October 22 marked the anniversary of the flu pandemic of 1918 which spread globally in little over a year and killed at least 50 million people. Commonly referred to as Spanish flu, the illness caused more deaths than World War I or the four years of Bubonic plague outbreak in the Middle Ages. Now, almost 80 years later, medicine has advanced significantly, yet the threat of pandemic flu is still very real. Last year, fear of a bird flu epidemic dominated news headlines as a number of humans in different regions were infected with the virus after being in close proximity to infected birds. If the virus were to mutate and become transmittable from person to person, a flu pandemic could emerge with effects just as catastrophic as the mass flu outbreak of 1918.

New strains of flu are the most likely to cause epidemics, but how do they come about? When the proteins (or antigens) on the surface of a flu virus change frequently, different strains of flu are created with new variations of surface proteins. Although differences between strains are usually relatively minor, occasionally major changes to the proteins will occur which can result in a virulent strain that causes pandemic flu. The population will have little or no immunity to such a new strain and this makes the virus more likely to spread quickly from person to person. With common flu, for example, a new flu vaccine is required each year since immunity to one strain will not necessarily provide immunity to other similar strains.

New vaccines

Developing a vaccine for a new strain can take time. Dr. Jim Robertson, principal scientist at the National Institute for Biological Standards and Control (NIBSC) in the UK, predicts that today, the complex genetic task of developing a suitable vaccine would take 1-2 months alone and producing it, a further 4-5 months. The reality is therefore that a pandemic flu could progress unopposed for up to six months. Furthermore, in a pandemic situation it is likely that two doses of vaccine would be required for it to be effective. Experts claim that it is inevitable that vaccines would be limited during the first year of an outbreak, which would cause the ethical dilemma of deciding who should be administered the vaccine first.


Assuming such medication would actually work on a pandemic strain of flu virus, Dr. Catherine Macken at Los Alamos National Laboratory in New Mexico has stated that antiviral medication can only abate the spread of infection and cannot provide any long-term immunity. Antiviral drugs act on viruses in a similar way to how antibiotics act on bacteria: as soon as treatment ceases, the risk of infection is restored. The limited supply and expiry date of these drugs would only act to defer a pandemic rather than deter it.

Preventing a pandemic

Experts are already thinking ahead and taking preventative measures. The World Health Organisation Global Influenza Surveillance Network is a network of laboratories worldwide that perform genetic analyses of around 2000 flu viruses each year to monitor and detect the emergence of new viruses. This allows early detection of strains that could cause pandemics and enables the development of new vaccines every year that are specific to the new strains.

By studying strains of flu that caused pandemics in the past, researchers may also gain some useful insight into the virus. On 17th October 2006, The National Institute of Health in the U.S. advised that federal scientists led by Dr. Gary Nabel at Vaccine Research Center at the National Institute of Allergy and Infectious Diseases (NIAID) had developed a vaccine that provided mice with immunity against the strain of the 1918 flu virus. “Understanding why this influenza virus was so deadly is an extremely important question”, says NIAID director Anthony S. Fauci. “By building upon earlier research where scientists successfully reconstructed the 1918 pandemic flu strain, Dr. Nabel and his colleagues have demonstrated that this virus is vulnerable to intervention. This knowledge will help further our continued efforts to develop treatments and vaccines to protect us against another deadly flu pandemic.”

In the meantime, what we can do is increase awareness. Global surveillance schemes and international sharing of information should help governments stay informed and give them time to plan appropriately. When a threat is imminent, strict detection methods should be swiftly implemented at ports of entry, and in high-risk public places like hospitals, so as to prevent as much as possible the spread of infection into new regions. Most importantly, preparing the population through education and awareness campaigns will mean that everyone knows what symptoms to look out for and how to respond efficiently and most of all, without panicking.