Frequently Asked Questions - Pandemic Influenza

• What is an influenza pandemic?
• When will the next influenza pandemic occur?
• What is the Government of Canada doing to protect us against the next pandemic?
• How many people would die in a pandemic? Is there anything we can do to reduce the number of deaths.
• Does the H5N1 influenza virus circulating in Southeast Asia and parts of Europe have the potential to spread around the globe?
• Why do we need a Canadian Pandemic Influenza Plan?
• What's the difference between vaccines and antivirals?
• Are vaccine manufacturers working on a pandemic vaccine?
• What's the purpose of working with an H5N1 vaccine?
• Right now, how long would it take for a pandemic vaccine to be available? How much could working with the H5N1 vaccine speed up the process?
• Are antiviral drugs part of Canada's strategy for fighting a pandemic?
• A study published in Nature suggested a pandemic could be slowed by using antivirals. Is this really possible?
• Who develops the Canadian Pandemic Influenza Plan?
• How was the plan developed?
• What kind of activities does the plan cover?
• How has the plan changed since it was released last year?

What is an influenza pandemic?

People are exposed to different strains of the influenza virus many times during their lives. Even though the virus changes, their previous bouts of influenza may offer some protection against infection caused by a similar strain of the virus. However, three to four times each century, for unknown reasons, a radical change takes place in the influenza A virus causing a new strain to emerge.

Since people have no protection against the new strain, it can spread rapidly around the world, causing what is known as a pandemic. Frequently, the pandemic influenza virus causes severe complications, such as pneumonia and death in previously healthy individuals. The last three pandemics occurred in 1918-19, 1957-58 and 1968-69.

When will the next influenza pandemic occur?

We know influenza pandemics are recurring events but they are unpredictable. It has been 36 years since the last influenza pandemic and, although it is impossible to predict with any certainty when the next one will hit, experts agree that we are overdue for one.

What is the Government of Canada doing to protect us against the next pandemic?

The Public Health Agency of Canada, together with other federal government departments and provincial and territorial governments, has taken and continues to take action in a number of areas to protect Canadians. Activities include:

• Maintaining the Canadian Pandemic Influenza Plan.The plan maps out how Canada will prepare for and respond to pandemic influenza. The Agency continues to work on the plan based on new information that comes available. The plan also provides a model for responding to other infectious disease outbreaks.
• Establishing a contract for pandemic vaccine production. The World Health Organization has recognized Canada as a leader in pandemic preparedness and one of the few countries in the world to put in place a domestic contract for pandemic influenza vaccine production.
• Developing and testing a prototype vaccine against the H5N1 influenza strain to speed up the availability of a pandemic vaccine when it is needed.
• Creating a national antiviral stockpile for use against an influenza pandemic. The national stockpile will be used to treat identified priority groups agreed upon by a national expert committee.
• Managing the National Emergency Stockpile System (NESS). The NESS contains everything that you would expect to find in a hospital, from beds and blankets and a supply of pharmaceuticals. This includes a stockpile of antiviral medication.
• Providing international leadership pandemic preparedness. For instance, Canada is collaborating with the WHO and other countries and is co-leading with the United Kingdom discussions related to the supply and use of antivirals within the Global Health Security Action Group with the G7 plus Mexico.
• Helping countries affected by H5N1 develop their capacity to respond an emerging infectious disease outbreak. The Public Health Agency's National Microbiology Lab (NML) has been working with Vietnam's National Institute of Hygiene and Epidemiology (NIHE) at their main laboratory in Hanoi, to improve its testing capability for avian influenza. Staff from the Public Health Agency have provided assistance on the ground in several countries in Southeast Asia.
• Conducting research to advance the global response to pandemic influenza. The National Microbiology Lab has been working to increase its vaccine development capacity and contribute to knowledge on pandemic influenza and what makes some strains particularly deadly. The NML has also been developing its ability to create a seed strain for a vaccine utilizing the reverse genetics technique. This will ensure that Canada is able to develop an influenza vaccine as rapidly as possible once a pandemic strain emerges.
• Managing a real-time alert system for serious respiratory illnesses (SRIs), including SARS, to ensure timely dissemination of information to the provinces and territories.
• Strengthening ongoing year round surveillance for influenza through the national FluWatch system.
• Strengthening linkages with animal influenza surveillance to improve Canada's ability for early detection of novel flu virus that can infect humans.
• Putting in place a hospital-based surveillance system to detect cases and clusters of severe or emerging respiratory infections and to effectively prevent and contain their spread in acute care facilities.
• Monitoring the global situation and verifying information received from the Global Public Health Information Network (GPHIN) alert system. GPHIN tracks thousands of global media stories on public health issues and allows the Public Health Agency to quickly identify and monitor cases of severe respiratory infections around the world.
• Ongoing support and maintenance of Quarantine Services at the Toronto, Vancouver, Montreal (Pierre Elliot Trudeau), Calgary, Edmonton, Halifax and Ottawa international airports. Quarantine officers provide health assessments for international traveller who have signs of illness.
• Increasing public awareness of influenza and influenza virus through collaboration with the CPHA and the Canadian Immunization Awareness Program (Canadian Coalition for Influenza Awareness).
  

How many people would die in a pandemic? Is there anything we can do to reduce the number of deaths.

Depending on the severity of the pandemic, we estimate that between 11,000 and 58,000 deaths may occur in Canada as a result of a new influenza virus. These numbers are based on the assumption that the virus infects between 15 and 35 percent of the population.

As well, the model used to calculate these numbers does not factor in the potential impact of a vaccine or antiviral drugs. We expect these measures would reduce illness and deaths. Clearly, the number of deaths, as in any influenza season, really depends on how the virus behaves, how it spreads and what we can do to limit these factors.

It is very difficult to predict the impact of a pandemic. People die from influenza and its complications every single year. Depending on the severity of the season, the number of deaths due to influenza and its complications could reach as high as 8,000 during a regular influenza season.

The Government of Canada is putting in place several measures to protect the health of Canadians. During a pandemic, one of the most important things the public will be able to do to prevent the spread of the virus and reduce its impact will be to use "good respiratory etiquette." This means doing things like covering your mouth with a tissue when you cough, staying home when you are sick and washing your hands frequently especially after touching your mouth, nose, eyes or used tissues.

Does the H5N1 influenza virus circulating in Southeast Asia and parts of Europe have the potential to spread around the globe?

Scientists agree avian influenza H5N1 is the influenza strain with the most potential to become a pandemic. Since 2003 there have been 100 confirmed human cases of avian flu and about 60 deaths. Scientists agree the more people affected by the avian virus the greater the likelihood the virus will mutate to create an new influenza strain to which humans have no immunity. If the new strain has the ability to transmit efficiently from person to person, the virus could spread rapidly and result in significant illness, death and social disruption.

Why do we need a Canadian Pandemic Influenza Plan?

The plan is a national one outlining the roles and responsibilities of governments so that we have a coordinated response that protects the health of all Canadians in the event of a pandemic. Federal, provincial and territorial governments use this plan as a framework or reference document when developing their own plans.

Planning for a pandemic requires a high level of coordination among and between all levels of government, the health care sector and emergency response services/organizations. Clarifying the roles and responsibilities and facilitating planning and preparedness activities with all stakeholders and at all levels of government will enable us to achieve the goals of the Plan: first, to minimize serious illness and death and second, to minimize societal disruption as the result of an influenza pandemic.

What's the difference between vaccines and antivirals?

Vaccines are the primary means to prevent illness and death from influenza. They stimulate the production of antibodies against the flu virus components included in the vaccine, providing immunity against the virus.

Antivirals are drugs used for the prevention and early treatment of influenza. If taken shortly after getting sick (within 48 hours), they can reduce influenza symptoms, shorten the length of illness and potentially reduce the serious complications of influenza. Antivirals work by reducing the ability of the virus to reproduce but do not provide immunity against the virus.

Are vaccine manufacturers working on a pandemic vaccine?

Vaccine manufacturers are doing the foundation work that is necessary to develop a pandemic vaccine but an actual vaccine against a pandemic cannot be manufactured until the virus has emerged.

Some vaccine manufacturers are working on an H5N1 vaccine or a "mock" pandemic vaccine. It's important to remember that an H5N1 vaccine is not a pandemic vaccine. We don't know for sure whether or not H5N1 will evolve into the pandemic strain but it is considered a "pandemic-like" virus, meaning it has shown the ability to infect humans causing severe illnesses and deaths. The WHO has encouraged vaccine manufacturers around the world to work with vaccine seed strains from pandemic-like influenza viruses, such as H5N1.

The National Institutes of Health (NIH) in the United States has produced an H5N1 vaccine that has been shown to produce an immune response in preliminary testing. However, people had to be given a large dose of the vaccine to get this response. Canada will be looking at the preliminary and final data from the U.S. trials and will use these results in designing and testing a similar vaccine in Canada. Canada needs to do its own trials in this area to increase domestic preparedness and to add to the international body of knowledge on the issue.

What's the purpose of working with an H5N1 vaccine?

In 2005, the Federal government announced $34 M for the development and testing of a pandemic-like vaccine. The goal of producing and testing a vaccine against H5N1 is to speed up the availability of a pandemic vaccine when it is needed.

Working with H5N1 should help identify and resolve regulatory issues ahead of time and determine an optimal vaccine formulation to immunize as many people as possible as quickly as possible. For example, it's not clear how many doses each person would need of a pandemic influenza vaccine in order to have protection against the virus. Knowing how many doses of the H5N1 vaccine are needed to provide protection would help in overall preparedness and planning.

Right now, how long would it take for a pandemic vaccine to be available? How much could working with the H5N1 vaccine speed up the process?

Potentially, it will take two to three months to produce the seed strain to begin manufacturing the new vaccine. Within 48 days of receiving the strain, we should have our first batch of the new vaccine for initial testing for safety and ability of the vaccine to stimulate antibodies. Based on our ability to produce 6 million doses per month, it could take 6 to 12 months to produce enough vaccine to protect all Canadians depending on the number of doses required.

Working with the H5N1 vaccine could accelerate the process by about 3 to 4 months. ID Biomedical, the company that has the government contract for pandemic vaccine development, has acquired the H5N1 vaccine seed strain and is working with the virus. We expect they will start producing the H5N1 vaccine in Spring 2006.

The goal of Canada's pandemic vaccine contract is to produce enough vaccine to protect all Canadians as quickly as possible. Canada was the first country in the world to plan for a secure vaccine supply through the contracting of a domestic supplier. The contract ensures that everything required for vaccine production, including the egg supply and storage facilities, is in place.

Are antiviral drugs part of Canada's strategy for fighting a pandemic?

Yes. The federal government has recently contributed $24 million towards the creation of a national antiviral stockpile. The national antiviral stockpile comprised of 16 million doses of oseltamivir (Tamiflu®) will be used to treat identified priority groups agreed upon by a national expert advisory committee on pandemic influenza. The priority groups include, for example, treatment of those hospitalized for influenza and those at high risk of influenza related complications, health care workers and essential services providers. Some provinces and territories have purchased additional amount of antivirals on their own.

In the absence of a vaccine, antivirals will be an important part of our response to a pandemic.

A study published in Nature suggested a pandemic could be slowed by using antivirals. Is this really possible?

The study published in the August 4, 2005 edition of Nature suggested that, under specific conditions, antivirals may play a role in the overall response to slowing down or containing the spread of a new influenza virus. The study also recommended the creation of an international antiviral stockpile.

It is important to remember that this sort of antiviral strategy will depend on many other important considerations, including the capacity for early detection of the emergence and spread of a novel influenza virus at the country of origin. This is why strengthening surveillance systems in Asian countries is a priority and is essential for a new influenza virus to be contained early.

Who develops the Canadian Pandemic Influenza Plan?

The members of the Pandemic Influenza Committee (PIC) have developed the plan with the contribution of many experts who have developed the technical annexes that accompany the Plan. The plan continues to evolve as we learn more about potential pandemic strains of influenza and measures that we can take to potentially affect the outcome of an influenza pandemic.

Members of PIC include provincial and territorial public health experts, other public health and emergency response experts, an ethicist, as well as the Public Health Agency of Canada officials. Members of the working groups that developed the technical annexes represent a broad range of expertise and experience relevant to pandemic planning. All provinces and territories currently have a copy of the Pandemic Influenza Plan and have used it for their own provincial and territorial planning. The plan is reviewed and approved by the Council of Deputy Ministers.

How was the plan developed?

The plan is based on the basic principles of public health and emergency response. Canada has had a pandemic influenza plan since 1988 and the plan continues to evolve based on our research, our experience and the experiences of other countries with disease outbreaks. It was developed collaboratively with the provinces and territories through the Pandemic Influenza Committee and in consultation with over 200 experts.

What kind of activities does the plan cover?

The goals of influenza pandemic preparedness and response are to minimize serious illness and overall deaths, as well as to minimize any social disruption among Canadians as a result of an influenza pandemic. It identifies, in particular, the prevention and preparedness activities that need to be addressed before a pandemic, including surveillance, vaccine programs, antivirals, health services, public health measures and communications.

How has the plan changed since it was released last year?

Since the plan was released last year, we continue to work on all the recommended preparedness activities and outstanding issues outlined in the Plan. The Pandemic Influenza Committee is currently updating the Plan to reflect the new pandemic phase terminology published by the WHO in early 2005. The update is expected to be completed and published on the PHAC website by December 2005.

Three additional technical annexes are currently being prepared for publication that further highlight necessary preparedness activities and stakeholder roles. Other annexes are being updated based on more recent data and experience with influenza outbreaks. These documents and other ongoing preparedness activities will continue to set the agenda for pandemic preparedness in Canada.

Canadian Pandemic Influenza Plan >>