Not Enough Shots: The Tricky Business of Vaccines

Sen. Joe Biden plans to push government officials to expedite the development of a virus-fighting shot. In a report last week, Mr. Biden’s office identified a deadly flu that the administration wants to eliminate in 2019, a quarter of a century after it was engineered in the lab.

For the past two years, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, has advocated the production of a synthetic vaccine — a shot derived from the virus itself, in a similar fashion to the one given to treat seasonal flu each year.

But while the administration has made headway on a biological analog of the pandemic virus used to prepare for another big outbreak, decades of back and forth have delayed plans to produce an actual, live vaccine for use against a pandemic. Because a flu shot contains all four influenza viruses that circulate in the U.S. each year, it will be more effective than a synthetic shot, said John J. Treanor, an infectious diseases professor at Boston University. (Mr. Biden is the former chairman of the Senate Foreign Relations Committee.)

So far, the only way to make an ethical shot of the so-called Type A H3N2 virus for the Jardine Forest outbreak, which killed 30 people in Colorado last year, has been to cull the virus from an animal egg, making it more harmful to animals and potentially making it less effective. If it was possible to make the shots directly from an influenza virus, it would be possible to have more control over its effectiveness and effectiveness against any other influenza viruses that could emerge around the world.

“In the event of another potential epidemic in the U.S., it could have a much more profound impact on our health and the world,” Dr. Fauci said, explaining that the deaths from this outbreak would not have been prevented had it not been for the decision to make the shots. “We are increasingly aware that the window to respond is close.”

The report lays out some preliminary efforts toward expanding production. The Department of Health and Human Services and the Centers for Disease Control and Prevention would have to approve the use of hemagglutinin, the protein that gives the flu its name. The government has already approved the use of the flu gene in a human vaccine, which has been in the pipeline for years.

But if the results of a pilot study were to be promising, Fauci believes that the government could find a way to build an assembly line for manufacturing flu shots within a year.

“We could get the pandemic vaccine manufactured very rapidly and provide it to communities,” he said. “We could also create an antidote that could protect from other more serious influenza epidemics that may be coming.”

While there are currently trials of a live flu shot in Scotland and the United Kingdom, a fresh start seems to be urgently needed. Over the last two decades, human immunodeficiency virus — the virus that causes AIDS — and influenza have both been on the rise in the U.S. as the U.S. population ages. As a result, the number of new H3N2 swine flu-related illnesses tripled last year and “severe” influenza activity is continuing to hit the nation, according to federal health officials. And they believe that a secondary wave of influenza may be coming in the coming months.

Currently, even after a flu outbreak, H3N2 remains the dominant strain around the world, Dr. Fauci said. Because there is no equivalent to an H3N2 and H1N1 vaccine in the U.S., supplies for H3N2 prevention are usually a piecemeal product made from a mixture of three or four viruses, said Dr. Patrick Moriarty, assistant professor of pediatric infectious diseases at Johns Hopkins Children’s Center.

A shot of the H3N2 virus would not prevent flu at all, but the potency and adaptability of H3N2 may make it particularly useful in a potential pandemic. It is roughly 20 times more virulent than H1N1, the other dominant influenza virus around the world, Dr. Fauci said. As a result, it can spread through a plane’s air ducts and decimate a patient within the first week of symptoms.

“Any infected person without a vaccine is in imminent danger,” Dr. Fauci said.

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