• As recently as 2018, flu cases overwhelmed US hospitals. If this reoccurs during the COVID-19 pandemic, the effects could be disastrous.
  • Flu vaccination should be a priority today to help reduce the burden on healthcare systems struggling with the current health crisis.
  • As we race to develop a COVID-19 vaccine, we must also develop a universal flu vaccine to ensure we are prepared for the next flu pandemic.

The world is focused on the COVID-19 vaccine race, in the hope that protective immunity from a vaccine will resolve the pandemic. Ongoing studies will determine whether any of the many candidate vaccines can meet that promise. In the meantime, we can take action to minimize the pandemic’s consequences – while protecting ourselves and our communities from another infectious threat – by getting a flu shot.

Influenza and COVID-19 are both viral diseases spread primarily by the respiratory route. As cold weather returns to the Northern Hemisphere and people spend more time indoors, transmission threat for both viruses will increase. Whether or not the coming flu season is severe, it will add to the stress on already overburdened health systems.

Influenza’s annual burden

Year after year, influenza claims between 300,000 and 600,000 lives, with complacency acting as its accomplice. In 2017, for example, influenza killed more people in the US than opioids—yet we’re so used to flu that the term has become generic. “Flu” in common parlance often encompasses milder illnesses such as bad colds or gastroenteritis caused by other pathogens. Some public health officials have suggested (somewhat tongue-in-cheek) that “flu” should be re-branded to reflect just how deadly it is.

As recently as 2018, influenza cases overwhelmed some US hospitals to the point of requiring all-too-familiar tents in parking lots to manage the overflow. If such demand coincides with a spike in COVID-19 cases, hospital beds and ventilators could quickly become scarce.

Flu meets COVID-19

Symptoms of both flu and COVID-19 include fever and coughing (along with headache, muscle aches and fatigue). Because of their similar clinical presentation, testing will be necessary to distinguish between them in order to track their spread, and also to ensure their appropriate treatment. Antiviral drugs for influenza have not proven effective against COVID-19; meanwhile, remdesivir, which can treat COVID-19 but not influenza, is in short supply. Coinfection with both viruses is a threatening possibility, and both weaken the body’s ability to fight off pneumonia and other infections.

Mask-wearing, social distancing and handwashing are our current arsenal against COVID-19 and these same measures will also minimize the spread of influenza. Yet influenza vaccination should be a priority, not just for self- and community protection against influenza but to reduce the flu-associated burden on healthcare systems.

Improving flu vaccine uptake through effective communication

COVID-19 has reinforced the value of vaccines – they save lives, and by reducing the spread of infection help to restore societies and economies. At the same time, however, misinformation and vaccine hesitancy, along with complacency, have led to low influenza vaccination levels in the US and Europe. Although the US Centers for Disease Control and Prevention recommends that nearly everyone aged six months or older should receive the annual flu vaccine, only 45% of all adults over the age of 18 in the US did so last season. Not a single EU country hit its 75% target coverage rate last season, and less than half of people eligible for the vaccine actually received it. Elsewhere, annual influenza vaccines remain beyond the capacity of health systems that have other priorities.

Image: Statista

COVID-19 complicates communication around influenza. Now and especially after a COVID-19 vaccine becomes available, it will be critical to provide information supporting timely access to annual flu vaccines and evidence-based mass communication campaigns that explain the health risks of influenza and the benefits of vaccination. On the other hand, we can take advantage of the present opportunity to reshape the narrative of influenza, which has long been tainted by misinformation about the vaccine and misunderstandings of the virus’ true dangers. Using current campaigns for mask-wearing and social distancing as models, we can tailor health messages to highlight how the flu vaccine protects vulnerable and high-risk groups, including the elderly and immunocompromised.

Expanding access to the influenza vaccine

Access to influenza vaccination can strengthen health security and pandemic preparedness and increase the capacity of healthcare systems everywhere to respond to other diseases. To provide a foundation for effectively reducing the global burden of influenza, the World Health Organization’s Global Influenza Strategy is proposing solutions to improve monitoring and response to flu, particularly in low- and middle-income countries.

Clearer understanding of the health, economic and social burdens of influenza should lead to increased demand for flu vaccines, and thus for manufacturing capacity. In 2020, manufacturers of influenza vaccine for the US anticipate providing 200 million doses and delivering it earlier than in previous seasons. Similar preventive measures must be incorporated globally to bridge gaps in access to the seasonal influenza vaccine.

Ultimately, we need a better vaccine

In 1918, a novel strain of influenza emerged against which humans had little to no immunity. Over the next 18 months, the virus spread around the world, killing an estimated 50 million people; milder pandemics in 1957,1968, 1977, and 2009 took between 2 and 4.5 million lives, combined. It is only a matter of time until the next influenza virus with pandemic potential emerges. COVID-19 revealed how poorly we have prepared for this inevitable challenge.

It was the threat of pandemic influenza that inspired the now famous strategies of social distancing to 'flatten the curve' in order to ease the burden on healthcare systems in the absence of a vaccine against an emerging influenza strain.

'Flattening the curve' refers to measures that keep daily disease cases at a manageable level
'Flattening the curve' refers to measures that keep daily disease cases at a manageable level
Image: US Centers for Disease Control and Prevention

True preparation against pandemic influenza requires lifelong or multi-year protection against a broad spectrum of strains with a universal influenza vaccine. Such a vaccine would solve the problem of vaccine delay and lack of availability in the early stages of a global pandemic, and it could be incorporated into immunization schedules in many low- and middle-income countries that currently lack an influenza vaccination programme.

As we race to develop a COVID-19 vaccine, we should at the same time be equally committed to developing a universal influenza vaccine so that when the next influenza pandemic emerges we have a vaccine in place. That way, we need not suffer the health, economic and social consequences while we wait for it to be developed.

Urgent and immediate action is needed to support research toward a universal influenza vaccine. Released in 2019, the Sabin-Aspen Vaccine Science & Policy Group’s annual report, Accelerating the Development of a Universal Influenza Vaccine, calls for collaboration and coordination among experts of different disciplines to advance this critical research agenda. Now that we have seen the devastating consequences of waiting to develop a vaccine until a pandemic is upon us, we must commit to the tougher race to deliver a universal influenza vaccine to the world.

The ultimate goal of preparedness is to have what you need before you need it. When the next influenza pandemic arises, we shouldn’t look back and wish we had done what we know we need to do now.