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Flu vaccine spending not enough, Minnesota researcher says

051718.N.DNT.FluShotC -- Michael Osterholm

A recent conversation between philanthropist Bill Gates and President Donald Trump is lending hope to those who want the federal government to spend more on the search for a better flu vaccine.

But although $100 million already has been earmarked for that search, it's not anywhere near enough, says a Minnesota infectious disease researcher.

"That's far, far short of what we need," said Michael Osterholm, director of the University of Minnesota's Center for Infectious Disease Research and Policy. "That's like buying 6 inches of rope for people who are drowning 30 feet out."

At issue are the flu shots health officials urge us to get every year. The same health officials don't hesitate to say that it's one vaccine that's not nearly as effective as they'd like.

During the past flu season, one of the worst in recent years, the flu vaccine turned out to be 36 percent effective, said Dr. Andrew Thompson, an infectious disease specialist at St. Luke's hospital in Duluth.

In Minnesota, it was at least the worst flu season of the decade. The state health department on Thursday reported more than 6,400 hospitalizations for flu so far this season — almost twice as many as in 2016-17 — and five pediatric deaths.

The 36 percent success rate for the vaccine was not particularly bad in terms of the vaccine's effectiveness, Thompson said. It's more in the middle of the road.

"A few years ago it was dismal; it was down around 10 percent or in the single digits," Thompson said. "And as high as 60 percent (other years). But still, that's not very good. ... If it only works half the time or less, it's hard to be a cheerleader."

That's why the search is on for a so-called "universal flu vaccine," or what Osterholm prefers to call a "game-changing" flu vaccine. The goal is a flu shot that would be much more effective against flu bugs and offer solid protection for at least one full year.

Gates, the Microsoft founder, told STAT that he talked up a universal flu vaccine during a conversation with Trump in March, the health website reported. Trump reportedly became so enthused he put Scott Gottlieb, director of the Food and Drug Administration, on speakerphone to ask about it. Gottlieb would only confirm that the call took place, STAT reported.

The reported exchange led the office of Sen. Amy Klobuchar, D-Minn., to put out a news release earlier this week urging Trump to support the Flu Vaccine Act. The legislation would assign an additional $1 billion to the National Institute of Allergy and Infectious Diseases, the lead agency for flu research. Klobuchar reported joining six other senators to send a letter to Trump seeking his support for the bill.

Already, the letter noted, the 2018 fiscal year appropriations bill Trump had signed included $100 million for the agency. The bill encouraged NIAID to prioritize "research related to a universal influenza vaccine."

Answers to what is meant by "universal flu vaccine" vary somewhat, but all agree it would have to be considerably better than the present model.

"Clearly they have to prove that this vaccine (would be) better than what's currently offered," said Dr. Rajesh Prabhu, infectious disease specialist at Essentia Health. "The criticism is the efficacy varies year to year."

But it's no easy fix, said Osterholm, whose book about the danger of killer germs, "Deadliest Enemy," was published last year. And the price tag will be way more than $100 million, way more than $1 billion.

"We're talking about billions of dollars, and there has to be a business proposition meaning that companies are going to take this and move forward," he said. "Just building one plant to make flu vaccine is in the many, many hundreds of millions of dollars."

Nonetheless, it would be worth the investment, infectious disease specialists say.

"If this is successful, we're talking about millions of infections and tens or hundreds of thousands of (premature) deaths which wouldn't happen," Thompson said.

Influenza annually costs the economy billions of dollars, Osterholm said. But another flu pandemic, such as the 1918 "Spanish flu" pandemic that claimed more lives than World War I, would be cataclysmic, taking a global economic toll in the trillions of dollars.

Historic evidence shows that the 1918 pandemic wasn't the first, Osterholm said, and he contends that if there's not a better vaccine, it won't prove to be the last.

"It will happen," he said. "It's like earthquakes, hurricanes and tsunamis — they happen. It might be 20, 40, 60 years, but they happen. And so an investment in a flu vaccine right now that could actually take pandemic flu off the table would rival anything we did with eradicating smallpox."

The specialists contacted for this story all said they're optimistic about a universal flu vaccine being available sometime in the future. In fact, just this month a Phase 2 clinical trial was launched of a potential universal vaccine developed in Israel, according to a NIAID statement.

But at best, a universal vaccine is some years away from becoming reality, they said.

"It's not like it will be available in two years," Prabhu said. "If it was that simple, it would have been done a long time ago."

Until whenever the better vaccine is out there, Prabhu and Thompson both said they'll continue to advocate that people get a flu shot in the fall.

"We keep saying that that's the best available," Prabhu said.

What is a universal flu vaccine?

According to the National Institute of Allergy and Infectious Diseases, a universal flu vaccine should:

• Be at least 75 percent effective

• Protect against group I and II influenza A viruses

• Have durable protection that lasts at least one year

• Be suitable for all age groups