About the Pandemic Preparedness Strategic Research Initiative (PPSRI)

The issue

Influenza causes fever, sore throat, muscle pain, headache and fatigue. Most people recover, but several thousand people worldwide die from the flu every year.  In the past, new strains of the influenza virus have emerged and caused influenza pandemics that claimed several million lives. The emergence of a highly pathogenic strain of avian influenza (H5N1) capable of transmission from birds to humans heightened concerns that a pandemic could be close at hand. An influenza pandemic could have severe health, economic and social consequences. Worldwide, between 2 million and 7.4 million people could die, including 11,000 to 58,000 Canadians. The Public Health Agency of Canada estimates that in total, 4.5 to 10.6 million Canadians could become ill.

Research has the potential to play a key role in helping prevent or lessen the impact of an influenza pandemic. In May 2006, the Government of Canada announced that it would provide $21.5 million over five years to support PPSRI's influenza pandemic research. To ensure that Canada had a coordinated and focused research effort, the Canadian Institutes of Health Research Institute of Infection and Immunity (CIHR-III) has established the Pandemic Preparedness Strategic Research Initiative (PPSRI). The mission of the PPSRI was to identify strategic research priorities and support pandemic preparedness research. The PPSRI was guided by a task group, consisting of representatives who carry out relevant research and members who would use the new research knowledge to guide the activities of the PPSRI.

The response

The task group, in consultation with stakeholders, identified four strategic research areas:

Vaccines and immunization programs: Vaccination is an excellent method of preventing and controlling the spread of infectious disease. However, developing effective influenza vaccines is a complex challenge. The efficacy of existing vaccines varies and can be low in vulnerable populations such as the elderly. A greater understanding of how the immune system responds to influenza would enable researchers to develop better vaccines. Current vaccine preparation methods are generally slow and require a lot of viral antigen. New influenza vaccines and technologies are needed to speed the availability of vaccines during a pandemic. It is difficult to know in advance the exact composition of a new pandemic strain and prepare an effective vaccine. To solve this problem, vaccines that offer cross-protection against many influenza strains would be ideal.

Key areas of research

  • Identify immune responses to influenza infection and vaccination and the indicators of protection
  • Optimize existing influenza vaccines and immunization programs
  • Develop new vaccines and technologies, including cross-protective vaccines
  • Assess the safety and potential benefits of current and new influenza vaccines

The virus: Not enough is known about the influenza virus - how it evolves, the molecular basis of its transmission or the mechanisms involved in its pathogenesis. In addition, reliable and rapid diagnostic tests for influenza are not currently available. Through improved diagnosis, health care professionals will be able to assess the effectiveness of vaccination programs more effectively.

Key areas of research

  • Determine the molecular basis of transmission of influenza, including the human/animal interface
  • Understand human and animal responses to influenza infection
  • Understand the genetics of influenza, including viral evolution and the determinants of host range and virulence
  • Develop and evaluate rapid diagnostic tests for influenza

Prevention and treatment: In the event of a pandemic, knowledge of how to prevent the spread of the virus and treat infected individuals will be critical. Researchers and health officials do not know enough about how the influenza virus spreads in humans or the best ways to prevent transmission between individuals. Anti-viral drugs will be an important therapeutic tool during the early stages of a pandemic before vaccines are available, so it will be essential to optimally use the limited supplies of these drugs. New anti-virals are needed in light of the limited number that are currently available, but developing a new anti-viral drug is a long-term project best suited to industry.

Key areas of research

  • Determine molecular basis for transmission of influenza viruses between humans
  • Establish methods to prevent transmission at the individual, institutional and community level
  • Determine risk factors for infection, including identification of susceptible populations
  • Develop methods for the rapid containment of infection and optimization of existing anti-viral drugs

Ethics, legal and social contract: There is an urgent need for researchers and public health officials to determine how to prevent and respond to a pandemic. We need to develop communication strategies that will effectively educate health care providers in the application of care guidelines and maintain trust between public health authorities and the public. It is vital that we prepare guidelines that address global, hospital and bedside requirements for the ethical allocation of scarce resources and quarantine procedures during a pandemic. It is also essential to understand the legal, social, economic and cultural impact of such measures and examine the needs of vulnerable populations, including children.

Key areas of research

  • Develop and optimize knowledge translation and communication strategies
  • Identify and address ethical, legal and social issues of surge capacity in pandemics, including resource allocation
  • Understand the perceptions among health care providers and the public on the scope and extent of obligations and duty to care during a pandemic

CIHR-III took a lead role in partnering with other CIHR Institutes and organizations (see list of Partners) to initiate funding opportunities for research in these strategic areas. CIHR and partners also worked to ensure that the research results were communicated to those who would be able to use the new information.

Overall Themes

Building research capacity

PPSRI's directed funding encouraged researchers to undertake influenza and pandemic research, thereby building the national expertise we'll need during a pandemic outbreak. Also, PPSRI grant recipients were required to include trainees in their research programs, increasing the number of highly qualified personnel in this area.

Preparing for outbreak research

To ensure that the research community is poised to act immediately in the event of a pandemic, PPSRI helped researchers prepare for the influenza A H1N1/09 pandemic that emerged. PPSRI offered application development funds, so that during the outbreak, research teams were be able to submit abbreviated applications for expedited peer review and funding.

Fostering collaborations and networks

Through the International Opportunities Program, PPSRI supported research collaborations between Canadian researchers and researchers in China. As well, CIHR-III worked with the Public Health Agency of Canada (PHAC) to establish an Influenza Research Network comprised of Canadian researchers who developed methodologies to evaluate influenza vaccines and implement immunization programs.

Enhancing communication and knowledge translation

Fostering communication was a central part of PPSRI's goal. For example, PPSRI research teams were required to collaborate with research users, such as public health practitioners and policy makers, throughout their research project. In addition, CIHR-III, PHAC and the Canadian Food Inspection Agency will hosted a meeting in November 2008 featuring presentations by Canadian and international authorities on pandemic and influenza research.  Two subsequent meetings for PPSRI-funded researchers were held in July 2009 and November 2010.

Impact

PPSRI increased research capacity and strengthened linkages and partnerships for enhanced pandemic influenza planning and control. Knowledge from PPSRI-funded research led to improved methods to prevent and treat seasonal influenza, and enhanced our ability to respond to other infectious disease outbreaks. Canada must remain committed to the intense, organized and sustained effort required to be ready to rapidly respond to the next pandemic, whenever it occurs.

Partners

  • Canadian Institutes of Health Research
  • Canada's Research-Based Pharmaceutical Companies (Rx&D) Health Research Foundation
  • Canadian Food Inspection Agency
  • Public Health Agency of Canada
  • Alberta Heritage Foundation for Medical Research (now Alberta Innovates – Health Solutions)
  • National Natural Science Foundation of China
CIHRFunding for Pandemic and Influenza Related Research
2000-01 $ 138,869
2001-02 $ 292,288
2002-03 $ 912,623
2003-04 $ 1,248,606
2004-05 $ 950,283
2005-06 $ 1,322,695
2006-07 $ 3,095,709
2007-08 $ 4,533,976
2008-09 $ 11,162,656
2009-10 $ 21,934,749
2010-11 $ 16,795,184
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