Alex Azar, secretary of Health and Human Services, led U.S. health officials and infectious disease experts in urging Americans to get their annual flu shots, emphasizing the virus kills tens of thousands of people across the nation every year.
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"The first and best defense is to get a flu vaccine," Azar said just before rolling up his sleeve and getting his own influenza shot at a Sept. 26 press briefing hosted by the National Foundation for Infectious Diseases.
A new NFID-sponsored survey, however, showed that only 52% of U.S. adults plan to get a flu shot this season, despite 60% responding that they thought the vaccine was the best way to prevent hospitalizations and deaths from the virus.
Even more concerning, said William Schaffner, medical director at NFID, the survey showed that nearly a quarter of U.S. adults 60 years or older with an underlying chronic disease, like asthma, diabetes or heart disease — those at the highest risk of influenza-related complications — said they did not plan to get vaccinated for the 2019-2020 flu season.
The flu vaccine worked best in children ages 6 months to 17 years during the 2018-2019 season, yet only 63% in that age group got the shot last year, said NFID President-Elect Patricia Whitley-Williams, a professor of pediatrics and division chief of allergy, immunology and infectious diseases at Rutgers Robert Wood Johnson Medical School.
Pandemic concerns
Those poor vaccination rates had Whitley-Williams concerned about how the U.S. would handle the next big flu pandemic — an event for which the infectious disease community thinks the time is ripe.
The medical community must figure out how to get more Americans to take the flu seriously and get vaccinated against the seasonal virus so that the innovations the infectious disease community is working on to produce pandemic and universal influenza vaccines can best be utilized, Whitley-Williams told S&P Global Market Intelligence.
While federal agencies are under a recently issued White House order to come up with a five-year plan to modernize the flu vaccine manufacturing process, Whitley-Williams said the infectious disease research community has already long been chasing that goal.
"There are many, many people working on it," she said.
Over the past several years, the U.S. National Institutes of Health has funded a number of academic researchers who are pursuing universal and pandemic vaccines, Whitley-Williams noted. Philanthropic organizations have also provided critical funding for those efforts, she added.
The Bill and Melinda Gates Foundation and the charitable organization Flu Lab recently awarded $12 million in grants to fund research into a universal flu vaccine.
Cracking the egg dilemma
The ultimate goal, though, is to get vaccine makers to move away from the more than 70-year-old antiquated egg-based process of developing their products and adopt newer technologies, Whitley-Williams said.
But only a few companies have moved in that direction.
One of those is CSL Ltd. unit Seqirus Inc., which produces a quadrivalent cell-based product, dubbed Flucelvax.
The company was established in 2015 when CSL bought Novartis AG's influenza vaccines business and its cell-based vaccine manufacturing facility in Holly Springs, N.C., which was built under a public-private partnership during the Obama administration.
Recent results showed Flucelvax had 36% greater protection against the flu versus egg-based vaccine, Gregg Sylvester, vice president of medical affairs at Seqirus, told S&P Global Market Intelligence.
Seqirus' application for its adjuvanted cell-based pandemic vaccine is currently pending before the U.S. Food and Drug Administration, Sylvester said.
The first-of-its-kind vaccine would only be used if a pandemic was declared, he noted.
Funding, incentives needed
Sylvester, Schaffner and Whitley-Williams all called for more government funding to back public-private partnerships to incentivize industry to pursue new technologies like cell-based and recombinant vaccines.
In his Sept. 19 executive order, however, President Donald Trump did not ask Congress for more government funding for such partnerships, nor did he provide any incentives for industry.
And in his last three budget requests to Congress, Trump sought significant cuts in funding for the NIH and the Centers for Disease Control and Prevention, including vaccines programs, though Azar insisted that did not involve influenza funding.
In March, however, Azar took away $124 million in fiscal 2019 congressionally allotted funds from the NIH and $14.2 million from CDC to use for the detained migrant children program. Some of those diverted funds were taken from the CDC's immunization programs, including funds intended for influenza planning and response efforts.
The NIH's National Institute of Allergy and Infectious Diseases — the agency that leads the U.S. research efforts on flu vaccines — lost about $19 million in diverted funds.

HHS Secretary Alex Azar being administered a flu shot by B.K. Morris, a nurse with Medstar Visiting Nurses Association