Universal flu vaccine worth every cent

New modeling by EPI researcher Burton Singer calculates that the substantial costs involved in developing a universal flu vaccine are worth every cent. Singer collaborated with a team from Yale University, University of Texas at Austin, and the University of Maryland to calculate that a universal flu vaccine would save $3.5 billion in direct medical costs annually and save 19,500 lives in the U.S. alone.

Congress, take heed: funding research and development of a universal flu vaccine is worth every cent. A successful vaccine could yield a 3:1 return on investment in the first year alone. 

Newly published research in PNAS analyzes the national economic and epidemiologic benefits from replacing our standard flu vaccine with a universal formulation that would protect against both seasonal flu variation and emerging strains. The study’s authors estimate a savings of $3.5 billion in direct medical costs and more than 19,500 lives saved annually.

“What we have demonstrated is that the significant costs involved in developing and rolling out a universal flu vaccine are entirely justified. The public health benefit is simply enormous,” says Burton Singer, the study’s corresponding author and an adjunct professor in UF’s Emerging Pathogens Institute and the College of Liberal Arts and Sciences department of mathematics. Singer is also a member of the National Academy of Sciences.

He and his colleagues quantified the benefits of a universal flu vaccine that specifically lasts for at least  one year and has at least 75 percent efficacy. Although no such vaccine currently exists, last summer the National Institute of Allergy and Infectious Diseases announced these two targets for the nearly 40 candidate universal flu vaccines undergoing clinical evaluation.

Congress earmarked $330 million for 2019 to further research and development of a general influenza vaccine that won’t be constrained by seasonal variation. The yet-to-be approved Flu Vaccine Act would approve another $800 million over a four year period. If all four additional years of funding are needed, and the goal is reached, then the return on investment would be roughly 3:1.

The research team built a model which mirrors current seasonal flu vaccine rates according to age and geographic uptake patterns. They also incorporated influenza types A and B, plus subtypes, age-specific transmission rates, severity and duration of infectiousness, in addition to other parameters. Then, using actual data from the 2018-2019 flu season, plus looking back to the 2010-2011 pandemic swine flu outbreak, they analyzed what these data would have looked like had a universal flu vaccine been available.

To estimate from a worst to best case scenario, they ran the numbers three ways: estimating a 10 percent replacement of seasonal flu vaccine with a universal vaccine, then 50 percent and 100 percent replacement. Here is what they found:

Keep in mind that these numbers only reflect the direct medical cost savings. Indirect costs, such as lost labor and productivity, would further increase monetary savings. And cost savings would increase even further if researchers exceed their targets and make a universal vaccine that’s effective for multiple flu seasons. Because a universal vaccine could be stockpiled, there would be even further savings in the event of a pandemic outbreak.

“These numbers are really quite conservative,” Singer says. “We were all very surprised to see that no one had yet undertaken modeling these benefits.”

The team used state-by-state data to further assess net gains. They found that states with existing flu vaccine rates higher than the national average of 45.6 percent, such as South Dakota, Rhode Island, Massachusetts and Maryland would have the highest per capita numbers of averted cases (see map A below). Similarly, states with a higher than average elderly population combined with a high existing rate of flu vaccination, such as West Virginia, Maine and Delaware, would see the greatest reductions in severe clinical outcomes and deaths (see maps B and C below).

But some more nuanced patterns also emerged. For example, Washington, Oregon and California would see the greatest savings in medical costs, but not because of unusually high numbers of cases averted. Rather, these states offer advanced health care in high-tech facilities which tends to be costlier than average.  (See map D above.)

Achieving a 75 percent efficacy to yield the benefits predicted in this research will take some time. But Singer believes the gap is narrowing. In a good year, the seasonal flu vaccine may have only a 60 to 66 percent efficacy. This is due to the long time lags between when the CDC predicts in March which strains will be prevalent in the U.S. the following fall, and the time it takes to make a vaccine specific to the predicted strains.

“Right now, we have such logistics involved in terms of constantly having to change the vaccine itself,” Singer says. “That is the ultimate obstacle with our current technology.” 

What some people may not realize, he says, is that the virus itself does not abruptly change by a substantial amount. “However, the effects may be wildly different from season to season. Just recall the 1918 flu outbreak, when tens of millions of people died across the globe,” he says. “Changes in the severity of the illness or its virulence can often be the result of very small changes to the pathogen itself.”

Rather than tinkering around the edges and targeting each season’s new, but minor tweaks, the universal vaccine would go to the heart of how influenza infects us. If you are interested to learn more about how that may work, then we recommend reading this.

By: DeLene Beeland