Endfluenza

We are working towards a shared goal of minimising the impact of influenza by 2020.

A Universal Flu Vaccine will provide long-lasting protection against multiple strains of flu, meaning flu as we know it will be a thing of the past.

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Universal Flu Vaccine: an end to influenza

The development of a Universal Flu Vaccine has long been an ambition for scientists and medical innovation, which could transform the vaccination landscape of the future. Fortunately, this future may now be closer than ever as several scientific groups become nearer to developing a Universal Flu Vaccine.

There are multiple organisations currently undertaking research to develop Universal Flu Vaccines, which will either boost the current annual flu vaccine, or will replace it by offering protection to a broader range of flu strains. Not all approaches will produce a vaccine with universal coverage. A true Universal Flu Vaccine targets the parts of the flu virus structure that do not change in any strain. As a result, they have the potential to offer protection from all annual and pandemic strains and could replace the annual flu vaccine entirely.

Governments and the World Health Organisation have set 2020 as the year a Universal Flu Vaccine should be available. The UK Government has stated its ambition to make the UK a vaccine manufacturing centre of excellence. At the end of 2017, the Government’s Life Sciences Sector Deal pledged an additional £66m in funding, to develop a new Vaccines Development & Manufacturing Centre for the UK.

A key focus of the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health in America, is the development of a Universal Flu Vaccine that would provide long-lasting protection against multiple strains of flu. Legislators are calling for action and funding to expedite research, and several studies are underway.

Universal Flu Vaccine: how does it work?

A true Universal Flu Vaccine targets the parts of the flu virus structure that do not change in any strain. As a result, they have the potential to offer protection from all annual and pandemic strains and could replace the annual flu vaccine entirely.

Three main approaches to a Universal Flu Vaccine are currently being investigated by different institutions.

The booster vaccine works by boosting the immune system as an addition to the annual flu vaccine. It must be given every year and doses will be limited by annual manufacturing capabilities.

The HA stem is a part of the flu virus structure which is fairly constant across viral strains, therefore acting as a good target for a subtype-specific or multi-subtype, long-lasting vaccine. A vaccine using this technology will not protect against all strains of flu and may need to be re-administered regularly.

T cell vaccines target internal proteins of the flu virus, teaching the T cells of the immune system to recognise and destroy cells that have been invaded by the flu virus. As the T cells remain permanently re-trained only one injection is thought to be needed. T cell technology also protects against all strains of the flu, including animal strains, which can lead to wide-spread pandemics. This type of vaccine could lead to the establishment of a new class of vaccines known as ‘Imuno Viral Modulators’ (IVMs). IVMs train the immune system not to lead to chronic disease if invaded by a foreign virus; providing a new platform for viral management and control.

Universal Flu Vaccine:
how soon will it be available?

    Phase I Phase II Phase III  
     
  Booster vaccines Improved immune response demonstrated but not yet efficacy No breakthrough designation available due to no efficacy data  
     
  Stem HA Anitbodies Improved immune responses demonstration but not efficacy    
     
  T cell universal Improved immune response and efficacy demonstrated Breakthrough designation should be available  

Annual Flu Vaccine: current limitations

A new flu vaccine is manufactured every year and aims to provide protection against either three or four strains of the flu virus. The World Health Organisation decides which strains should be included in that year’s vaccine well in advance of the start of the flu season by predicting which flu strain will be most harmful and common in that particular year. The vaccine is then built to provide protection for these specific, chosen strains. This is why a new vaccine is needed every year.

However, the predictions aren’t always right and flu viruses are constantly changing, which means the seasonal vaccine is not always fully effective. Until a better option exists, the best way to prevent the flu is by getting the annual flu vaccination each year.

The challenges of the annual flu vaccine include:

  • Variable efficacy – Yearly guesswork involved to predict each strain leads to 10-60% efficacy.1
  • Limited supply – The manufacturing process for the annual vaccine is slow and difficult, and a maximum of only 350 million doses are available globally each year. This means only certain populations and demographics are vaccinated.
  • Burden on the health services – In the UK the NHS spends more than £100m a year on the annual vaccination programme, which also takes up considerable staff time and energy.2 Despite this, only 70% of eligible groups take up the offer of a vaccine each year.3
  • No preparedness for pandemics – The specific targeting means annual vaccines cannot protect against pandemic strains that may arise. No products are currently available for stockpiling. Pandemic vaccines can only be made once the strain is known which can cause delays.

What is the Flu?

The flu is a contagious respiratory illness caused by influenza viruses that infect the nose, throat, and sometimes the lungs. Flu symptoms come on very quickly and are much more severe than the common cold. It can cause mild to severe illness and at times can lead to death. In the UK, the flu season lasts from December to March. This is when the highest rates of flu occur due to the virus spreading via coughs and sneezes. The virus can live on hands and surfaces for up to 24 hours.4

Every year the flu virus evolves into a number of new strains. Some strains are more dangerous than others and some will become more common, while others will not. Because of this annual evolution of the flu, the prominent strain each season will be different. It is this variation that makes prevention and treatment of the flu with a single, annual vaccine difficult.5 Despite this, getting a flu vaccine each year is currently the best way to prevent the flu.

More information about symptoms and treatment can be found at:

  • US – the Centers for Disease Control and Prevention (CDC) website6
  • UK – the NHS website7

Flu in the UK

19,000 hospital admissions attributed annually to flu8

8.4% hospitalised flu cases result in death9

Average of 8,000 deaths attributable to flu per year10

Managing Flu and its related symptoms costs between £55bn and £72bn per year11

7.6m working days a year are lost, costing the economy in excess of £1.35bn12

Only 70% of eligible people receive the seasonal flu vaccine each year3

Flu in the US16,17

On average, 200,000 flu-related hospitalisations per year

12,000 – 56,000 flu-related deaths per year

Managing flu and its related symptoms costs $87 billion

Each year, 5-20% of the U.S. population contracts the flu

Adults ages 18-64 account for almost 60% of flu hospitalisations

Less than half of all people 6 months and older (46.8%) and adults 18 and older (43.3%) received a flu shot during the 2016-2017 season18

Flu Globally

3,000,000 hospitalisations as a result of flu13

Between 290,000 to 650,000 deaths per year14

Flu costs $1 million to $6 million per 100,000 population15

Flu in the news

Positive results from field study of universal flu vaccine represents a significant advance in the management of influenza disease18 June 2018

British company, Imutex, today announces positive results from a second Phase IIb study of FLU-v, a broad spectrum, stand-alone, single injection influenza vaccine. Primary and secondary endpoints were achieved, as well as reduction in influenza infection rates and severity and duration of symptoms. The study was conducted as part of the EU-funded European Universal Influenza Vaccines Secured Consortium (UNISEC) project.

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Bill and Melinda Gates Foundation Announce $ million Universal Influenza Vaccine Development Grand Challenge27 April 2018

The goal of the grand challenge, launched by the Bill & Melinda Gates Foundation, together with Google co-founder Larry Page and his wife Lucy, is to fund ideas that support transformative rather than incremental research. In his statement, Bill Gates warned that the world is unprepared for the next pandemic which is likely to be caused by flu. Finding a Universal Flu Vaccine that protects from all strains including those which are potentially pandemic, is therefore vital. The development of a Universal Flu Vaccine is underway by various companies with options from UK-based Imutex and Vaccitech already in late-stage development.

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Universal Flu Vaccine that protects against all strains may be available in two years26 March 2018

Trial results of Universal Flu Vaccine 'FLU-v', created by British company Imutex, suggest a single jab protects against all strains of flu for up to a decade. Trial data show 80% were prevented from getting flu after having the jab. The vaccine also limited flu-like symptoms, with 60% of those given the jab developing fewer than two symptoms. With these Phase IIb results announced, Imutex hope to achieve a 'breakthrough designation' from the US FDA paving the way to make it available on the NHS.

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Flu Sending Fewer to Doctor's Office, But Season 'Not Over Yet'23 February 2018

The deadly grip of the flu season appears to be weakening, but experts warn 'we're still in the thick of it.'

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  1. Yearly guesswork involved to predict each strain leads to 10-60% efficacy. Paules C, Sullivan S, et al. Chasing Seasonal Influenza — The Need for a Universal Influenza Vaccine. The New England Journal of Medicine 2018; 378: 7-9
  2. In the UK the NHS now spends more than £100m a year on the annual vaccination programme (including children). GOV.UK Flu vaccination programme extended to all children. https://www.gov.uk/government/news/flu-vaccination-programme-extended-to-all-children [accessed Mar 2018]
  3. Public Health England, Seasonal influenza vaccine uptake in GP patients: winter season 2016 to 2017. May 2017. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/613452/Seasonal_influenza_vaccine_uptake_in_GP_patients_winter_season_2016_to_2017.pdf [accessed Feb 2018]
  4. Bean B, Moore BM, et al. Survival of Influenza Viruses on Environmental Surfaces. The Journal of Infectious Diseases. 1982;146(1):47-51
  5. Public Health England, The Green Book; Chapter 19. Dec 2017 https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/663694/Greenbook_chapter_19_Influenza_.pdf [accessed Feb 2018]
  6. Centers for Disease Control and Prevention. Key Facts about Influenza. https://www.cdc.gov/flu/keyfacts.htm [Accessed Feb 2018]
  7. NHS Flu. https://www.nhs.uk/conditions/flu/ [Accesed March 2018]
  8. Pitman RJ, Melegaro A, et al. Assessing the burden of influenza and other respiratory infections in England and Wales. The Journal of Infection. 2007;54: 530-538
  9. In the UK an average of 600 people a year die from complications of flu. University of Oxford Vaccine Knowledge Project. http://vk.ovg.ox.ac.uk/influenza-flu [accessed Mar 2018]
  10. Green et al (2013). Mortality Attributable to Influenza in England and Wales Prior to, during and after the 2009 Pandemic. PLoS ONE 8(12): e79360. doi:10.1371/journal.pone.0079360
  11. Depending on disease severity, pandemic influenza alone could reduce gross domestic product by 0.5-4.3%. Smith R, Keogh-Brown M, et al. The economy-wide impact of pandemic influenza on the UK: a computable general equilibrium modelling experiment. The British Medical Journal. 2009; 339. http://www.bmj.com/content/339/bmj.b4571.short [accessed Mar 2018]
  12. A pre-pandemic vaccine with moderate efficacy and 60% coverage could result in savings of £2.2bn-£10.8bn. Smith R, Keogh-Brown M, et al. The economy-wide impact of pandemic influenza on the UK: a computable general equilibrium modelling experiment. The British Medical Journal. 2009; 339. http://www.bmj.com/content/339/bmj.b4571.short [accessed Mar 2018]
  13. Molinari NM, Ortega-Sanchez IR, et al. The annual impact of seasonal influenza in the US: Measuring disease burden and costs. Vaccine 2007;25(27): 5086-5096
  14. Iuliano AD, Roguski KM, et al. Estimates of global seasonal influenza-associated respiratory mortality: a modelling study. The Lancet. 2017
  15. WHO. Influenza vaccines. WHO position paper. Weekly Epidemiol Record 2005;80(33):279-87
  16. CDC Foundation. Flu Prevention. https://www.cdcfoundation.org/businesspulse/flu-prevention-infographic [Accessed Feb 2018]
  17. Centers for Disease Control and Prevention. Key Facts about Seasonal Flu Vaccine. https://www.cdc.gov/flu/protect/keyfacts.htm [Accessed Feb 2018]
  18. Centers for Disease Control and Prevention. Flu Vaccination Coverage, United States, 2016-17 Influenza Season. https://www.cdc.gov/flu/fluvaxview/coverage-1617estimates.htm