Exploring Lessons Learned from
a Century of Outbreaks
READINESS FOR 2030
PROCEEDINGS OF A WORKSHOP
V. Ayano Ogawa, Cecilia Mundaca Shah,
and Anna Nicholson, Rapporteurs
Forum on Microbial Threats
Board on Global Health
Health and Medicine Division
THE NATIONAL ACADEMIES PRESS
Washington, DC
www.nap.edu
THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001
This activity was supported by contracts between the National Academy of Sciences and the National Institute of Allergy and Infectious Diseases/National Institutes of Health (10003226), Uniformed Services University of the Health Sciences (10003626), U.S. Agency for International Development, U.S. Army Medical Research and Materiel Command (10001249), U.S. Centers for Disease Control and Prevention (10002642), U.S. Department of Homeland Security (10003591), U.S. Department of Veterans Affairs (10003353), and U.S. Food and Drug Administration (10002125) and by the American Society for Microbiology, EcoHealth Alliance, Infectious Diseases Society of America, Johnson & Johnson (10003710), Merck Co., Inc., Sanofi Pasteur, and The University of Hong Kong. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.
International Standard Book Number-13: 978-0-309-49032-0
International Standard Book Number-10: 0-309-49032-4
Digital Object Identifier: https://doi.org/10.17226/25391
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Copyright 2019 by the National Academy of Sciences. All rights reserved.
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Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2019. Exploring lessons learned from a century of outbreaks: Readiness for 2030: Proceedings of a workshop. Washington, DC: The National Academies Press. doi: https://doi.org/10.17226/25391.
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PLANNING COMMITTEE ON EXPLORING LESSONS LEARNED FROM A CENTURY OF OUTBREAKS: READINESS FOR 20301
KEIJI FUKUDA (Chair), Director and Clinical Professor, School of Public Health, The University of Hong Kong
DENNIS CARROLL, Director, Global Health Security and Development Unit, U.S. Agency for International Development
PETER DASZAK, President, EcoHealth Alliance
EMILY ERBELDING, Director, Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, U.S. National Institutes of Health
JENNIFER L. GARDY, Senior Scientist, British Columbia Centre for Disease Control; Associate Professor, School of Population and Public Health, University of British Columbia, Canada
KAREN GROSSER, Former Vice President, Development, Infectious Disease, and Vaccine Therapeutic Area, Formerly Johnson & Johnson
ELIZABETH D. HERMSEN, Head, Global Antimicrobial Stewardship, Merck & Co., Inc.
DANIEL B. JERNIGAN, Director, Influenza Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention
KENT E. KESTER, Vice President and Head, Translational Science and Biomarkers, Sanofi Pasteur
JONNA A. K. MAZET, Professor of Epidemiology and Disease Ecology; Executive Director, One Health Institute, School of Veterinary Medicine, University of California, Davis
SUERIE MOON, Director of Research, Global Health Centre, The Graduate Institute of International and Development Studies, Geneva
DAVID NABARRO, Advisor, Health and Sustainability, 4SD—Skills, Systems, and Synergies for Sustainable Development
KUMANAN RASANATHAN, Board Member, Health Systems Global
PETER A. SANDS, Executive Director, The Global Fund to Fight AIDS, Tuberculosis and Malaria
JAY P. SIEGEL, Retired Chief Biotechnology Officer and Head of Scientific Strategy and Policy, Johnson & Johnson
___________________
1 The National Academies of Sciences, Engineering, and Medicine’s planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteurs and the institution.
Health and Medicine Division Staff
CECILIA MUNDACA SHAH, Director, Forum on Microbial Threats, Board on Global Health
V. AYANO OGAWA, Program Officer, Board on Global Health
T. ANH TRAN, Research Assistant, Board on Global Health
JULIE PAVLIN, Director, Board on Global Health
FORUM ON MICROBIAL THREATS1
PETER DASZAK (Chair), President, EcoHealth Alliance
KENT E. KESTER (Vice Chair), Vice President and Head, Translational Science and Biomarkers, Sanofi Pasteur
MARY E. WILSON (Vice Chair), Clinical Professor of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco
KEVIN ANDERSON, Senior Program Manager, Science and Technology Directorate, U.S. Department of Homeland Security
TIMOTHY BURGESS, Director, Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences
DENNIS CARROLL, Director, Global Health Security and Development Unit, U.S. Agency for International Development
EMILY ERBELDING, Deputy Director, Division of AIDS, National Institute of Allergy and Infectious Diseases, U.S. National Institutes of Health
MARCOS A. ESPINAL, Director, Communicable Diseases and Health Analysis, Pan American Health Organization
KEIJI FUKUDA, Director and Clinical Professor, School of Public Health, The University of Hong Kong
JENNIFER GARDY, Senior Scientist, British Columbia Centre for Disease Control; Associate Professor, School of Population and Public Health, University of British Columbia, Canada
JESSE L. GOODMAN, Professor of Medicine and Infectious Diseases; Director, Center on Medical Product Access, Safety, and Stewardship, Georgetown University
EVA HARRIS, Professor, Division of Infectious Diseases and Vaccinology, University of California, Berkeley
CAROLINE S. HARWOOD, Gerald and Lyn Grinstein Professor of Microbiology, University of Washington
ELIZABETH D. HERMSEN, Head, Global Antimicrobial Stewardship, Merck & Co., Inc.
RIMA F. KHABBAZ, Deputy Director for Infectious Diseases; Director of Office of Infectious Diseases, U.S. Centers for Disease Control and Prevention
MICHAEL MAIR, Acting Director, Office of Counterterrorism and Emerging Threats, U.S. Food and Drug Administration
___________________
1 The National Academies of Sciences, Engineering, and Medicine’s forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteurs and the institution.
JONNA A. K. MAZET, Professor of Epidemiology and Disease Ecology; Executive Director, One Health Institute, School of Veterinary Medicine, University of California, Davis
SALLY A. MILLER, Professor of Plant Pathology and State Extension Specialist for Vegetable Pathology, Ohio Agricultural Research and Development Center, The Ohio State University
SUERIE MOON, Director of Research, Global Health Centre, The Graduate Institute of International and Development Studies, Geneva
DAVID NABARRO, Advisor, Health and Sustainability, 4SD—Skills, Systems, and Synergies for Sustainable Development
RAFAEL OBREGON, Chief of Communication for Development, United Nations Children’s Fund
KUMANAN RASANATHAN, Board Member, Health Systems Global
GARY A. ROSELLE, Chief of Medical Service, Veterans Affairs Medical Center; Director, National Infectious Disease Services, Veterans Health Administration
PETER A. SANDS, Executive Director, The Global Fund to Fight AIDS, Tuberculosis and Malaria
THOMAS W. SCOTT, Distinguished Professor, Department of Entomology and Nematology, University of California, Davis
JAY P. SIEGEL, Retired Chief Biotechnology Officer and Head of Scientific Strategy and Policy, Johnson & Johnson
PAIGE E. WATERMAN, Lieutenant Colonel, U.S. Army; Director, Translational Medicine Branch, Walter Reed Army Institute of Research
MATTHEW ZAHN, Medical Director, Division of Epidemiology and Assessment, Orange County Health Care Agency
National Academies of Sciences, Engineering, and Medicine Staff
CECILIA MUNDACA SHAH, Director, Forum on Microbial Threats, Board on Global Health
V. AYANO OGAWA, Program Officer, Board on Global Health
T. ANH TRAN, Research Assistant, Board on Global Health (until March 2019)
NATALIE LUBIN, Research Assistant, Board on Global Health (from March 2019)
JULIE PAVLIN, Director, Board on Global Health
Reviewers
This Proceedings of a Workshop was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published proceedings as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the charge. The review comments and draft manuscript remain confidential to protect the integrity of the process.
We thank the following individuals for their review of this proceedings:
Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the content of the proceedings nor did they see the final draft before its release. The review of this proceedings was overseen by DAVID R. CHALLONER, University of Florida. He was responsible for making certain that an independent examination of this proceedings was carried out in accordance with standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the rapporteurs and the National Academies.
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Acknowledgments
The Forum on Microbial Threats staff and planning committee of the workshop deeply appreciate the many valuable contributions from individuals who assisted us with this project. Thank you to Nancy Cox, Lawrence Gostin, Gabriel Leung, and David Relman for their input during the planning of the pre-workshop event, as well as Elvis Garcia and Liana Rosenkrantz Woskie for authoring the commissioned paper. The pre-workshop, workshop, and this proceedings would not be possible without the presenters and discussants, who gave so generously of their time and expertise. A full list of the speakers and moderators from both events and their biographical information may be found in Appendix E.
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Contents
Organization of the Proceedings of a Workshop
2 IS THE WORLD READY TO RESPOND TO THE NEXT INFLUENZA PANDEMIC?
Historical Influenza Pandemics
An In-Depth Examination of the 1918 Influenza Pandemic
Potential Impacts of a Modern Pandemic
3 GLOBAL PROGRESS TO PREPARE FOR THE NEXT INFLUENZA PANDEMIC
Scientific Advances in Countering Pandemic Influenza
Progress Toward a Universal Influenza Vaccine
Global Governance to Bolster Pandemic Preparedness
4 REFLECTIONS ON A CENTURY OF INFECTIOUS DISEASE OUTBREAKS AND PANDEMICS
Impact of Outbreaks and Pandemics on People, Communities, and Economies
A Century of Evolving Pandemic and Emerging Infectious Disease Challenges
5 BUILDING LOCAL AND NATIONAL CAPACITIES FOR OUTBREAK PREPAREDNESS
Lessons from the Middle East Respiratory Syndrome Outbreak in Saudi Arabia
Lessons from the Ebola Virus Disease Epidemic in Liberia
Lessons from the Severe Acute Respiratory Syndrome Outbreak in Hong Kong
Lessons from Working in the Frontlines with Local Communities and International Organizations
6 A SPECTRUM OF CONSIDERATIONS FOR PANDEMIC VACCINES
Manufacturing Capacity and Production
Timing and Deployment of Vaccines
World Health Organization’s Role and Legal Considerations in Vaccine Response
Context for the Development of the PIP Framework: Perspective from Indonesia
Context for the Development of the PIP Framework: Perspective from the United States
Process of Developing the PIP Framework
Potential Challenges and Opportunities for the PIP Framework
8 OVERCOMING IMPEDIMENTS TO ACHIEVING GREATER PREPAREDNESS
Institutionalizing Preparedness
U.S. Leadership in Advancing Global Preparedness
Making the Case for Local Preparedness
Broadening the Concept of Health Security
Small-Group Discussions: Potential Strategies to Systematize and Integrate Preparedness
9 VISIONS ON POTENTIAL PRIORITIES AND ACTIONS FOR PREPAREDNESS BY 2030
Political Prioritization and Strategies for Preparedness
Building Preparedness Capacities on Day-to-Day Systems
E BIOGRAPHICAL SKETCHES OF PRE-WORKSHOP AND WORKSHOP SPEAKERS AND MODERATORS
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Boxes, Figures, and Table
BOXES
3-1 Influenza Vaccinology: Some Persistent Needs and Challenges
3-2 Development of a One Health Approach for H5N1 in Hong Kong
4-1 The U.S. National Biodefense Strategy (2018)
5-1 Risk of Influenza Transmission in Mass Gatherings
7-1 Some Challenges and Concerns About the Pandemic Influenza Preparedness (PIP) Framework
8-1 U.S. Leadership in Global Efforts to Combat Antimicrobial Resistance
8-2 Potential Priorities for Ending the Cycle of Panic and Neglect
FIGURES
2-1 Global distribution of deaths associated with the first year of 2009 pandemic H1N1
3-1 Adjusted influenza vaccine effectiveness estimates in the United States
3-2 Iterative pathway to a universal influenza vaccine
3-3 Increasing number of human cases of novel influenza A infections, 1959–2017
4-1 Pandemic vaccine response targets
4-2 Combined interventions suppress the epidemic curve
4-3 Pneumonia and influenza mortality in influenza pandemics
4-4 Proposed phases of epidemic and pandemic alert and response developed in 2008
9-1 Status of core capacities by sub-region in the Americas
TABLE
Acronyms and Abbreviations
AAAS | American Association for the Advancement of Science |
APHA | American Public Health Association |
ASPR | Assistant Secretary for Preparedness and Response |
BARDA | Biomedical Advanced Research and Development Authority |
CBER | Center for Biologics Evaluation and Research |
CDC | U.S. Centers for Disease Control and Prevention |
CEPI | Coalition for Epidemic Preparedness Innovations |
CoV | coronavirus |
CVV | candidate vaccine virus |
FAO | Food and Agriculture Organization of the United Nations |
FBI | Federal Bureau of Investigation |
FEMA | U.S. Federal Emergency Management Agency |
GDP | gross domestic product |
GHSA | Global Health Security Agenda |
GISN | Global Influenza Surveillance Network |
GISRS | Global Influenza Surveillance and Response System |
GLASS | Global Antimicrobial Surveillance System |
GOARN | Global Outbreak Alert and Response Network |
GPMB | Global Pandemic Monitoring Board |
HA | hemagglutinin |
HHS | U.S. Department of Health and Human Services |
IHR | International Health Regulations |
IPAPI | International Partnership for Avian and Pandemic Influenza |
IRAT | Influenza Risk Assessment Tool |
IVPP | influenza viruses with pandemic potential |
JEE | Joint External Evaluation |
MERS | Middle East respiratory syndrome |
NA | neuraminidase |
NIAID | National Institute of Allergy and Infectious Diseases |
NPI | nonpharmaceutical intervention |
NVPO | National Vaccine Reporting Office |
OIE | World Organisation for Animal Health |
PAHO | Pan American Health Organization |
PIP | Pandemic Influenza Preparedness |
SARS | severe acute respiratory syndrome |
SDG | Sustainable Development Goal |
UN | United Nations |
USDA | U.S. Department of Agriculture |
WHO | World Health Organization |