illness, were seen as
areas with current unmet research needs, whereas development and testing of new
vaccines are currently more well-resourced research areas. For example, in terms of
the research response to the pandemic, Malik Peiris reported that abstracts for the
upcoming Options VII meeting in Hong Kong were dominated by vaccine studies,
whereas studies involving animals or clinical management were the most under
represented.
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
Clinical management. The need for novel antivirals, new formulations for use in
special populations (e.g., neonates/infants, ICU patients), and studies of drug
combinations was highlighted. A comparison to the SARS response was drawn, in
which a robust laboratory effort led to the rapid identification of the pathogen and
conventional public health measures were effective in limiting its spread. In contrast,
determination of its genesis and on best practices for treating affected persons was
much delayed. Even now the appropriate therapies for SARS patients are undefined.
In addition, the very modest extent to which vaccine research efforts prior to the
pandemic actually contributed to our ability to respond to the pandemic was noted.
Social measures were seen by some as potentially more important, though the
research base in this area is much less developed.

Communication and behavioural research. The importance of research on
communication and behaviour modification including compliance with recommended
public health measures was identified as a key gap in research need. It was noted
that the European Commission has a new call for proposals specifically in this area,
which could complement the WHO research agenda process.

Vaccine access. The question was raised whether we are using old, fundamentally
flawed strategies such as advance purchase commitments and vaccine stockpiling,
both of which favour well-resourced countries, in our pandemic vaccine response.
There was also discussion that even with significant improvements in the time in
which vaccines can be produced, a vaccine made in response to a pandemic
influenza virus would still only ever be received by the survivors of the first (and
maybe even the second) wave of a pandemic. One suggestion was that research
efforts should perhaps be focussed instead on cross protective/universal epitope
vaccines.

There was lengthy discussion of ways in which vaccines could be produced more
rapidly in response to a pandemic. These included identification of potential
pandemic strains so that a library of candidate seed viruses, as well as associated
primers and probes for detection can be developed. The pre-production of vaccine
strains for a variety of potential pandemic strains was also suggested, although work
will need to be done to establish whether this is practical, or whether the number of
potential pandemic strains is too large. There were also suggestions of further
research into parallel production methodologies with novel technologies to allow
more rapid vaccine production, as well as the use of adjuvant to allow antigen
sparing. There are also needs for more accurate and rapid quality control methods,
such as HPLC or mass spectroscopy, for checking the purity and quantity of vaccine
antigen produced.

More rapid vaccine approval. Some of the factors behind the delay in releasing
pandemic H1N1 vaccines and how the timing for producing the ‘first dose’ could be
reduced were discussed. However, it was also noted that the timings of the median
and last doses were perhaps better measures of our response to the pandemic. In
addition, it was suggested that a strong message needs to be sent to regulatory
authorities that a different set of ‘rules’ is perhaps needed in a pandemic setting.
There needs to be constructive thinking on reducing the burden of beaurocracy by
forging increased willingness for mutual respect of licences.

Vaccine immunogenicity and correlates of immunity. It was also seen as important to
develop new ways to evaluate some of the newer vaccine technologies to ensure we
are assessing their immunogenicity and efficacy properly. The scientific community
and regulatory authorities need to move beyond the current approaches, particularly
in validating correlates of immunity other than traditional serologic techniques, as
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these do not work reliably for live-attenuated, conserved epitope, or other novel nonHA based vaccines .

Dr Suwit Wibulpolprasert, from the Thai Ministry of Health questioned whether more
research on pharmacologic interventions could contribute to better preparedness in
less well resourced countries. He made the observations that while resources could
have been saved if we had known in advance that only one dose of vaccine was
enough to elicit protection or more doses delivered if we had been able to produce
the vaccine faster, these changes would be of little benefit to the Thai people or those
in less-resourced countries.
From a less economically developed country
perspective, he thought that there is a far greater need for research focus on social
and public health measures which are low cost and easy to implement. Research
into public health communication, and development of broadly applicable nonpharmaceutical interventions would be far more useful in allowing developing
countries to protect themselves, although their effectiveness, especially in the face of
a more lethal threat, remains to be established.
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ANNEX A: AGENDA
Influenza Research 2010: Pandemic Response and Future Directions
1 Great George Street, Westminster, London, UK
Thursday June 24th
12.30-1.30pm Lunch
1.30-1.40
Welcome and overview, Dr Jimmy Whitworth (Wellcome Trust)
Session 1:
Pandemic influenza research in the UK
1.40 - 1.50
Influenza activities and UK funders’ response to pandemic H1N1 Professor
Frederick Hayden (Wellcome Trust).
1.50 - 2.00
Mechanisms of Severe Acute Influenza Consortium (MOSAIC)
Professor Peter Openshaw (Imperial College London).
2.00 - 2.10
FluWatch surveillance programme Dr Andrew Hayward (UCL).
2.10 - 2.25
Pandemic H1N1 and swine: the Combating Swine Influenza (COSI) initiative
Dr Ian Brown (Veterinary Laboratories Agency).
2.25 - 2.40
Q&A
Session 2:
WHO: Pandemic influenza vaccines
2.40 - 3.05
Pandemic plans and H1N1 vaccine experience: production, access,
distribution and effectiveness. Dr Marie-Paule Kieny (IVR WHO).
3.05 - 3.20
Q&A
3.20 - 3.40
Tea and coffee
Session 3:
Research Agenda for Influenza
3.40 - 4.00
WHO Public Health Research Agenda for Influenza: development and
implementation. Dr John Tam (GIP WHO).
4.00 - 4.50
Panel discussion: Taking forward Global Influenza Research.
Professor Fred Hayden (Wellcome Trust) – Chair.
Dr Nancy Cox (US CDC).
Professor David Salisbury (UK Department of Health).
Dr Norbert Hehme (IFPMA)
Professor Malik Peiris (University of Hong Kong).
Dr Suwit Wibulpolprasert (Ministry of Public Health, Thailand).
Dr Marie-Paule Kieny (IVR, WHO).
Dr Linda Lambert (US NIH).
Dr John Tam (GIP, WHO).
Dr Douglas Holtzman (BMGF).
4.50 - 5.00
Closing remarks
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ANNEX B:
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