Influenza: the next pandemic?
Janette Ramahat-Langendoen

Many were caught by surprise when COVID-19 took over the world in record time. However, experts have been warning us of a situation like this for years. Shall we listen to them and prepare ourselves for the next pandemic? Influenza can be seen as a likely candidate to cause the next one. In this series of articles, we explore influenza and the possibility of it becoming the next pandemic by consulting experts from various fields. 

In this article, we talk with dr. Janette Ramahat-Langendoen, a microbiologist from the RadboudUMC in Nijmegen, the Netherlands. 

How does your work relate to influenza?  

Since October 2013, I've been working at the Radboud university medical center as a clinical microbiologist with a focus on virology. So the influenza virus is one of the more important parts of my job! Every year, when the influenza season is approaching, we prepare our laboratory to perform proper diagnostics, both timely and accurate. And of course, we anticipate more materials coming in from patients who are suspected of having an influenza virus infection. For the hospital I work at, the influenza season is a yearly returning substantial burden. Before the start of the epidemic, we had large vaccination campaigns for health care workers, to avoid infection in this very important group of employees. During an influenza epidemic, depending on the severity, a lot of patients will be admitted for whom enough hospital beds should be available. This is quite a task for us, as every patient suspected of or confirmed with the influenza virus infection should be placed in isolation: a one-person room, with personal protective equipment for health care workers who come in contact with the patient.

What do you think is the greatest risk of the influenza A virus?

The biggest risk is the ability of influenza A virus to mutate. We have these yearly epidemics because of the relative ease of influenza virus to mutate into variants to which we have less immunity based on previous infections. Besides, the influenza virus is also very frequently found in animals, especially birds. Avian influenza virus strains can mingle with the human influenza virus, either via a so-called ‘mixing vessel’ (e.g. pigs) or, sporadically, directly from birds to humans. These animal influenza viruses are totally new for humans, no immunity exists, so a pandemic could occur. We have seen those influenza pandemics in the past, the most famous is of course the ‘Spanish flu’ in 1918, but we also experienced one rather recently (Mexican flu, 2009). So this is a real risk of these viruses.

What do you think of the initiative of SensUs to stimulate the development of rapid tests for influenza? 

I think it’s a very good initiative. In order to be able to act on the infection and transmission of the influenza A virus, either within patient care or infection control and public health, you need to diagnose the virus first. Not only in high-income countries with well-equipped laboratories but also in middle and low-income countries, where you have to deal with different circumstances. So in my opinion, developing a device that is easy to handle, gives an adequate result in a timely manner, and uses material that is easy to get from a patient is crucial.

What is something you think our society should learn from the current pandemic to prepare for the next pandemic?

The current pandemic shows us (again) that we are living in a small world, where the transmission of virus infections is facilitated by people able to travel around the world with relative ease. So to be prepared, we also need to take into account the situation in other parts of the world. It may seem far away and not of great concern for our way of living, but as we experience in this COVID pandemic, the world is our backyard. Preventing pathogens from jumping from animals to humans is a key factor. Additional efforts besides current ones will be necessary focusing on several important domains: from basic research into virus evolution and transmission patterns to contributing socio-economic factors in less fortunate countries around the world. Because in the end, prevention is far more important than reacting to the next pandemic.