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The H5N1 avian flu threat has been with us for more than 2 decades, and over that time the virus has continually evolved. Nearly 4 dozen H5Nx candidate vaccine viruses (CVVs) have been selected by WHO for development, although many of these older CVVs are for viruses that no longer circulate in the wild, having been supplanted by newer versions.
Having a proven CVV already tested and approved can save months of valuable time if mass production and distribution of a pandemic vaccine are ever required, although an emerging pandemic virus might not be an exact match.
Since H5 viruses have been such a rapidly moving target, early attempts to stockpile large quantities of vaccine have pretty much been abandoned. Most of those early stockpiles have long expired, or no longer match circulating strains.
Rather than pour expired vaccine down the drain, in 2008 Japan offered free H5 vaccines to high risk groups (see Japan Begins Pre-pandemic Inoculation Of Health Care Workers).
While it isn't certain exactly how protective current CVVs would be against the current (and highly diverse) crop of H5N1 viruses, last week the European Union announced the procurement of 665,000 doses of H5N1 vaccine from Seqirus, with the first shipment to go to Finland.
PRESS RELEASE 11 June 2024 Brussels
Commission secures access for Member States to 665,000 doses of zoonotic influenza vaccines to prevent avian flu
Today, the Commission's Health Emergency Preparedness and Response Authority (HERA) as part of its mandate on preparedness, has signed on behalf of participating Member States, a joint procurement framework contract for the supply of up to 665,000 pre-pandemic vaccine doses of the up-to-date Zoonotic Influenza Vaccine Seqirus, as well as an option for a further 40 million doses over the duration of the contract. Thanks to this contract the participating Member States will have access to medical countermeasures to prevent avian flu.
The vaccine is intended for those most exposed to potential transfers of avian influenza from birds or animals, such as poultry farm workers and veterinarians. It aims to prevent the spread or potential outbreaks of avian influenza in Europe, protecting citizens and livelihoods. The vaccine is the only preventive zoonotic avian influenza vaccine currently authorized in the EU.
Fifteen EU and EEA Member States are participating in this voluntary procurement with the company Seqirus UK Ltd. The contract allows each participating country to take into account their public health context and order vaccines depending on national need. The contract will run for a maximum of 4 years.
Shipments are currently being prepared to Finland for immediate vaccinations of the workers at risk of exposure, at the Member State's request. Shipments to other participating countries will follow.
Background
Seqirus UK Ltd has an EU wide modified marketing authorisation for this vaccine for use in adults, which protects against flu caused by H5 strains of the influenza A virus.
The EU's mechanism of joint procurement is laid down in the EU's Joint Procurement Agreement for Medical Countermeasures, which is signed by 36 countries, including all EU and EEA Member States. The mechanism allows the participating countries to jointly procure medical countermeasures on a voluntary and flexible basis. These countermeasures include vaccines, therapeutics, medical devices, and these can be used as an alternative or to complement to procurement at national level.
The Agreement secures a more equitable access to specific medical countermeasures and improves the security of supply, together with more balanced prices for the participating countries. The Agreement also contributes to the EU-level preparedness for public health crises or pandemics.
This initial order is enough to vaccinate 330,000 people, and the full order enough for 20 million. But the EU would need something in excess of 1 billion doses to cover their entire population.
Although it isn't expressly stated why Finland will receive the first shipment, Finnish fur farms have been hard hit over the past year with H5N1, with > 70 farms affected and more than 500,000 animals (mink, foxes, raccoon dogs) culled.
While reporting of new cases ended last December, the testing of hundreds of farms, and the culling and disposal of hundreds of thousands of animals, appears to have taken a heavy financial toll on their inspection agency.
Last week we saw a disturbing announcement that Finland's Food Agency To Curb Services & Lay Off Animal Disease Investigators, where they reported:
. . . The Food Agency has to lay off personnel and . . . leave unfilled vacancies.
The cost-saving measures also affect the Food Agency's service ability in laboratories investigating animal diseases. We try to serve our customers as well as possible, but there may be a delay in the completion of studies during the rest of the year.
Given the absence of any follow-up reports on the inspection and culling of fur farms since late last fall, it is difficult to know how many of the Finland's 400+ fur farms were actually inspected, and how robust re-inspection and continued surveillance of Finland's fur farms will be going forward.
Fur farms are undoubtedly high risk venues for zoonotic transmission of novel flu viruses (see PNAS: Mink Farming Poses Risks for Future Viral Pandemics), making those workers an obvious choice for early vaccination.
Against this backdrop, we have the following statement issued by Finland's MOH on plans to offer the H5N1 vaccine to vulnerable groups, including farmers and veterinarians.
Avian influenza vaccine to be offered to people at risk of infection
Ministry of Social Affairs and Health
Publication date13.6.2024 15.07
PRESS RELEASE
Avian influenza vaccines will be offered to people who may be exposed to avian influenza. Vaccinations are scheduled to start as soon as possible.
Finland will receive vaccines as part of the EU’s joint procurement, in which 15 countries are taking part. The framework contract was signed by the EU’s Health Emergency Preparedness and Response Authority (HERA) on behalf of the participating Member States.
The avian influenza vaccine was developed by the pharmaceutical company Seqirus UK Ltd, and the contract for the supply of this vaccine will run for four years. The countries participating in the joint procurement will order vaccines depending on their national need.
Vaccine helps to protect fur and poultry farm workers and official veterinarians
The vaccine is intended for poultry and fur farm workers, veterinarians and other people who are at high risk of being infected with avian influenza. Based on a risk assessment, the Finnish Institute for Health and Welfare will determine the groups of people for whom the vaccine is recommended. The vaccine aims to prevent avian influenza infections and the severe forms of the disease.
The Finnish Institute for Health and Welfare will provide more information on avian influenza vaccinations soon. The wellbeing services counties are responsible for organising the vaccinations and providing information at the local level, whereas the Finnish Medicines Agency and the Finnish Institute for Health and Welfare are responsible for monitoring the safety of vaccines.
Avian influenza is poorly transmitted to humans
Avian influenza A(H5N1) circulated extensively among wild birds throughout Europe in 2020–2023. In Finland, the A(H5N1) virus caused exceptionally large mass deaths of wild birds and infections among farmed fur animals in summer 2023.
So far, no avian influenza infections have been detected in humans in Finland. Avian influenza can be transmitted to humans by infected or dead animals or their secretions or faeces. However, the avian influenza virus is poorly transmitted to humans, and in general, very few cases of infection occur.
The Finnish Food Authority monitors the occurrence of avian influenza in wild birds in Finland and works to prevent the spread of the disease on farms.Inquiries:
- European Commission press release on the vaccine procurement
- Avian influenza on the website of the Finnish Institute for Health and Welfare (in Finnish and Swedish)
- Avian influenza on the website of the Finnish Food Authority (in Finnish and Swedish)
Taneli Puumalainen, Director General, Ministry of Social Affairs and Health, tel. +358 295 163 280, taneli.puumalainen(at)gov.fi
Anniina Virkku, Medical Specialist, Finnish Institute for Health and Welfare, tel. +358 29 524 8231, anniina.virkku(at)thl.fi
It remains to be seen, of course, how effective that vaccine will be against current and future strains of H5N1, and how much uptake it will see from farm workers.
But it is - at the very least - a proactive step against the burgeoning H5N1 threat.
And those have been in relatively short supply of late.
