Helen L. Regnery,

       Two important meetings today. The first concerned directions for vaccine selection in preparation for the Geneva meeting and the second involved funding.
       First–thoughts on vaccine selection. It is always amazing, the amount of data that begins to come together during January. It is almost as if we have roped the virus and we are pulling tighter and tighter toward our goal, while the virus is fighting hard to escape or get another family member to take over the battle. Only this week, we learned that the Sydney virus had been circulating in Asia before it was detected in New Zealand and Australia. It was unfortunate that none of the Influenza Centers recognized the Sydney virus in their tests last January. This is why it’s important to have an active, fully participating global-surveillance system. Although the system is in place (and has been for 50 years!), limited resources have left gaps that are important to close. It is time to strengthen the infrastructure.
       In any case, we are testing more and more viruses this year, since all the indicators are telling us that this season is one of the more intense, in terms of cases. The advent of molecular technology has given us an edge for analyzing the viruses. By sequencing the viruses recovered from sick people, we are able to draw an evolutionary tree and watch the branches grow. These are the data we analyzed today. On the tree, we can see which branch the Sydney virus sits upon. We can also see twigs for new members that may become branches. The trick is to gain enough data to feel comfortable that one twig is going to outgrow another, and that this family member would make a good vaccine candidate. Once a twig becomes a full branch, it quits growing and a new twig takes over and becomes a branch. Today the data told us that there is a twig close to the Sydney virus that seems to be growing. To stay ahead of the viruses, it may be best to choose as next year’s vaccine strain one that is closely related to the Sydney.
       My apologies to readers–it is hard to explain the complexity and science that go into the vaccine decision each year. Although the FDA advisory panel recommended that Sydney be included in the vaccine next year, the recommendation is provisional, and it is up to us to generate the data that in the final analysis will help everyone make the best possible choice of vaccine. We’re going to look closely at the growing twig on the Sydney branch and make the best possible choice we can within the month. This vaccine candidate will at least be related to Sydney. It is always important to remember that once a virus strain has circulated widely in a population, that strain is then replaced by a new twig, or family member. This is one reason we use all the force we can to try to outsmart the virus.
       Funding. A very exciting meeting. If the possibility of increased funding becomes a reality, then we can really start to close the gaps in our surveillance systems, national and international. We will be able to improve our vaccine-strain selection and improve our efforts for prevention and control of influenza. We will never be able to eradicate influenza, as we did smallpox and polio, but we certainly can try to control the viruses during the interpandemic years and prevent as much disease as possible. Importantly, we will be able to respond to a pandemic effectively. I would be extremely happy to retire knowing that all the wheels that turn within the influenza global-surveillance system are well greased and running smoothly.