Fighting Flu During COVID-19: Q&A with Respiratory Virus Prevention Programs Director Joe Bresee

Flu season has begun in many countries. Each year, there are up to five million cases of severe illness and an estimated 650,000 deaths. Influenza is caused by a respiratory virus that leads to annual epidemics and occasional pandemics.

For 20+ years, Dr. Bresee has worked in respiratory virus prevention.

Respiratory virus experts see ways to apply lessons and strategies from the COVID-19 pandemic and previous flu outbreaks to protect people from these and other  transmissible diseases.

We speak with Dr. Joe Bresee, who leads The Task Force’s Respiratory Virus Prevention Programs, about flu season, COVID-19, helping countries respond to both, and The Task Force’s approach to respiratory virus prevention.

What should people keep in mind this flu season?

More than ever, make sure to get your influenza vaccine. Even though COVID-19 has been our main focus these past two years, influenza is still a major public health threat both in the U.S. and worldwide.

We have not seen much influenza since COVID emerged, fortunately, in part because the social distancing and mask wearing that was effective in reducing spread of COVID-19 also worked very well for influenza. That is a good thing but that also means that when influenza returns, fewer people will have been exposed to recent influenza viruses, potentially leaving more people susceptible. Because influenza viruses constantly change, the flu viruses that may circulate this season might be viruses for which fewer people have immunity.  So the vaccine, which is updated to protect against the latest viruses, is even more critical.

However, we’re at risk of vaccine and disease fatigue, so fewer people might want to get the flu vaccine than in a normal year. We’re living in a pandemic and our lives have been consumed by information about COVID-19 and vaccinations so thinking about another disease and making sure to get that vaccine too will not be top of mind for many.

For these reasons, we’re concerned about and planning for a severe influenza season, and the risk is not only more cases but more flu cases compounded by peaks in COVID-19 cases that we’re anticipating during the colder months in many countries. This means greater strain on our health and public health systems.

What to Keep in Mind This Flu Season

What do you think will be the major challenges for countries during this flu season?

Losing focus on flu in the face of the fatigue that both clinicians and the public are feeling around the COVID-19 pandemic will be a major challenge.

For The Task Force’s Partnership for Influenza Vaccine Introduction program (PIVI, one of the Respiratory Virus Prevention programs) that means making sure our partner countries have the capacity to keep flu a priority in addition to COVID-19. We work with partner countries to help them establish the structure, the capacity, and the routine of seasonal flu vaccination programs so that the countries’ national health systems are ready and their citizens are ready for even a bad flu season during a pandemic. 

As we’ve seen with many diseases, health departments and ministries of health are having to figure out how to prioritize other health issues while the COVID-19 pandemic is consuming the majority of resources. How can we help leaders make these difficult decisions?

On a country level, it is about providing the data, the evidence on flu so that county, state, provincial, and national leaders can make the most informed decision about where to put their precious resources. On the international level, we need to make the case that increasing support to influenza prevention and preparedness is not necessarily just about giving leaders the information to make a case for the tradeoffs. We still have an obligation to present the data in an unbiased way, but we must also be a mechanism by which the total resources available for flu prevention are increased. Watch to hear about the role data can play in low-resource settings.

Each year a new flu vaccine is developed to be most effective for the circulating strain. Tell us about The Task Force’s work to develop a universal flu vaccine that will be effective for all strains.

One of the great challenges of influenza is that the virus mutates very quickly and because of that the vaccine that works well this year may not work well next year as the virus changes to evade the vaccine. That’s why we need annual vaccination.

Dr. Bresee explains how a universal flu vaccine would work

This presents a lot of challenges scientifically, and also programmatic challenges in conducting annual vaccination programs, especially for low- and middle-income countries who have limited resources to acquire and administer vaccines.

The Task Force’s Global Funders Consortium for Universal Influenza Vaccine Development brings together major stakeholders in influenza vaccine research and development to accelerate creation of a universal flu vaccine. The consortium promotes coordination among researchers who are working to develop this improved flu vaccine by increasing funding, eliminating duplicative work, improving efficiency, and ensuring that identified gaps are being filled.

Tell us how programs fighting respiratory viruses like flu have helped support countries’ response to COVID-19.

The work that has been done by programs like PIVI and other flu and respiratory virus prevention programs has been really important for COVID-19 response because the target populations are the same – health workers, the elderly, pregnant women, adults. That’s important because most countries, including low- and middle-income countries, are used to administering vaccines targeted for infant populations or very young children. So countries that are very good at administering measles or polio vaccines to young children are not necessarily ready to administer adult immunization programs.

Influenza vaccination provides countries with the platform for administering adult immunization programs for any vaccine. The same planning that goes into seasonal flu vaccine campaigns – understanding who you’re going to give the vaccine to, where they are, how to give it, who is going to give it – is all the same planning that goes into delivering COVID-19 vaccines. We’ve seen already that countries like PVI partners who are able and have delivered seasonal influenza vaccines are having an easier time with vaccinating their citizens against COVID-19.

Why are we seeing a surge in COVID-19 cases/hospitalizations in many areas, particularly where vaccination coverage is low?

Like influenza, coronaviruses mutate and evolve continuously. This has led to the development of new variants of this coronavirus, like the Delta variant, that spread between people more efficiently. This has clearly led to the recent surges, especially in populations and countries with low vaccination rates.

The good news is that the COVID-19 vaccines protect against the Delta variant and others, certainly protecting against getting severely sick. But watch to learn more about the roadblocks.

Vaccine equity continues to be an issue, with many countries lacking access to vaccines, and leaders last month at the UN General Assembly and the U.S. COVID-19 Summit discussing how to make more vaccines accessible globally.  Do most countries have the capacity to administer vaccines on a large scale once they do receive enough doses?

Some have greater capacity than others, but few countries have implemented such a large and complex program of vaccinations so quickly.

That’s why we established The Task Force’s CoVID-19 Vaccine Implementation Program (CoVIP), which works with up to 35 low- and middle-income countries to develop the systems needed for a successful vaccine roll out.

Header photo: A health worker prepares a flu vaccine at a health clinic in Kenya during a vaccination campaign. Photo courtesy of Reyoh Photography for PIVI.

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