Vaccination for pandemic influenza: a six point agenda for interpandemic years

Background. The demand for influenza vaccine is driven by recognition of its health and economic benefits. Vaccine reduces all cause mortality in the elderly by 30 to 50% and prevents greater than or equal to30% of hospital admissions for influenzarelated respiratory disease, heart disease and stroke. However, because most influenza vaccine (85%) is produced in only eight countries, adequate production and equitable distribution of vaccine throughout the world will pose a serious challenge when the next influenza pandemic appears. Methods. This article reviews a six point agenda for pandemic vaccination that should be undertaken during interpandemic years. The agenda includes preparing vaccine seed strains using reverse genetics, determining the characteristics of a pandemic vaccine and vaccination schedule, considering global registration of pandemic vaccines, increasing vaccination in interpandemic years, documenting the epidemiology of vaccine use and addressing political issues that will affect the global supply of pandemic vaccines. Conclusions. Planning for pandemic vaccination must begin during the interpandemic period to ensure a vaccine supply that will be adequate to meet demand in all countries. This will require the skills not only of experts in virology, epidemiology and public health but also those in politics, economics and law. The task will be complex, but its promised benefits will be immense.