Study: Steps to Save Lives in a Flu Pandemic

By Brian Lau

In a new analysis, Stanford researchers, in collaboration with others across the country, suggest changes policy makers could address now to save thousands of lives and billions of dollars in the event of a pandemic, such as the one the world saw in 2009 when H1N1 swept around the world.

A new bird flu strain -- H7N9 -- emerged in March, 2013, World Health Organization report 400 deaths since last April, most of them in Asia.

Researchers used data from the 2009 pandemic and the virus characteristics of the H7N9 bird flu in a model to estimate the health and economic consequences. They studied the effect of both vaccination programs and public health initiatives, using different time points during the first 12 months of a simulated severe pandemic in a densely populated metropolitan area.

In 2009, a vaccine was developed and became available 9 months into the pandemic. Researchers found that a shorter time to vaccination -- 6 months instead of 9 --  would avert nearly 6,000 deaths and save $1.9 billion in treatment costs. The study was published in the Annals of Internal Medicine this week.

Influenza is a virus that changes its structure frequently. These subtle changes allow the virus to evade the human immune system and result in repetitive flu outbreaks. This is why each year we have to get a new flu shot.

Occasionally, the flu virus undergoes a major shift in its structure, allowing a strain that normally infects only animals to make the jump to humans. These major changes make the virus so unique that our immune systems cannot recognize and fight the virus -- meaning higher rates of infection and potentially causing a large regional or global pandemic.

The backbone of the U.S. Centers of Disease Control and Prevention’s response to an influenza pandemic is to develop and distribute an appropriate vaccine. Currently, flu vaccines are egg-based and require months for manufacturers to optimize growth conditions and produce vaccines.

“Best-case scenario: egg-based vaccine delivery is completed in 5 months”, said Dr. Nayer Khazeni, lead author and assistant professor of medicine at the Stanford University School of Medicine. Moving toward new technologies "can decrease this time by 2-3 months." 

Public Health Measures Can Save Lives in Pandemic

Still, regardless of the method of vaccine development, there will be a delay from the time a virus appears to delivery of a vaccine. During this time period, public health officials can limit the spread of the virus, the researchers said, possibly through school and childcare closures or even voluntary isolation. But, isolating the population until vaccines are delivered may not be practical or safe. The economic fallout alone could be detrimental.

The study found that a 33 percent decrease in contacts with infected individuals would save as many lives and reduce cost similar to vaccinating the population at 4 months into a pandemic. This could result in saving over 11,400 deaths and about $3.8 billion in health care costs compared to vaccinating at 9 months as in the 2009 flu pandemic.

Brian Lau is a freelance writer and an orthopedic surgery resident at UCSF medical center. Follow him on Twitter.