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Research conducted by LSHTM into how governments and international organisations are preparing for an influenza pandemic has made an important contribution towards efforts to avoid the risks of up to 150m deaths anticipated by WHO in the event of such a pandemic. Governments, including the UK, and global institutions, have made policy changes and resource allocation decisions directly as a result of this research and technical advice.
Research carried out by the Health Protection and Influenza Research Group (HPIRG), Division of Epidemiology and Public Health, impacted directly on the UK Government's response to the 2009 influenza pandemic, feeding directly into policy-making decisions. The group was appointed as an official WHO Collaborating Centre for pandemic influenza in 2010 and through its related research has "reduced the economic impact on Member States for pandemic preparedness" (quote from reference 7, section 5). In 2011, it secured £7M funding from the US Centers for Disease Control and Prevention (CDC) to lead `once only' work to determine the modes of influenza transmission using a human challenge model.
Research undertaken at UCL's Centre for Infectious Disease Epidemiology has provided evidence about vaccination of different groups against influenza which have influenced policy and practice. In particular, our work underpins the government's ongoing policy on vaccination of healthcare workers, and is cited every year in the Chief Medical Officer's letter to healthcare workers as well as international recommendations on influenza vaccination of healthcare workers, including widespread mandatory vaccination programmes in North America. Research on influenza and acute cardiovascular events has informed US recommendations for prevention of stroke through vaccination. Recent work also informed the decision in the UK to extend regular influenza vaccination to children.
Researchers in the Epidemiology Group at the University of Warwick have an international reputation for high-quality mathematical modelling of human infectious diseases, with particular emphasis on population heterogeneity and variability. Such formulations and insights are an important component of predictive modelling performed by Public Health England (PHE), and are helping to shape national policy for a range of vaccine-preventable infections.
The Warwick group was instrumental in providing a range of real-time analyses and advice to UK authorities during the 2009 H1N1 (swine-flu) pandemic, acknowledged by the Department of Health (DoH) to be "fundamental to the construction of the UK's pandemic response" and making an important contribution to the overall programme which "led to the saving of many hundreds of millions of pounds of taxpayers money, while greatly increasing the health of the Nation". Modelling and analysis carried out at Warwick continue to provide insight into the control and containment of future pandemics and are considered "essential in determining UK pandemic policy".
Researchers in the University of Cambridge's Department of Zoology have developed a new methodology to analyse pathogen evolution. This `antigenic cartography' has led to the group becoming integrally involved in the World Health Organisation (WHO) influenza vaccine strain selection process, and has directly contributed to more accurate and appropriate flu vaccine design, with associated international impacts on disease prevention and public health (the flu vaccine is given to ~350 million people annually). The research has directly affected how public health professionals conduct disease surveillance and sampling.
Research from the University of Oxford has played a major role in the development of effective vaccines to combat the urgent worldwide problem of influenza. This methodology, licensed to AstraZeneca, has been used to prepare the currently licensed live attenuated influenza vaccine FluMist. Since its introduction in 2006 it is estimated that FluMist or other vaccines produced using reverse genetics have saved the lives of thousands of people worldwide who would otherwise have died from flu and its complications. FluMist has generated close to $1 billion income for the manufacturers (MedImmune, owned by AstraZeneca).
Research by the Community and Health Research Unit (CaHRU) has had broad international and national impact on community-based prevention, influencing influenza and pneumococcal vaccination policy and practice in the UK, North America and Australia, and impacting on general practitioner and primary healthcare. This has led to improvements in influenza vaccination in the elderly aged 65 years and over as well as younger people aged two years and over at risk of influenza and pneumonia, in Lincolnshire, UK and internationally via policy, education and guidance since 1999.
The research has increased public and practitioner awareness of the link between influenza and cardiovascular disease and the potential for influenza vaccination to prevent acute myocardial infarction (AMI) and stroke. It has affected international vaccination policy; through the findings being incorporated into national guidance for general practices and e-learning on how to improve UK influenza vaccination rates. Overall there has been a substantial take-up of our findings and recommendations.
Pioneering interdisciplinary research at the Royal Veterinary College (RVC) has enabled governments internationally and global health authorities to respond swiftly to the outbreak of a disease that causes huge economic losses, threatens the livelihoods of vulnerable populations in the developing world and endangers human lives. Supported by proactive dissemination, it has shaped the control policies and risk management strategies of the United Nations and governments across Asia, Africa and Europe, as well as a national contingency plan for the UK. And it has demonstrated that costly vaccination campaigns and mass culling programmes can be avoided in efforts to bring the disease under control.
Impact: BEAST software has widespread applications with impacts on public health policy, service provision and awareness, and in other contexts such as commercial disputes and criminal cases.
Beneficiaries: Public agencies such as health bodies and criminal courts; ultimately, global and local populations subject to infectious disease epidemic and pandemic outbreaks in which BEAST is used to inform the response.
Significance and Reach: BEAST is critical software that has been used to understand the spread of and to inform the response to global pandemics such as H1N1 swine-flu. It is also used to determine disease origin and transmission issues in specific situations (e.g. in criminal cases). The reach of this software is therefore both global and local.
Attribution: Rambaut (UoE) co-led the phylogenetic research and developed BEAST with Drummond (Auckland, NZ). The subsequent epidemic and pandemic analyses were variously led by Rambaut and Pybus (Oxford) and by Ferguson (Imperial College London).
Research on novel statistical methods for disease surveillance and influenza vaccine effectiveness has led to the development of a suite of automatic systems for detecting outbreaks of infectious diseases at Health Protection Scotland (HPS). This work has improved the public health response and helped to reduce costs in Scotland and also in the wider UK and EU by providing real-time early warning of disease outbreaks and timely estimates of the effectiveness of the influenza vaccine. This research, commissioned by the Scottish Government, through HPS, and also the UK National Institute for Health Research (NIHR) and the European Centres for Disease Control (ECDC), but used in a wider context by many others, formed the basis for the HPS response to the H1N1 Influenza Pandemic and monitoring of the effects of Influenza Vaccines.