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If we know how to make a vaccine for it, why was it not included in the annual flu vaccine this year? I was assuming the reason is that we don't know how to make a vaccine for a potential future H5N1 that can sustain human-to-human transmission because it doesn't exist and may be sufficiently different from the currently known strains that a different vaccine may be necessary (or, worse, that immune imprinting may mean a future vaccine against the pandemic strain wouldn't work as well).
Uhhhhhh I don't want to do a lit review so please forgive me if I get some of the details wrong but basically they try and predict well in advance which mutations are going to be prevalent the next year (like almost a year in advance) and make all the vaccines accordingly. The mutations are typically pretty well understood, that's what the H and Ns are about.
This is also why the flu vaccine doesn't always stop the flu, you can end up with one of the other variations, which annoys people to no end and makes them feel like it's pointless, it's not.
I believe the specific issue with H5N1 is that it stays trapped in the lower lungs which makes it even more dangerous (because you get more ARDS) but less contagious since you have less of the virus carried in cough and so on. The specific elements responsible for this are not necessarily in the same place in other animals, which can be why something is virulent in pigs or whatever but not humans.
My favorite example of this is the fact that allergic reactions for dogs are more diarrheal as opposed to throat closing, because that's where the histamine receptors are mostly located in dogs.
So it's more that a year ago or whenever they were actually selecting the strains for this year, H5N1 wasn't looking as scary, but maybe it could be included in next years' (assuming we don't get a pandemic and manage to rush a separate vaccine before then)?
Yeah my understanding is that we are sitting on a stockpile of at least 5 mill doses, and our routine process could be reasonably effective at dealing with this without resorting to "novel" technologies, but it's very severe and potentially a fast moving problem.
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