A global system for the next generation of vaccines

The rapid development of vaccines against COVID-19 raises questions about what could be achieved in vaccines to other major diseases. Influenza presents an important case study; it is one of the few infections that causes substantial public health burden in its endemic form while also having proven pandemic potential. We offer a first step in bringing together the value proposition of future influenza vaccines considering two key characteristics: the breadth of protection that vaccines offer (against individual strains, all strains within a subtype, multiple subtypes, or all subtypes) and the duration for which protection remains effective (see the figure). We examine implications of these characteristics, from both epidemiologic and economic perspectives, and discuss how a future market for influenza vaccines might best align public health and economic incentives. Although many of these factors are specific to influenza, we consider comparisons with other major infections, such as tuberculosis and COVID-19.