Are we prepared for the next influenza pandemic? Lessons from modelling different preparedness policies against four pandemic scenarios

Jasmina Panovska-Griffiths*, Luca Grieco, Edwin van Leeuwen, Marc Baguelin, Richard Pebody, Martin Utley

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

17 Citations (Scopus)

Abstract

In the event of a novel influenza strain that is markedly different to the current strains circulating in humans, the population have little/no immunity and infection spreads quickly causing a global pandemic. Over the past century, there have been four major influenza pandemics: the 1918 pandemic (“Spanish Flu”), the 1957–58 pandemic (the “Asian Flu”), the 1967–68 pandemic (the “Hong Kong Flu”) and the 2009 pandemic (the “Swine flu”). To inform planning against future pandemics, this paper investigates how different is the net-present value of employing pre-purchase and responsive- purchased vaccine programmes in presence and absence of anti-viral drugs to scenarios that resemble these historic influenza pandemics. Using the existing literature and in discussions with policy decision makers in the UK, we first characterised the four past influenza pandemics by their transmissibility and infection-severity. For these combinations of parameters, we then projected the net-present value of employing pre-purchase vaccine (PPV) and responsive-purchase vaccine (RPV) programmes in presence and absence of anti-viral drugs. To differentiate between PPV and RPV policies, we changed the vaccine effectiveness value and the time to when the vaccine is first available. Our results are “heat-map” graphs displaying the benefits of different strategies in pandemic scenarios that resemble historic influenza pandemics. Our results suggest that immunisation with either PPV or RPV in presence of a stockpile of effective antiviral drugs, does not have positive net-present value for all of the pandemic scenarios considered. In contrast, in the absence of effective antivirals, both PPV and RPV policies have positive net-present value across all the pandemic scenarios. Moreover, in all considered circumstances, vaccination was most beneficial if started sufficiently early and covered sufficiently large number of people. When comparing the two vaccine programmes, the RPV policy allowed a longer timeframe and lower coverage to attain the same benefit as the PPV policy. Our findings suggest that responsive-purchase vaccination policy has a bigger window of positive net-present value when employed against each of the historic influenza pandemic strains but needs to be rapidly available to maximise benefit. This is important for future planning as it suggests that future preparedness policies may wish to consider utilising timely (i.e. responsive-purchased) vaccines against emerging influenza pandemics.

Original languageEnglish
Pages (from-to)223-232
Number of pages10
JournalJournal of Theoretical Biology
Volume481
DOIs
Publication statusPublished - 21 Nov 2019

Bibliographical note

Funding Information:
This paper is an extension of a work based on independent research commissioned and funded by the National Institute of Health Research (NIHR) Policy Research Programme (Responsive Operational Research facility to support Health Protection Policy, grant number 027/0085). The views expressed in the publication are those of the author(s) and not necessarily those of the NHS, the NIHR, the Department of Health and Social Care, 'arms' length bodies or other government departments. JPG was supported fully and MU in part by the NIHR Collaboration for Leadership in Applied Health Research and Care North Thames at Bart's Health NHS Trust (CLAHRC North Thames). EvL was funded by the NIHR Health Protection Research Units (HPRU) in Respiratory infections. All authors declare no competing interests. JPG developed the work described in this paper with contributions from LG, MU, EvL, MB and RP. JPG drafted the paper with contribution from LG, MU, EvL, MB and RP and the final paper was approved by all authors.

Funding Information:
This paper is an extension of a work based on independent research commissioned and funded by the National Institute of Health Research (NIHR) Policy Research Programme (Responsive Operational Research facility to support Health Protection Policy, grant number 027/0085 ). The views expressed in the publication are those of the author(s) and not necessarily those of the NHS, the NIHR, the Department of Health and Social Care, 'arms' length bodies or other government departments. JPG was supported fully and MU in part by the NIHR Collaboration for Leadership in Applied Health Research and Care North Thames at Bart's Health NHS Trust (CLAHRC North Thames). EvL was funded by the NIHR Health Protection Research Units (HPRU) in Respiratory infections.

Publisher Copyright:
© 2019

Keywords

  • Epidemiological modelling
  • Net-present value of pandemic immunisation
  • Pandemic influenza
  • Pre-purchase pandemic vaccine
  • Responsive-purchase pandemic vaccine

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