Urgent strategic research into influenza to inform health policy and protect the public

In the past 100 years, Australians have been at the forefront of influenza containment, research and prevention. During the “Spanish flu” pandemic in 1918, Australia developed successful containment strategies (Box 1).

Research into the influenza virus has been a particular strength in Australian virology (Box 2), having been pioneered in the 1930s by Sir MacFarlane Burnet and his group at the Walter and Eliza Hall Institute, Melbourne. Eminent Australians who subsequently made major discoveries in a range of areas (Box 2) include Laver, Webster and Ada at the John Curtin School of Medical Research, Colman and Ward at the Commonwealth Scientific and Industrial Research Organisation (CSIRO) in Canberra, and White and his group at the University of Melbourne (for complete list see Fenner4).

The Australian World Health Organization Collaborating Centre for Reference and Research on Influenza was established at CSL (then the Commonwealth Serum Laboratories) in Melbourne in 1951, and will move to collocate with the Victorian Infectious Diseases Reference Laboratory (VIDRL) in 2007. The WHO Centre has been instrumental in providing timely information on the epidemiology of circulating strains of influenza virus to allow preparation of effective vaccines, based on isolates sent from the WHO National Influenza Centres in Sydney (Institute of Clinical Pathology and Medical Research, Westmead), Melbourne (VIDRL) and Perth (PathWest), and other laboratories in the Public Health Laboratory Network and in the Asia-Pacific region.

It has long been recognised that pandemics of influenza occur in Australia about every 30 years, and that the next one is overdue. The advent and spread of highly pathogenic avian influenza A/H5N1 in Asia and parts of Europe in the past decade, and the recent increase in human cases linked to infected birds have heightened awareness and concern that the virus may cross the species barrier and spread rapidly among humans. This concern has resulted in major planning to protect Australia and Australians from the most serious consequences of a pandemic and to inform policy through substantial investment in research.

The Australian health management plan for pandemic influenza1,2 provides the framework and focus for action to reduce the impact of a pandemic in Australia. The process of drafting and refining the plan revealed gaps in knowledge about influenza, including avian influenza, as well as gaps in infrastructure that must be redressed if Australia is to be well prepared to respond to a pandemic.

As the principal provider of Australian public health and medical research funding, the National Health and Medical Research Council (NHMRC) in 2005 awarded about $450 million in grants across a broad range of research areas and groups. The research expertise this supports is often drawn on by governments to provide advice on policy, and has been a source of ongoing assistance in pandemic planning. During 2005, research into influenza and other viral infections received $4.3 million through investigator-initiated grant proposals.

A set of strict criteria for “urgent research” was developed by the then Strategic Research Development Committee of the NHMRC in 1999. Severe acute respiratory syndrome was the first subject to meet these criteria and to receive research funding. The NHMRC definition of urgent research was relaxed in 2005, when it was recognised that potentially high-impact problems such as avian influenza did not meet the original criteria. A special program of urgent research around planning for pandemic influenza was then initiated.

Responsiveness to research regarded as urgent required the NHMRC to develop a new definition of urgent research (Box 3), to identify the research targets, advertise grants, set up rigorous peer review of applications, and allocate funds, all within a short time frame.

The funding program built a $6.5 million portfolio from the available $7.5 million. Thirty-three applications were successful.6 Unsuccessful applications did not reach the standard considered fundable or were judged to be outside the scope of the urgent research program. The distribution of funded grants by areas designated in the call for applications is summarised in Box 4. Despite the short lead time for submission of applications and an expectation that successful projects would be implemented immediately, the NHMRC’s call for urgent research was met with considerable effort and goodwill from researchers and administrators in university research offices and research institutions across Australia, who worked together to develop and dispatch some excellent proposals in a short period.

The NHMRC was able to develop and fund a portfolio of tightly targeted research within a short period in 2005. This research is expected to yield new treatments and strengthen preventive measures and interventions as part of an integrated national response, including:

• Increased understanding of the avian influenza virus and host responses;

• Advanced technology for detection and identification;

• Advanced vaccine production and efficacy; and

• Better informed models and plans for Australian public health and community interventions, including communication strategies and a checklist for business interests.

Integration of research outcomes into national policies and practice will depend on continued close collaboration and communication between the NHMRC, researchers, practitioners and the relevant government departments.

The strong response to this call for urgent research reflects in part the impressive intellectual lineages in Australian influenza research,4 and would not have been possible had Australia not made significant, long-term investment in research in the fields of immunology, microbiology, vaccine development and public health research in the preceding decades.

The NHMRC’s capacity to marshal research resources in response to the risk of an avian influenza pandemic compares favourably with that of other countries. For example, the European Commission, the Canadian Institutes of Health Research and the Medical Research Council of the United Kingdom did not call for policy-oriented research on avian influenza until early 2006, and will not be in a position to fund grants in this area until late 2006 or early 2007. The legislation that governs the operations of the NHMRC has recently been revised, and the changes will further assist the organisation to respond to priority, urgent and emergent issues of national concern to the health and research sectors.