In the teeth of one of the deadliest flu seasons in several years, scientists have already placed a bet on how to tackle the virus next winter.
Late last month, the World Health Organisation (WHO) identified the flu strains it believes the public will need protecting from next year. It ordered large drug companies to develop vaccines to match up.
Among those likely to answer the call are Britain’s GSK, Pfizer in the US and France’s Sanofi. All concerned need to up their game, given the current flu season has wreaked havoc across the northern hemisphere.
The UK has seen the highest flu rates for seven years – with 193 confirmed deaths and 1,552 admissions to intensive care. Flu activity has also been widespread in the US, where a government study found this year’s vaccine had only been 36pc effective.
Past pandemics show the devastation unchecked flu can cause. This year is the 100-year anniversary of the Spanish Flu, which left up to 100m people dead worldwide. The biggest problem with flu jabs is they are largely reliant on guesswork.
“The reason why it varies is because they are redeveloped every season on the basis of what the WHO predicts will be the prevalent strains,” says Thomas Breuer, the chief medical officer of GSK Vaccines. “Sometimes they are right, sometimes they are wrong.”
This year, most vaccines in Britain have not protected people against a strain called B-Yamagata – known as “Japanese flu” – which has been one of the main ones in circulation.
For the NHS, the stakes are high. “We’ve had many more very serious cases this year, particularly with strain B,” an NHS intensive care nurse said, who declined to be named.
“At our hospital, it can cost £1,500 a day, sometimes as much as £3,000, to treat a patient in intensive care.
“However clever you are, you are not going to be able to get the predictions right every year with the flu jab. Maybe it’s time for a new approach.”
Thankfully, drug firms are fully in agreement. Pharmaceutical giants are competing in a global race to develop the world’s first “universal” flu vaccine that protects against all strains.
It is one of the most hotly contested fields in the £22bn global vaccines industry. The main players are grappling with some of the biggest challenges in medicine, including developing potential vaccines for HIV, malaria and Ebola.
Companies have more than 300 vaccines in research and development. There is also potential to develop vaccines for diseases such as cancer and asthma, and vaccines have a role in combating anti-microbial resistance – aka “superbugs”. But like all areas of modern medicine, it has its flashpoints.
Pharmaceutical firms have faced accusations of unfairly profiteering from the flu pandemic in the US, while in the UK this week the industry clashed with the Government over its plans to overhaul access to vaccines on the NHS.
An industry trade body called the proposals – which are now out for consultation – “profoundly concerning”, saying they risked making it harder for people to access vaccines on the NHS. Vaccines must also compete for research cash against fast-growing, more profitable fields, such as cancer treatments.
GSK’s Breuer insists vaccines do not play second fiddle at the FTSE 100 firm. His division has revenues of a little over £5bn, and GSK’s relatively new chief, Emma Walmsley, has given the unit a target of achieving mid-to-high single-digit percentage growth annually. Breuer is excited by the challenge posed by flu. “Our long-term plan is cracking the holy grail and coming up with a universal flu vaccine that you don’t have to change every year,” he says.
Current flu vaccines work by targeting surface parts of the virus molecule that “change frequently”, he says, making them quickly redundant.
However GSK’s experimental jab targets parts of the molecule that don’t change, potentially leading to a universal breakthrough.
The company is working on the inoculation with leading academics at New York’s Icahn School of Medicine. They started a clinical trial with patients in September last year, with a readout expected in 2020.
A German rival company, Curevac, is separately working on its own universal flu vaccine candidate, which works in a different way by attacking the flu molecule’s DNA code.
However, Breuer cautions not to expect a quick solution from either of the companies. “Vaccines are 10-year endeavours,” he says.
It is not just drug giants in the race. Oxford University spin-out Vaccitech – which employs just eight staff – started an early clinical trial with the NHS last October involving more than 800 people of an immune-system-boosting flu jab. It only targets strain A – so can’t claim to be a universal vaccine – but still has the potential to greatly improve protection as a supplementary vaccine.
“This is a critical time, with scientists working on an array of new approaches to tackling flu,” says Tom Evans, Vaccitech’s chief executive. The firm would look to partner with a bigger rival on a follow-up trial if its initial investigation proves successful.
Industry figures say the UK is the world leader for vaccination programmes. But they worry the Government is in danger of throwing this away.
This week’s controversial consultation on vaccines included a range of proposals on ways to better fund vaccines. It arose after a public outcry over the death of two-year-old Faye Burdett in 2016 from Meningitis B, which led to an 820,000-signature petition calling for all children to be vaccinated for the disease. This was rejected as “not cost effective”.
The blueprint includes measures such as assessing the effectiveness of a vaccine over the lifetime of a patient, which are meant to lead to better decisions on funding inoculations.
But a proposal to reduce the cost-effectiveness threshold – known as a QALY (quality-adjusted life year) – for vaccines below that of medicines has provoked ire from drug firms.
“The UK is really exemplary in this field,” says Breuer. “So it really raises eyebrows to see them raising barriers. It signals a move away from prevention, which I don’t understand.”
Sanofi also weighed in on the changes, saying in a statement it “does not believe this is in the interests of public health” and “would undermine the UK’s status as a world leader in vaccination”.
Whether the Government will heed the industry’s concerns remains to be seen. If pandemic risks such as flu are to be tackled a harmonious relationship would no doubt help.