Proceedings of the Canadian Pandemic Preparedness Meeting: Outcomes, Impacts and Lessons Learned

Montréal, QC
November 12 to 13, 2010

Other format

Executive Summary

The purpose of this report is to summarize the proceedings of the third annual Canadian Pandemic Preparedness Meeting that took place on November 12-13, 2010 in Montréal, Québec. Over 140 influenza and pandemic researchers and experts attended the meeting to communicate their research results, network and discuss future directions for research in this critical area. Many of the participants were recipients of Pandemic Preparedness Strategic Research Initiative (PPSRI) funding. The meeting was sponsored by Canadian Institutes of Health Research (CIHR) and the Public Health Agency of Canada (PHAC).

Dr. Marc Ouellette, Scientific Director of the CIHR Institute of Infection and Immunity (CIHR-III) opened the meeting by providing a brief overview of PPSRI. CIHR created the PPSRI in 2006 following a funding allocation of $21.5 million over five years from the Government of Canada. Funding grew to $45.7 million with support from PPSRI partners: PHAC, the Canadian Food Inspection Agency (CFIA), Alberta Innovates – Health Solutions, and Canada's Research Based Pharmaceutical Companies (Rx&D). To date, more than 90 projects have been funded through the PPSRI, and research capacity in influenza and pandemic preparedness has increased substantially.

To set the stage for the rest of the meeting, Dr. Robert Webster of St. Jude Children's Research Hospital gave a keynote lecture on pandemic influenza and the need to remain vigilant. The natural reservoir of all influenza viruses is migratory aquatic birds, but poultry, swine and other animals also act as reservoirs. Human influenza pandemics are caused when a new influenza strain emerges from animals and acquires human-to-human transmissibility. While the H1N1 (2009) strain is now stable in humans, it continues to mutate in swine, and H5N1 (avian influenza) also remains a threat. Thus, Dr. Webster concluded that there are still several gaps in influenza and pandemic preparedness knowledge, including the need to investigate influenza viruses in reservoir species, particularly apparently healthy pigs, in order to better predict viruses with pandemic potential.

Following the keynote lecture, participants then presented the results of their research in four plenary oral presentations, four concurrent breakout sessions and two poster sessions. The plenary presentations, concurrent breakout sessions and poster sessions focussed on four research themes: Biology and Diagnostics; Pandemic Planning and Ethics; Transmission, Modeling and Infection Control; and Vaccines. Brief synopses of the four plenary presentations are provided in the body of the report, and abstracts of all of the presentations are included in the appendices.

In addition to presentations of research results, the breakout sessions also provided an opportunity for participants to provide feedback to CIHR and partners about the PPSRI. To focus discussions, participants were asked by meeting organizers to discuss the following questions:

Have we advanced the critical knowledge base relevant to the pandemic response and what were the key advances achieved as a result of this initiative?
What topics were well covered by the initiative, and which topics still need to be improved upon or addressed for a future pandemic-related initiative?
What achievements have been accomplished with respect to enhancing research capacity, as well as network linkages and establishing infrastructure?
Do you feel that there were any barriers that prevented the goals of the PPSRI from being achieved and if so, what were they? How would you suggest that such barriers are overcome for a future initiative?

In a plenary session at the end of the meeting, summaries of the responses to these questions were presented by the breakout session chairs and all meeting participants had an opportunity to comment further. A detailed summary of the responses and discussion to these questions is found in the body of the report. In general, participants agreed that the critical knowledge base relevant to pandemic responses has been advanced, and several key advances were identified. Participants also highlighted gaps in knowledge that should be addressed by a subsequent pandemic-related initiative. Research capacity has been enhanced and critical networks and collaborations have been established as a result of PPSRI funding. A common point of discussion was that research funding must be maintained because seasonal influenza poses a yearly challenge, and we must maintain the infrastructure and expertise that has been developed so that we will be able to respond rapidly to a new pandemic threat.

In their closing remarks at the end of the meeting, Dr. Patricia Huston a senior medical advisor at PHAC and Dr. Ouellette both thanked participants for attending and actively contributing to the meeting. Dr. Huston called the meeting productive and thought provoking, and Dr. Ouellette stated that the meeting reinforced the value of strategic initiatives. Efforts are being made at multiple levels to secure long-term funding for influenza and pandemic research, but the future is uncertain. Both thanked the Meeting Planning Committee and Meeting Secretariat for their efforts in organizing the meeting. Dr. Ouellette closed by wishing participants a safe journey home.

Meeting Overview

Over 140 influenza and pandemic researchers and experts attended the third Canadian Pandemic Preparedness Annual Meeting entitled "Outcomes, Impacts and Lessons Learned" on November 12-13, 2010 in Montréal, Québec. Many of the meeting participants were recipients of Pandemic Preparedness Strategic Research Initiative (PPSRI) grants that were awarded to support research in the area of influenza and pandemic preparedness.

The main objectives of the meeting were:

to provide an opportunity for participants to communicate the results of their research;
to enhance interactions and collaborations between meeting participants; and
to identify future directions for research in this critical area.

The meeting was sponsored by Canadian Institutes of Health Research (CIHR) and the Public Health Agency of Canada (PHAC) and was organized by a Planning Committee with Secretariat support from CIHR (see Appendix 1). The meeting began with a keynote lecture on pandemic influenza and the need to remain vigilant by Dr. Robert Webster of St. Jude Children's Research Hospital in Memphis, Tennessee. Many of the participants then presented the results of their research in four plenary sessions, four concurrent breakout sessions and two poster sessions. At the end of the meeting, participants gathered together to discuss key research and capacity building achievements of the PPSRI and identified remaining gaps in influenza and pandemic preparedness knowledge (see Appendix 2 for the Meeting Program and Appendix 3 for a List of Meeting Participants).

Welcome and Opening Remarks

Dr. Marc Ouellette, Scientific Director, CIHR Institute of Infection and Immunity (CIHR-III)

Dr. Ouellette extended a warm welcome to meeting participants. He then gave a brief overview of the PPSRI. The PPSRI was created in 2006 following the outbreaks of severe acute respiratory syndrome (SARS) and in response to the emergence and threat of a highly pathogenic form of avian influenza (H5N1), which remains a concern.

The PPSRI was initially supported by an allocation of $21.5 million over five years from the Government of Canada. Partnerships increased the total available funds to $45.7 million over five years. PPSRI partners are: CIHR-III, PHAC, the Canadian Food Inspection Agency (CFIA), Alberta Innovates – Health Solutions, and Canada's Research Based Pharmaceutical Companies (Rx&D).

To date, more than 90 projects have been funded through PPSRI, and research capacity in influenza and pandemic preparedness has increased substantially. For example, the number of publications in these fields by Canadian researchers has more than doubled from 60 in 2005 to 140 in 2010. In addition, influenza and pandemic preparedness researchers have also been successful in open CIHR competitions. In 2010, for example, CIHR invested $20 million in this research area with $9 million coming from the PPSRI and the rest coming from open grant competitions.

While one of the main reasons for the Montréal meeting was to learn more about the outcomes of the research supported by PPSRI and CIHR, another major goal was to gather feedback from researchers and experts concerning the key advances in knowledge and enhancements made to research capacity as a result of the Initiative, areas that require additional study, and barriers that might have prevented the goals of the PPSRI from being realized along with suggestions for how these could be overcome in a future initiative. Dr. Ouellette closed by thanking the members of both the Planning Committee and Meeting Secretariat for organizing the meeting and wished all participants a productive meeting.

Keynote Lecture

Pandemic Influenza-overcoming pandemic fatigue: we cannot afford to be complacent

Dr. Robert Webster, St. Jude Children's Research Hospital

Dr. Webster provided an overview of the emergence and control of influenza viruses and discussed gaps in our current knowledge. He began by summarizing the 2009 influenza pandemic. This pandemic was caused by a novel variant of H1N1 that was first detected in humans in North America in 2009. The virus spread rapidly around the world and caused at least 6,000 deaths. Although the virus resembled the devastating 1918 Spanish H1N1 influenza virus, it was not as virulent, so despite initial fears, the pandemic was only modestly severe. Infections, however, were more severe in young adults (70% cases <30 years), and obese individuals were five times more likely to be hospitalized. In addition, 5% of all deaths were in pregnant women even though this group represents only 1% of the world's population.

The natural reservoir of all influenza viruses is migratory aquatic birds, but poultry, swine and other animals also act as reservoirs. While the H1N1 (2009) virus currently appears to be stable in humans, it is reassorting in pigs, meaning that it could evolve to give rise to a new pandemic strain. The highly pathogenic H5N1 influenza (bird flu) also remains a concern. This novel influenza virus emerged in 1996 in Southern China and has spread to over 60 countries in Eurasia and Africa. To date, over 500 million poultry have been destroyed, and 507 human cases have been reported including 302 deaths. Humans mainly get infected via exposure to birds with, to date, no consistent human-to-human transmission. While the virus has not yet spread to the Americas or Australia, Dr. Webster believes that spread is inevitable. Vaccination of poultry in Vietnam has greatly reduced the number of human deaths from H5N1, but this approach has not been successful in Egypt.

Vaccines are used to prevent transmission of influenza in humans, but it can take six months to produce a pandemic influenza vaccine because the viruses used to produce the vaccines are grown in eggs. Therefore, new approaches to produce influenza vaccines more quickly are needed. Better methods to communicate the safety of vaccines to the general public are also required. In addition, new types of antivirals are needed: we now have only two classes of these drugs, and viral resistance can develop rapidly.

Looking to the future, Dr. Webster outlined several measures that should be taken to mitigate and prepare for the next influenza pandemic. We should eliminate live poultry markets throughout the world. We should work to understand the burden of influenza in swine, both locally and globally, by performing virological and serological surveillance in apparently health pigs. In addition, we should continue to investigate the genomics of influenza viruses in reservoir species so that we can better predict viruses with pandemic potential. (See Appendix 4 for a biography of Dr. Webster.)

Plenary Presentations

Four plenary presentations each with a focus on a specific research theme: Biology and Diagnostics; Pandemic Planning and Ethics; Transmission, Modeling and Infection Control; and Vaccines were delivered by experts in the field of influenza and pandemic preparedness. A synopsis of each presentation is provided below. Presentation abstracts submitted by the presenters are found in Appendix 5.

Genomic and structural map of adaptive evolution of human influenza A virus to increased virulence

Dr. Earl Brown, University of Ottawa

Influenza viruses consist of RNA, proteins and lipids. The genes of the RNA component code for molecules that allow the virus to attach to and enter host cells and then work with the host's cellular machinery in order to replicate. Changes (i.e. mutations) in the sequences of these viral genes can alter the host range and virulence of the virus. Dr. Brown and the Canadian Influenza Pathogenesis Team used serial passage to adapt the 1968 H3N2 human pandemic virus to the mouse lung in order to identify the specific mutations that mediate evolution to high virulence in this alternate mammalian host. The team found that as few as six genetic changes greatly increased virulence in the mice.

Mutations that caused the greatest increase in virulence were in the genes coding for PB2, which is needed for viral replication, and hemagglutinin, which is used for the binding and entry of the virus into target cells. Mutations were also observed in the NS1 gene, which codes for a protein that inhibits specific antiviral responses of the host cell. The mutations in NS1 were similar to those found in pandemic and highly pathogenic human influenza viruses, demonstrating the clinical relevance of this research. The research results will help to provide a genetic basis for the assessment of the pandemic potential of novel influenza viruses and further define the functions and properties of genes associated with host range and virulence.

Ethics and Pandemic Preparedness: Local and global lessons learned in the PPSRI

Dr. Ross Upshur, University of Toronto

Dr. Upshur described an innovative program of community-partnered research called the Canadian Program of Research on Ethics in a Pandemic (CanPREP) for which he is the Team Leader. CanPREP is comprised of three interlinked collaborative working groups targeting key ethical issues related to pandemics: healthcare provider obligations and institutional support for healthcare providers; priority setting for scarce resources; and risk communication and knowledge transfer. The overall goal is to build an ethical framework that is guided by ethical decision-making processes and informed by ethical values. Each working group brought together study investigators, end-users, community partners, and research trainees in interdisciplinary scholarship.

Several methods of stakeholder engagement were developed and used by the research team to gather opinions including: town hall forums, national public telephone surveys, an on-line healthcare worker survey, focus groups, public symposia, webcast seminars and research-based theatre. In fact, meeting participants had an opportunity to learn more about the research-based theatre approach when, as part of the meeting banquet, members of the CanPREP team gave a reading of an engaging play entitled: Abide with Me: A Story of Two Pandemics that was written by Dr. Kate Rossiter, a CanPREP researcher. The research findings of CanPREP have informed policy decisions from local to international levels (e.g. Supplementary Criteria for ICU Triage in a Pandemic Working Group with the Joint Centre for Bioethics and regional hospitals; the Colleges of Physicians and Surgeons in Ontario and Nova Scotia, the Public Health Agency of Canada Pandemic Vaccination Group Taskforce and the World Health Organization Outbreak Communications Planning Guide Workgroup).

Influenza Transmission Studies in the Hutterite Community

Dr. Mark Loeb, McMaster University

Most of the knowledge of influenza infections, specifically how long infections last and how long an infected individual is able to spread the virus have come from challenge studies in which a limited number of individuals, usually adults, are inoculated with influenza viruses. This may not fully represent what actually happens in the community, and does not take into consideration the role that children play in viral spread. To address this gap in knowledge, Dr. Loeb and his research team examined naturally acquired influenza infections in ten Hutterite colonies near Red Deer, Alberta from 2007 to 2010. When two or more cases of influenza were detected in sentinel participants within 48 hours, throat and nasal swabs (used to measure influenza viral load and shedding) were obtained from all study participants whether or not they had flu symptoms.

Of the 839 participants, 28% became infected with influenza during the study. Different viral strains were predominant in each of the three influenza seasons: H1 in 2007-08, H3 and B in 2008-09, and pandemic H1 in 2009-10. The highest viral load was detected within two days of a positive test for H1, but this peak was delayed by a couple of days for H3. Viral shedding lasted for approximately five days after the onset of symptoms, but ranged from 1 to 16 days. Children tended to shed the virus longer than adults. Approximately 10% of those who tested positive for the virus had no influenza-like symptoms. Viral shedding in these asymptomatic individuals was infrequent, and when present, was of shorter duration than that seen in symptomatic individuals. The results of this research will inform policy decisions on how best to prevent the spread of annual and pandemic influenza.

Dr. Loeb also briefly reported the results of a cluster, randomized-control, blinded study that demonstrated that immunizing children and adolescents against influenza significantly prevented influenza infections in unimmunized residents of Hutterite communities. These results have recently been published (JAMA 2010; 303:943-950) and demonstrate the value of immunizing selected populations, such as children and adolescents, in times of vaccine scarcity.

The PHAC/CIHR Influenza Research Network (PCIRN)

Dr. Scott Halperin, Dalhousie University, IWK Health Centre, Dr. David Scheifele, BC Children's Hospital and University of British Columbia, Dr. Marcia Johnson, University of Alberta and Alberta Health Services, Dr. Jeff Kwong, Institute for Clinical Evaluative Sciences, Dr. Gaston de Serres, Institut national de santé publique du Québec, Dr. Mark Loeb, McMaster University (on behalf of Dr. Shelly McNeil, Dalhousie University, IWK Health Centre)

PCIRN is a network of networks focused on five themes: Rapid Clinical Trials; Rapid Program Implementation; Vaccine Coverage; Vaccine Safety and Vaccine Effectiveness; each managed by a principal investigator. The overall goal is to provide information about influenza vaccines in a timely manner to affect public health-decision making. The formation and implementation of this pan-Canadian network happened to coincide with the 2009 influenza pandemic, which presented number of logistical challenges. Despite this, a network of over 80 investigators at over 30 institutions was established and activated during the 2009 influenza season. The Network collected data on vaccine safety, effectiveness, coverage and implementation, as well as undertook a number of vaccine clinical trials. Highlights of research results to date include:

The PCIRN Rapid Trials network drew on vaccine trialists across Canada to conduct independent assessments of the adjuvanted H1N1 (2009) vaccine in order to address major unanswered questions for public programs. Four studies were conducted concurrently during Nov/Dec 2009 with Arepanrix^tm (GSK) – the vaccine that was used in Canada during the pandemic. A study of aboriginal adults given the standard dose of vaccine indicated that this vulnerable population group responded very well. A study of other adults given seasonal vaccine concurrently or at a later visit revealed no interference with responses to concurrently administered vaccines, with good responses to both. A study of young children after one and two doses showed that one dose was helpful, but protection was substantially greater after a second dose. Likewise, a second dose improved immune responses in adults with HIV infection.

More recently, in August 2010, the Rapid Trials network examined the safety of the 2010/11 seasonal influenza vaccine, which contains three influenza strains including H1N1 (2009). This study was important because the researchers wanted to assess the consequences of revaccinating against the H1N1 (2009) virus. 325 adult subjects were enrolled in a rapid pre-licensure trial. The safety profile was as expected, and the results were widely disseminated just 43 days from the start of the trial. The scale and rapidity of the trial was unprecedented in Canada. The trial has been repeated in 215 children, and initial findings are consistent with the adult study.

The PCIRN Vaccine Coverage network examined methods to collect individual-level data at immunization sites. Individual-level data are needed by the public health community for the evaluation of vaccination programs and improvement of client care. During the H1N1 (2009) influenza vaccination campaign, a range of data collection systems were used across Canada. Electronic client registration and vaccine record keeping reduced time spent on data collection by 17-40%. Frontline staff perceived electronic data collection methods to be as acceptable and easy to use as paper methods. Electronic systems cost the same or less than hybrid (paper and electronic) systems over a five year period and captured more data.

The PCIRN Vaccine Safety network conducted several studies during the 2009-10 influenza season. In one study, surveillance of healthcare workers following immunization against the H1N1 (2009) virus revealed that the vaccine was safe with no serious long-term adverse events, although some individuals experienced local and allergic-like reactions.

The PCIRN Vaccine Safety network also carefully monitored adverse events to the H1N1 (2009) vaccine in approximately 4,000 egg-allergic individuals. The study was needed because influenza viruses used in vaccines are grown in eggs, and individuals with severe egg allergies are usually discouraged from being vaccinated. None of the 4,000 study subjects developed severe allergic reactions (anaphylaxis).

One of the studies conducted by the PCIRN Vaccine Effectiveness network was to examine pandemic (2009) vaccine effectiveness in 1143 healthcare workers and other working adults. 48.2% of the study participants received the H1N1 (2009) vaccine, and vaccine effectiveness was 77% and 89% seven and 14 days post vaccination, respectively; the ability to estimate vaccine effectiveness, however, was somewhat limited due to late the availability of the vaccine in relation to pandemic peak activity and low overall attack rates (2% in unvaccinated).

Poster Sessions

A total of 46 posters describing research results were presented by meeting participants on the first day of the meeting. The two poster sessions were well attended, and presenters and meeting participants engaged in lively discussions. See Appendix 6 for poster session abstracts.

Concurrent Breakout Sessions

During the afternoon of the first day of the meeting, participants gathered in smaller groups in one of four concurrent breakout sessions:

Biology and Diagnostics, Co-chairs: Dr. Earl Brown and Dr. Todd Hatchette
Pandemic Planning and Ethics, Chair: Dr. Ross Upshur;
Transmission, Modeling and Infection Control, Co-chairs: Dr. Brian Ward and Dr. Susan Tamblyn; and
Vaccines, Chair: Dr. Veronika von Messling

The sessions began with several ten-minute oral presentations of research results related to the session theme (see Appendix 7 for abstracts of the presentations). This was followed by an open discussion of four questions that had been prepared by the meeting organizers. The questions were:

Have we advanced the critical knowledge base relevant to the pandemic response and what were the key advances achieved as a result of this initiative?
What topics were well covered by the initiative, and which topics still need to be improved upon or addressed for a future pandemic-related initiative?
What achievements have been accomplished with respect to enhancing research capacity, as well as network linkages and establishing infrastructure?
Do you feel that there were any barriers that prevented the goals of the PPSRI from being achieved and if so, what were they? How would you suggest that such barriers are overcome for a future initiative?

Plenary Discussion of Breakout Session Feedback

In a plenary session at the end of the meeting, the Chairs of the breakout sessions presented an overview of the responses to the four questions posed by meeting organizers (listed above). Plenary session participants were also given an opportunity to make additional comments. The points made during each presentation have been combined and are summarized below:

Advancing Knowledge

There was general agreement amongst participants that several key advancements in influenza and pandemic knowledge have been made as a result of the PPSRI. In the area of biology, we now have a greater understanding of the viral mutations that make influenza more virulent. More is also known about the host responses to influenza infections, including the host factors that contribute to influenza infection severity. PPSRI researchers have identified several promising antiviral candidates and new strategies for the use of existing licensed products for the treatment of influenza infections.

Research in the area of pandemic planning and ethics has increased our understanding of the ethical issues that arise during a pandemic. Several novel tools have been developed and have been used to engage the public and key stakeholders concerning these issues. The knowledge that has been acquired as a result of this research has informed policy decisions from the regional to international level, including the PHAC and the World Health Organization (WHO).

In terms of preventing the spread of seasonal and pandemic influenza, we now have a greater understanding of natural influenza infections in the community. Results from the study of cough mechanics will aid in the development of methods to prevent human-to-human transmission. PPSRI-funded researchers have also developed several mathematical models that allow them to predict how various public health measures would modify seasonal and pandemic influenza transmission. This information helps officials make informed decisions about public health interventions.

PPSRI-funded researchers have made significant contributions in the area of vaccines. Several novel, egg-independent vaccine platforms have been developed. We also have a more detailed knowledge of the contribution of the host's cellular immune responses to both adjuvanted and non-adjuvanted vaccines. The PHAC/CIHR Influenza Research Network and other PPSRI-funded researchers conducted critical vaccine and immunization program studies related to the H1N1 (2009) immunization campaign and seasonal influenza vaccines, thus providing essential information to public health officials.

Descriptions of some of the advances described by PPSRI-funded researchers at the Montréal meeting are found in Appendix 8 (see Appendices 5-7 for all of the meeting abstracts).

Remaining Knowledge Gaps

Despite the advances that have been made, participants agreed that there are still several knowledge gaps. We need a greater understanding of influenza viral transmission and viral genomics, including information about the animal-human interface. Together this would aid in the prediction of which influenza strain will be the next threat, along with its characteristics, and would provide an evidence-based approach to infection control measures. The knowledge gained will also be more broadly applicable to other human infectious diseases in which animals act as reservoirs.

More information is needed concerning influenza pathology including reasons for differences in severity of disease among individuals, and the factors that confer protective immunity to influenza (aside from antibody titres). Along with a greater understanding of influenza and host biology and interactions, the information would aid in the development of new preventative measures, including better vaccines, and treatments for influenza.

The 2009 H1N1 pandemic demonstrated that we need to develop better ways to be flexible and nimble in our response during a pandemic and to be able to rapidly address research questions. This will require, in part, methods that foster an open-access approach to science. We also need to develop better ways to involve and engage the media in helping them understand and communicate research results, along with new approaches to maintain public trust in health care and to improve the response of health services during a pandemic.

Mathematical modeling of disease spread and the consequences of various public health interventions greatly assists health policy makers. The best modeling is 'local', that is, it uses local data to reflect local realities, but modeling at different levels is also needed (i.e. local, national and international). There are active debates in the modeling community regarding the use of simple vs. complex models. Future modeling studies should include an examination of how transmission is sustained in different settings. In addition, approaches are needed to ensure that modeling data is translated into public health action.

A major drawback of current influenza vaccines is that they must be developed every year so that they match the influenza strain that is circulating during a particular season. One of the goals for the future should be to develop a universal vaccine that would protect individuals against all influenza strains, even ones that have not yet evolved. In addition, while some of the vaccine platforms that have been identified and developed by PPSRI-funded researchers are a move towards a universal vaccine, they require further study and development before they can be adopted for use in humans.

Enhancing Research Capacity

The networks and collaborative groups that were established as a result of the PPSRI brought together clinicians, researchers, modelers and other key stakeholders and enhanced research capacity and knowledge translation in the area of influenza and pandemic preparedness. Many of these multi-centre groups were established before 2009, enabling a rapid Canadian research response to the H1N1 (2009) pandemic. The PPSRI was also a catalyst for national and international collaborations that have enabled a sharing of knowledge, reagents and expertise.

Formal networks that were either established and/or developed as a result of the PPSRI include:

The PHAC/CIHR Influenza Research Network. It was established just at the start of the H1N1 (2009) pandemic and provided critical information that was needed for the H1N1 (2009) immunization campaign. The network continues to address questions about seasonal influenza vaccines and also pandemic planning.
The Canadian Program of Research on Ethics in a Pandemic (CanPREP). It developed innovative methods to engage the public and key stakeholders and helped inform policy decisions related to pandemic preparedness.
MITACS. It comprises several centres of research, has a large and innovative modeling internship program and supports annual pandemic workshops and a regular summer school.
Pan-InfORM. It is a multidisciplinary collaboration that produced multiple publications during the pandemic, with a focus on knowledge translation.
CanPan. It conducted over twenty projects during the pandemic and has a large internship program. Major successes include international collaborations, real-time parameter estimation, and acquisition of Canadian household data for contact network modeling.

Trainees at all levels were supported as a result of the PPSRI funds. Many of the trainees presented posters or gave oral presentations at the meeting in Montréal, which further enhanced their training. Several have chosen to continue to work in influenza and pandemic preparedness research, establishing a new generation of researchers and other highly qualified personnel in this field.

Overcoming Barriers in Future Initiatives

Participants identified several barriers that slowed their research progress, and also offered suggestions for how these might be overcome in a future initiative. For example, research was hindered because of limited access to reagents, patient samples and biosafety level 3 (BSL-3) facilities. In order to reduce delays, participants suggested that expanded and accessible repositories for reagents and patient samples should be developed, along with expedited material transfer agreements that follow appropriate ethical procedures. To this end, it would be useful to have a "starter kit" of reagents/samples for academic research labs.

Clinical research was slowed because of insufficient point-of-care diagnostics and methods for the rapid collection of data in order to enroll people into trials. A major hurdle was the time for ethics review, which should be streamlined.

Although several strategies were used by the PPSRI to foster research collaborations, participants stated that researchers should be encouraged to network more within their specialties in order to best use all of the new knowledge generated by the Initiative. CIHR funding rules posed difficulties for Canadian researchers interested in forming international research collaborations. For a future initiative, new funding mechanisms should be developed to enhance international collaborations.

Researchers who are engaged in early vaccine research and development face difficulties in bringing promising vaccine candidates through the pre-approval and clinical trial process, because of limited expertise and facilities. These should be enhanced. Participants in the Vaccines Breakout Session suggested that the involvement of pharmaceutical companies should be encouraged through independent funding mechanisms.

Participants also highlighted the need for the timely dissemination of research results, including expedited peer review and publication to ensure that government agencies and the general public are well informed about important discoveries. A systematic approach to information communication is needed. A major role could be played by a scientific body that represents the general scientific community, but is not associated with the government. This organization could publish, for example, a real-time reporting system equivalent to the CDC Morbidity and Mortality Weekly Report (MMWR). In addition, researchers could make better use of CIHR Knowledge Translation (KT) and Knowledge to Action (K2A) programs. New approaches are also needed to involve journalists more fully in the research process, even at the discovery stage.

It is essential to maintain the momentum of the PPSRI by developing a sustained national strategy for influenza and pandemic research with ongoing support. This would ensure that the necessary expertise and infrastructure is in place in order to quickly respond to new threats, such as a future influenza pandemic. It will also ensure that we are better equipped to deal with seasonal influenza, which is a yearly health concern. Funding is critical for long-term projects such as vaccine development and to support essential surveillance infrastructure.

Participants acknowledged that diminished public interest in pandemics is a potential barrier for further funding. They suggested that methods are needed to engage the Canadian public to advocate for increased research funding and to build solidarity between researchers and the Canadian public. In addition, perhaps there needs to be a broader focus on infectious diseases with pandemic potential in a future initiative, since the initial focus of the PPSRI on avian influenza was too narrow in retrospect.

Closing Remarks

Dr. Patricia Huston, Senior Medical Adviser, PHAC

On behalf of the PHAC, Dr. Huston thanked the meeting participants for attending and contributing to the meeting. She also thanked the Planning Committee and Meeting Secretariat for their efforts in organizing such a productive and thought-provoking meeting. Dr. Huston acknowledged the contributions of CIHR in leading the PPSRI and of PCIRN for its efforts in answering several key questions regarding both the pandemic and seasonal influenza vaccines. She said that she enjoyed learning more about the research achievements of the meeting participants. Efforts are being made at multiple levels to secure funding for influenza and pandemic preparedness research over the long term. The 2009 pandemic illustrated that knowledge translation is critical, and Dr. Huston stated that new mechanisms for knowledge translation are needed. She concurred with the suggestion from meeting participants that Canada needs and MMWR-style weekly report for the rapid publication of useful public health information and recommendations.

Dr. Marc Ouellette, Scientific Director, CIHR-III

Dr. Ouellette thanked meeting participants for taking the time to present the results of their research and for actively participating in the meeting. He said that the meeting had reinforced in his mind the value in strategic initiatives. It is clear that the PPSRI has built research capacity in influenza and pandemic preparedness. Dr. Ouellette stated that some of the more applied projects will continue to require targeted funds and that seasonal influenza and pandemic preparedness are ongoing issues, so CIHR will continue to pursue strategies to secure funds for these areas. Dr. Ouellette closed by thanking the Planning Committee and Meeting Secretariat for their efforts and wished all participants a safe journey home.

Evaluation of the Meeting

Participants and meeting organizers were very pleased with the collegial and productive nature of the meeting. Most participants stated that the meeting had provided an excellent overview of research results. Participants stated that each of the three types of sessions (plenary, breakout and poster) contributed to the overall positive experience (Appendix 9).

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