Frontiers: HPAI: Pandemic Preparedness for a Scenario of High Lethality with No Vaccines

#18,811

Regardless of what pathogen causes it, one of the realities of the next pandemic is that vaccines will probably not be widely available to the public during the first 6 to 12 months of the outbreak.  

For some, particularly in developing countries, that wait could be much longer. 

This is a scenario we've covered many times (see Maggie Fox's SCI AM - A Bird Flu Vaccine Might Come Too Late to Save Us from H5N1), and it mirrors much of what we saw with SARS-CoV-2. 

But COVID, as bad as it was, is hardly the worst that a pandemic could throw at us. It has been estimated its CFR (Case Fatality Rate) was somewhere between 1% and 2% prior to the introduction of a vaccine. 

Even if we discount the oft-quoted 35% CFR estimate for MERS-CoV, and 50% CFR for HPAI H5N1 as being highly inflated (which I strongly suspect), a fatality rate 1/10th the size (3.5%-5.0%) would still exact a horrendous toll. 

We've also seen warnings that our current influenza antivirals may be lacking (see St. Jude Researchers: Current Antivirals Likely Less Effective Against Severe Infection Caused by Bird Flu in Cows’ Milk) along with signs of growing antiviral resistance in avian flu (see Emerg. Microbes & Inf: Oseltamivir Resistant H5N1 (Genotype D1.1) found On 8 Canadian Poultry Farms).

Figuring out how to deal with such a dire situation is an unenviable task, but we've started to see a small resurgence in pandemic planning around the globe. 

• Earlier this month Switzerland Unveils New Pandemic Plan
• Last summer both South Korea and Japan issued revised pandemic plans
• Last April the ECDC published ECDC Guidance: Recommendations for Preparedness Planning for Public Health Threats
• and recently the WHO ratified a 2025 Pandemic Agreement.

But far too many jurisdictions continue to rely on nearly 20-year-old pandemic plans, many of which focused heavily on how to deliver a (likely non-existent) vaccine to the public (see Where Have All The Planners Gone?).

Today we have a perspective article from researchers at Brazil's FIOCRUZ (Fundação Oswaldo Cruz) - along with local and international partners - on the challenges of preparing for a high impact pandemic for which vaccines will be (at least initially) unavailable.

While focused on HPAI viruses, it doesn't limit itself to H5N1, recognizing that both H5Nx and H7Nx viruses pose a significant pandemic threat.  The report suggests the risks of seeing an HPAI pandemic appear to be growing, and cites numerous problems with the rapid production of vaccines. 

• We've looked at the difficulties in producing bulk HPAI vaccines in the past, particularly in egg-based production facilities (see Manufacturing Pandemic Flu Vaccines: Easier Said Than Done).  

• Newer vaccine technologies - while promising - have often been met with resistance (see Moderna Announcement: HHS Cancellation of HHS Late-Stage Contract To Provide mRNA H5 Vaccine. 

Among the author's suggestions; adopting an integrated and digitalized One Health surveillance system, and using AI technology to create broadly protective vaccines, enhance pandemic planning, and optimize resource allocations. 

The authors close by stating: 

What is needed is a shift toward faster action and a coordinated, inclusive strategy that prioritizes preparedness before a next pandemic begins. The time to act is now.

I've reproduced the abstract below, but you'll want to follow the link to read it in its entirety.  I'll have a bit more after the beak. 

Sec. Infectious Diseases: Epidemiology and Prevention

Volume 13 - 2025 | https://doi.org/10.3389/fpubh.2025.1613869
Highly pathogenic avian influenza: pandemic preparedness for a scenario of high lethality with no vaccines

Cristina Possas 1*,Ernesto T. A. Marques 2,3*,Alessandra Oliveira 4,Suzanne Schumacher 4,Marilda M. Siqueira 5,John McCauley 6, Adelaide Antunes 4,7,Akira Homma 1

Abstract

Highly Pathogenic Avian Influenza (HPAI) viruses, particularly H5N1 and H7N9, have long been considered potential pandemic threats, despite the absence of sustained human-to-human transmission. However, recent outbreaks in previously unaffected regions, such as Antarctica, suggest we may be shifting from theoretical risk to a more imminent threat.

These viruses are no longer limited to avian populations. Their increasing appearance in mammals, including dairy cattle and domestic animals, raises the likelihood of viral reassortment and mutations that could trigger a human pandemic. 

If such a scenario unfolds, the world may face a crisis marked by high transmissibility and lethality, without effective vaccines readily available. Unlike the COVID-19 pandemic, when vaccines were rapidly developed despite inequities in access, the current influenza vaccine production model, largely reliant on slow, egg-based technologies, is insufficient for a fast-moving outbreak.

While newer platforms show promise, they remain in early stages and cannot yet meet global demand, which alerts to the urgent need for accelerating vaccine and drug development, especially universal vaccines, next-generation vaccine platforms designed to provide broad, long-lasting protection against a wide spectrum of HPAI virus subtypes and strains.

Here we propose a paradigmatic shift toward a more integrated, digitalized One Health surveillance system that links human, animal, and environmental data, especially in high-risk spillover regions. We underscore that Artificial Intelligence can revolutionize pandemic preparedness strategies, from improving early detection to speeding up vaccine and drug development and access to medical care, but should not be considered a stand-alone solution.

        (Continue . . . )
 

This is a thought provoking article, and while I have serious qualms about our head-long rush towards AI, I can certainly see how AI might help with the tracking of new zoonotic threats, the development of vaccines, and the allocation of resources during a pandemic. 

And few could doubt that developing a global One Health Surveillance system is imperative if we are to track, and hopefully contain, the HPAI threat. 

But good ideas and AI generated pandemic plans  - no matter how well conceived  - are never enough. 

As the authors state; ` . . . global cooperation, including geo-politically sensitive routes, is essential to mitigating the threat of HPAI and preventing future pandemics.

And that's the rub.  

Most countries today remain in deep denial about the potential of seeing another pandemic and are more consumed with stoking their economies, and retaining political power.   

We continue to see many countries are slow to share information, and some some appear to be burying `bad news' completely (see From Here To Impunity).

While I'd like to be optimistic, `Global Cooperation' in this highly competitive and politically polarized 21st century has become an increasingly rare commodity.  

The good news is we are not entirely held hostage to the glacial pace of government cooperation and preparedness.

 

We can still take steps to make our families, our businesses, our network of friends and neighbors, and even our local communities to become more resilient to disasters, including pandemics. 

September is National Preparedness Month, and while most people only consider threats like hurricanes, floods, earthquakes, and wildfires, there are plenty of things you can do now to prepare for the next pandemic. 

It just takes the willingness to act now, when preparing remains relatively easy and cheap.  As we saw in 2020, once the alarm is sounded, you will be competing for rapidly dwindling resources. 

Although the following cautionary quote is nearly 20 years old, it is just as valid today as it was in 2006:

“Everything you say in advance of a pandemic seems alarmist. Anything you’ve done after it starts is inadequate." - Michael Leavitt, Former Secretary of HHS