Preparing for and preventing a peak mortality risk

Bird flu, swine flu – with the last major global H5N1 outbreak in 2007 and the H1N1 influenza in 2009, it is tempting to regard pandemics as a dead issue. This is far from the case: A serious pandemic, with its widespread loss of life, would not only bring the global economy to a halt, it would also pose a significant risk to global life and health insurers. It is important for the industry and for society to continue to be vigilant about peak mortality risk – as Professor Rolf M. Zinkernagel, member of the Swiss Re Advisory Panel and 1996 Nobel laureate in Physiology or Medicine, explains.

Professor Zinkernagel, how well do you think societies are prepared for a global pandemic, along the lines of the most recent outbreaks of the H5N1 and H1N1 viruses?

We are as well or better prepared now than we have been during the past thirty years. All influenza infections behave like classical pandemics: they vary in their morbidity and mortality; the full severity of the pandemic is only recognised once it is in full swing – or even over. This makes swift assessment critical: If the WHO and its associated laboratories can quickly determine which strains of influenza to include in the next annual vaccine – and if the vaccine is then produced in bulk and effectively distributed – we are all better prepared for the next outbreak.

What new technological measures are being deployed against future influenza pandemics?

There have been two main innovations: antiviral drugs and new vaccine production techniques. While conceptually very clear, antiviral drugs should be efficient but the epidemiological evidence and the efficacy of antiviral drugs in a pandemic is far from clear.

For vaccines, the well-established method of growing influenza strains in chicken eggs is still widely used, but may increasingly be replaced by proven and FDA-approved in vitro cultivated cell lines, which allow for faster production – and improved purification procedures. In addition, the use of adjuvants in cultivated cell lines enhances the vaccine’s immunising power.

Is there more that can be done in terms of prevention?

Three conditions would improve prevention: improved hygiene; improved education – and the acknowledgement that global funding is necessary to bring about the first two conditions. Education in developing countries, particularly for girls, is key to improving health and reducing pandemics. Mothers have the biggest impact on health, because they traditionally look after hygiene within the house, the family, the village and the community. In the developed world, an excellent investment would be to improve not just vaccines, but the acceptance of vaccines prior to the outbreak of a pandemic.