Better Prepare Than React: Reordering #PublicHealth #Priorities 100 Years After the #SpanishFlu #Epidemic (Am J Public Health, abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Am J Public Health. 2018 Nov;108(11):1465-1468. doi: 10.2105/AJPH.2018.304682. Epub 2018 Sep 25.

Better Prepare Than React: Reordering Public Health Priorities 100 Years After the Spanish Flu Epidemic.

Greenberger M1.

Author information: 1 Michael Greenberger is with the Carey School of Law and the Center for Health and Homeland Security, University of Maryland, Baltimore. He is also the founder and director of the University of Maryland Center for Health and Homeland Security.



This commentary argues that 100 years after the deadly Spanish flu, the public health emergency community’s responses to much more limited pandemics and outbreaks demonstrate a critical shortage of personnel and resources. Rather than relying on nonpharmaceutical interventions, such as quarantine, the United States must reorder its health priorities to ensure adequate preparation for a large-scale pandemic.

PMID: 30252520 PMCID: PMC6187800 DOI: 10.2105/AJPH.2018.304682 [Indexed for MEDLINE] Free PMC Article

Keywords: Pandemic Influenza; Pandemic Preparedness; Spanish Flu; USA.



The #Physician’s #Duty to #Treat During #Pandemics (Am J Public Health, abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Am J Public Health. 2018 Nov;108(11):1459-1461. doi: 10.2105/AJPH.2018.304582. Epub 2018 Sep 25.

The Physician’s Duty to Treat During Pandemics.

Orentlicher D1.

Author information: 1 David Orentlicher is with the William S. Boyd School of Law and the Health Law Program, University of Nevada, Las Vegas.



Physicians assume a primary ethical duty to place the welfare of their patients above their own interests. Thus, for example, physicians must not exploit the patient-physician relationship for personal financial gain through the practice of self-referral. But how far does the duty to patient welfare extend? Must physicians assume a serious risk to their own health to ensure that patients receive needed care? In the past, physicians were expected to provide care during pandemics without regard to the risk to their own health. In recent decades, however, the duty to treat during pandemics has suffered from erosion even while the risks to physicians from meeting the duty has gone down. After exploring the historical evolution of the duty to treat and the reasons for the duty, I conclude that restoring a strong duty to treat would protect patient welfare without subjecting physicians to undue health risks.

PMID: 30252517 DOI: 10.2105/AJPH.2018.304582 [Indexed for MEDLINE]

Keywords: Pandemic Preparedness; Bioethics.


The #SpanishFlu, #Epidemics, and the Turn to #Biomedical #Responses (Am J Public Health, abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Am J Public Health. 2018 Nov;108(11):1455-1458. doi: 10.2105/AJPH.2018.304581. Epub 2018 Sep 25.

The Spanish Flu, Epidemics, and the Turn to Biomedical Responses.

Schwartz JL1.

Author information: 1 The author is with the Department of Health Policy and Management, Yale School of Public Health, and Section of the History of Medicine, Yale School of Medicine, New Haven, CT.



A century ago, nonpharmaceutical interventions such as school closings, restrictions on large gatherings, and isolation and quarantine were the centerpiece of the response to the Spanish Flu. Yet, even though its cause was unknown and the science of vaccine development was in its infancy, considerable enthusiasm also existed for using vaccines to prevent its spread. This desire far exceeded the scientific knowledge and technological capabilities of the time. Beginning in the early 1930s, however, advances in virology and influenza vaccine development reshaped the relative priority given to biomedical approaches in epidemic response over traditional public health activities. Today, the large-scale implementation of nonpharmaceutical interventions akin to the response to the Spanish Flu would face enormous legal, ethical, and political challenges, but the enthusiasm for vaccines and other biomedical interventions that was emerging in 1918 has flourished. The Spanish Flu functioned as an inflection point in the history of epidemic responses, a critical moment in the long transition from approaches dominated by traditional public health activities to those in which biomedical interventions are viewed as the most potent and promising tools in the epidemic response arsenal.

PMID: 30252511 DOI: 10.2105/AJPH.2018.304581 [Indexed for MEDLINE]

Keywords: Pandemic Influenza; Pandemic Preparedness; Spanish Flu; Infectious diseases; Vaccines; Quarantine measures.


The #PanVax #Tool to Improve #Pandemic #Influenza #Emergency #Vaccination Program #Readiness and Partnership (Am J Public Health, abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Am J Public Health. 2019 Sep;109(S4):S322-S324. doi: 10.2105/AJPH.2019.305233.

The PanVax Tool to Improve Pandemic Influenza Emergency Vaccination Program Readiness and Partnership.

Carias C1, Lehnert JD1, Greening B Jr1, Adhikari BB1, Kahn EB1, Meltzer MI1, Graitcer SB1.

Author information: 1 Cristina Carias, Bradford Greening Jr, Emily B. Kahn, and Martin I. Meltzer are with the Health Economics and Modeling Unit, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA. Jonathan D. Lehnert, Bishwa B. Adhikari, and Samuel B. Graitcer are with the Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention. Jonathan D. Lehnert is also with IHRC, Atlanta.




To show how the Centers for Disease Control and Prevention’s Pandemic Vaccine Campaign Planning Tool (PanVax Tool) can help state and local public health emergency planners demonstrate and quantify how partnerships with community vaccine providers can improve their overall pandemic vaccination program readiness.


The PanVax Tool helps planners compare different strategies to vaccinate their jurisdiction’s population in a severe pandemic by allowing users to customize the underlying model inputs in real time, including their jurisdiction’s size, community vaccine provider types, and how they allocate vaccine to these providers. In this report, we used a case study with hypothetical data to illustrate how jurisdictions can utilize the PanVax Tool for preparedness planning.


By using the tool, planners are able to understand the impact of engaging with different vaccine providers in a vaccination campaign.


The PanVax Tool is a useful tool to help demonstrate the impact of community vaccine provider partnerships on pandemic vaccination readiness and identify areas for improved partnerships for pandemic response.

PMID: 31505153 DOI: 10.2105/AJPH.2019.305233

Keywords: Pandemic Influenza; Vaccines; Pandemic Preparedness; USA.


#ICU #Preparedness During #Pandemics and Other #Biological #Threats (Crit Care Clin., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Crit Care Clin. 2019 Oct;35(4):609-618. doi: 10.1016/j.ccc.2019.06.001. Epub 2019 Jul 12.

Intensive Care Unit Preparedness During Pandemics and Other Biological Threats.

Maves RC1, Jamros CM2, Smith AG2.

Author information: 1 Division of Infectious Diseases, Department of Internal Medicine, Naval Medical Center, 34800 Bob Wilson Drive, San Diego, CA 92134, USA. Electronic address: 2 Division of Infectious Diseases, Department of Internal Medicine, Naval Medical Center, 34800 Bob Wilson Drive, San Diego, CA 92134, USA.



In the twenty-first century, severe acute respiratory syndrome (SARS), 2009 A(H1N1) influenza, and Ebola have all placed strains on critical care systems. In addition to the increased patient needs common to many disasters, epidemics may further degrade ICU capability when staff members fall ill, including in the course of direct patient care. In a large-scale pandemic, shortages of equipment and medications can further limit an ICU’s ability to provide the normal standard of care. Hospital preparedness for epidemics must include strategies to maintain staff safety, secure adequate supplies, and have plans for triage and prioritization of care when necessary.

Published by Elsevier Inc.

KEYWORDS: Disaster preparedness; Influenza; Pandemic

PMID: 31445608 DOI: 10.1016/j.ccc.2019.06.001

Keywords: Pandemic preparedness; Infectious diseases; Intensive Care.


#Pandemic #bonds: designed to #fail in #Ebola (Nature, summary)

[Source: Nature, full page: (LINK). Summary, edited.]

Pandemic bonds: designed to fail in Ebola

Olga Jonas


The final toll of the Ebola outbreak in West Africa in 2014–16 was more than 11,000 lives, plus an estimated US$53 billion from economic disruption and collapse of health systems. In the outbreak’s wake, the global health community scrambled to deliver initiatives for increased health security. One flagship programme was the World Bank’s Pandemic Emergency Financing Facility (PEF). Under the scheme, investors who buy pandemic bonds receive generous ‘coupons’, which annually pay about 13% interest. This compensates investors for the risk that the bonds will make ‘insurance’ payouts to fight pandemics under certain conditions. Otherwise, cash returns to the investors when the bonds mature in July 2020.


Nature 572, 285 (2019) / doi: 10.1038/d41586-019-02415-9

Keywords: International cooperation; Pandemic preparedness; Ebola; DRC.


#Evaluation of novel #disposable #bioreactors on #pandemic #influenza virus production [#CVV] (PLoS One, abstract)

[Source: PLoS One, full page: (LINK). Abstract, edited.]


Evaluation of novel disposable bioreactors on pandemic influenza virus production

Chia-Chun Lai, Tsai-Chuan Weng, Yu-Fen Tseng, Jen-Ron Chiang, Min-Shi Lee, Alan Yung-Chih Hu

Published: August 12, 2019 / DOI:



Since 1997, the highly pathogenic influenza H5N1 virus has spread from Hong Kong. According to the WHO bulletin report, the H5N1 virus is a zoonotic disease threat that has infected more than 850 humans, causing over 450 deaths. In addition, an outbreak of another new and highly pathogenic influenza virus (H7N9) occurred in 2013 in China. These highly pathogenic influenza viruses could potentially cause a worldwide pandemic. it is crucial to develop a rapid production platform to meet this surge demand against any possible influenza pandemic. A potential solution for this problem is the use of cell-based bioreactors for rapid vaccine production. These novel bioreactors, used for cell-based vaccine production, possess various advantages. For example, they enable a short production time, allow for the handling highly pathogenic influenza in closed environments, and can be easily scaled up. In this study, two novel disposable cell-based bioreactors, BelloCell and TideCell, were used to produce H5N1 clade II and H7N9 candidate vaccine viruses (CVVs). Madin-Darby canine kidney (MDCK) cells were used for the production of these influenza CVVs. A novel bench-scale bioreactor named BelloCell bioreactor was used in the study. All culturing conditions were tested and scaled to 10 L industrial-scale bioreactor known as TideCell002. The performances of between BelloCell and TideCell were similar in cell growth, the average MDCK cell doubling time was slightly decreased to 25 hours. The systems yielded approximately 39.2 and 18.0 μg/ml of HA protein with the 10-liter TideCell002 from the H5N1 clade II and H7N9 CVVs, respectively. The results of this study not only highlight the overall effectiveness of these bioreactors but also illustrate the potential of maintaining the same outcome when scaled up to industrial production, which has many implications for faster vaccine production. Although additional studies are required for process optimization, the results of this study are promising and show that oscillating bioreactors may be a suitable platform for pandemic influenza virus production.


Citation: Lai C-C, Weng T-C, Tseng Y-F, Chiang J-R, Lee M-S, Hu AY-C (2019) Evaluation of novel disposable bioreactors on pandemic influenza virus production. PLoS ONE 14(8): e0220803.

Editor: Balaji Manicassamy, University of Iowa, UNITED STATES

Received: February 20, 2019; Accepted: July 23, 2019; Published: August 12, 2019

Copyright: © 2019 Lai et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the manuscript and its Supporting Information files.

Funding: The authors would like to thank Mr. Anthony Chang for English editing, and the US CDC for supplying the egg-derived vaccine strains. The authors would also like to thank the funding support from the Ministry of Science and Technology (R.O.C. 102-2622-B-400-001-CC2; 103-2622-B-400-001-CC2). Mr. Chia-Chun Lai is currently pursuing his Ph.D. studies under the Graduate Program of Biotechnology in Medicine, National Tsing Hua University and the National Health Research Institutes. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.

Keywords: Avian Influenza; H5N1; H7N9; Vaccines; Pandemic preparedness.