Instruct: Given a question, retrieve relevant passages that can help answer the question.
Query: When was the flu vaccine introduced?
Vaccination against influenza began in the 1930s with large scale availability in the United States beginning in 1945.[12][13] It is on the World Health Organization's List of Essential Medicines, the most effective and safe medicines needed in a health system.[14] The wholesale price in the developing world is about $5.25 USD per dose as of 2014.[15] In the United States, it costs less than $25 USD as of 2015.[16]
Since avian flu is not going away as was hoped, more data is needed to figure out how best to cope. Governments are funding a variety of studies from cell culture of flu viruses to H5N1 vaccination effectiveness to adjuvants to wild bird migration patterns to wild bird avian flu subtype distribution to poultry flu vaccination etc. The information being gathered is increasing the world's ability to keep H5N1 contained, limiting its speed and extent of mutation, and buying time for new flu vaccine manufacturing methods and factories to come on line so that when the next flu pandemic happens the death toll can be minimized.
The CDC recommends the flu vaccine as the best way to protect people against the flu and prevent its spread. The flu vaccine can also reduce the severity of the flu if a person contracts a flu strain that the vaccine did not contain.[17] It takes about two weeks following vaccination for protective antibodies to form.[18]
Indeed, vaccines, including the influenza vaccine, Tdap, and pneumococcal vaccines, are less effective in adults over the age of 65. Nevertheless, the CDC recommends that elderly adults get the flu vaccine because influenza infection is particularly dangerous in this population and vaccine provides at least a moderate level of immunity to the flu virus.
Prof. Arnon is currently performing research on a universal, recombinant influenza vaccination, as well as cancer vaccine research. In a 2009 paper, Arnon speaks of research using virus-like particles (VLP) to induce an immune response. These particles cannot replicate, but possess the specific antigen presenting proteins that immune cells use to identify viruses. Therefore, a vaccine could introduce VLPs to an individuals immune system and bring about the production of memory cells. Arnon and Ben-Yedidia hypothesize that these vaccines would be effective against H5N1, a pandemic virus more commonly known as bird flu. They have tested the various synthetic vaccinations on mice and observed a significant immune response. In addition, they have put human lymphocytes in mice and also observed an immune response. Their research formed the basis of the company BiondVax, who have taken the universal flu vaccine into human clinical trials.
After a meeting with the WHO on 14 May 2009, pharmaceutical companies said they were ready to begin making a swine flu vaccine. According to news reports, the WHO's experts will present recommendations to WHO Director-General Margaret Chan, who was expected to issue advice to vaccine manufacturers and the Sixty-second World Health Assembly. WHO's Keiji Fukuda told reporters "These are enormously complicated questions, and they are not something that anyone can make in a single meeting." Most flu vaccine companies can not make both seasonal flu vaccine and pandemic flu vaccine at the same time. Production takes months and it is impossible to switch halfway through if health officials make a mistake. If the swine flu mutates, scientists aren't sure how effective a vaccine made now from the current strain will remain. Rather than wait on the WHO decision, however, some countries in Europe have decided to go ahead with early vaccine orders.
Research suggests that VLP vaccines against influenza virus could provide stronger and longer-lasting protection against flu viruses than conventional vaccines. Production can begin as soon as the virus strain is sequenced and can take as little as 12 weeks, compared to 9 months for traditional vaccines. In early clinical trials, VLP vaccines for influenza appeared to provide complete protection against both the Influenza A virus subtype H5N1 and the 1918 flu pandemic. Novavax and Medicago Inc. have run clinical trials of their VLP flu vaccines.
Dossaev announced on 20 March 2006 that tests had confirmed that a dead swan found in Mangghystau Province, on Kazakhstan's Caspian Sea coast, had bird flu. Several areas in northern Kazakhstan were quarantined in 2005 when the H5N1 bird flu strain was found. Thousands of domestic fowl were culled when bird was detected in Kazakhstan in August. Asylbek Kozhimuratov, the Kazakh agriculture minister, said that all domestic poultry in Mangghystau had been vaccinated. Fowl in Atyrau province, a location of suspected vulnerability to bird flu, were being vaccinated. The Kazakh government started vaccinating about 8 million fowl in February to limit the spread of bird flu.
In January 2018, analyzing the reason for the spike, "The Atlantic" noted that the flu season was possibly worse because the dominant circulating strain was the H3N2 strain, which for unknown reasons tends to hit humans harder than other strains and result in worse flu seasons when dominate. Also, the H3N2 strain, according to the CDC, affects elderly and young children more than other strains, resulting in more severe hospitalizations and deaths. 
"The Atlantic" also noted that the 2017 vaccine for the flu was only ten percent effective against H3N2 in Australia. As the typical practice of studying and creating the current vaccines in chicken eggs tends to result in mutations, 2017 was the first year that researchers used dog cells rather than chicken eggs to create the H3N2 component of the vaccine Flucelvax. However, due to cost, most Americans did not get Flucelvax in 2017 and 2018 and likely received vaccines grown with chicken eggs. "The Atlantic" noted that the vaccine still protected against other strains such as the H1N1 and B virus, and did provide at least some immunity to H3N2.
"The Committee for Medicinal Products for Human Use (CHMP), which reviews applications for 27 EU countries, found that Novartis's Optaflu vaccine, given to more than 3,400 people during clinical studies, met the CHMP's immunogenicity criteria [...] Novartis has said that Optaflu is a subunit vaccine, meaning it contains individual viral proteins rather than whole virus particles. [...] Novartis said it anticipates applying for US licensing of its cell-based flu vaccine in 2008. The company conducted phase 1 and 2 clinical trials of the vaccine in the United States and in July 2006 announced it would build a $600 million plant in Holly Springs, North Carolina, to make cell-culture flu vaccines. In May 2006, the United States Department of Health and Human Services awarded Novartis a $220 million contract to develop cell-based flu vaccines, and Novartis has said the money would go toward the cost of the new facility. Depending on when its vaccine is approved by the U.S. Food and Drug Administration (FDA), the plant could begin production as early as 2011 and be ready for full production as early as 2012, with an annual output of 50 million doses of a trivalent vaccine, the company has said. In the event of a flu pandemic, the facility is designed to have the capacity to make up to 150 million monovalent (single strain) doses each year within 6 months of a pandemic declaration, Novartis said. Novartis' other cell-based vaccine production facility is in Marburg, Germany."
Flu vaccine is usually grown by vaccine manufacturers in fertilized chicken eggs.[109][110] In the Northern hemisphere, the manufacturing process begins following the announcement (typically in February) of the WHO recommended strains for the winter flu season.[109][111] Three strains (representing an H1N1, an H3N2, and a B strain) of flu are selected and chicken eggs inoculated separately. These monovalent harvests are then combined to make the trivalent vaccine.[112]
Immunosignatures were used to test if the efficacy of a vaccine could be predicted (in mice), using different strains of the influenza virus. Mice were given a seasonal flu vaccine, or a vaccine against the specific flu virus tested in the study (PR8). The mice were then infected with the PR8 flu strain. Those groups of mice which were given the PR8-specific vaccine not only survived, but did not display any symptoms of the flu. The mice which received either of the two seasonal flu vaccines all developed flu symptoms, and some (20-40%, depending on which seasonal vaccine received) were killed by the PR8 infection.
In recent years, research has concerned use of an antigen for the flu hemagglutinin (HA) stem.
Based on the results of animal studies, a universal flu vaccine may use a two-step vaccination strategy: priming with a DNA-based HA vaccine, followed by a second dose with an inactivated, attenuated, or adenovirus-vecto-based vaccine.
On 20 May 2009, AP reported: "Manufacturers won't be able to start making the [swine flu] vaccine until mid-July at the earliest, weeks later than previous predictions, according to an expert panel convened by WHO. It will then take months to produce the vaccine in large quantities. The swine flu virus is not growing very fast in laboratories, making it difficult for scientists to get the key ingredient they need for a vaccine, the 'seed stock' from the virus [...] In any case, mass producing a pandemic vaccine would be a gamble, as it would take away manufacturing capacity for the seasonal flu vaccine for the flu that kills up to 500,000 people each year. Some experts have wondered whether the world really needs a vaccine for an illness that so far appears mild."
Another option proposed by the CDC was an "earlier rollout of seasonal vaccine," according to the CDC's Daniel Jernigan. He said the CDC would work with vaccine manufacturers and experts to see if that would be possible and desirable. Flu vaccination usually starts in September in the United States and peaks in November. Some vaccine experts agree it would be better to launch a second round of vaccinations against the new H1N1 strain instead of trying to add it to the seasonal flu vaccine or replacing one of its three components with the new H1N1 virus.
In September 2009, AVN campaigned against the swine flu vaccine, calling it "madness" to use a vaccine which they claimed was "laden with toxic mercury." Dorey further argued that more testing was needed on the vaccine before it was offered to the public and that it could prove to be more dangerous than the flu itself. She told the Australian Broadcasting Corporation that the swine flu should be treated no differently from the seasonal flu and that the government was wasting money by spending over a hundred million dollars on the vaccine. Dorey's claims were rejected by the Australian Medical Association and other medical experts.
Influenza vaccines, also known as flu shots or flu jabs, are vaccines that protect against infection by influenza viruses.[2] A new version of the vaccine is developed twice a year, as the influenza virus rapidly changes.[2] While their effectiveness varies from year to year, most provide modest to high protection against influenza.[2][3] The United States Centers for Disease Control and Prevention (CDC) estimates that vaccination against influenza reduces sickness, medical visits, hospitalizations, and deaths.[4] When an immunized worker does catch the flu, they are on average back at work a half day sooner.[5] Vaccine effectiveness in those under two years old and over 65 years old remains unknown due to the low quality of the research.[6][7] Vaccinating children may protect those around them.[2]
China's Ministry of Health has gathered experts to draft the Influenza A(H1N1) vaccine and immunity strategy which would include, 'when, how and against whom' the vaccine should be used.
The ministry's Contingency Office deputy director, Liang Wannian, said the optimum objective of the flu vaccine was for the protection of high-risk population, especially people with basic illness and pregnant women. The first batch of China's A (H1N1) flu vaccine is expected to be ready by July, and would undergo a two-month clinical test before it is available in the market. China's flu vaccine strategy is to stockpile enough vaccine for one per cent of her population by 1 October, as a preventive measure to encounter any vast outbreak of the flu. Liang said China would take more severe and effective preventive measures at its many gateways and educate the people on the H1N1, also known as swine flu.
Flu vaccinations have been used to diminish the effects of the flu season; pneumonia vaccinations additionally diminishes the effects and complications of flu season. Since the Northern and Southern Hemisphere have winter at different times of the year, there are actually two flu seasons each year. Therefore, the World Health Organization (assisted by the National Influenza Centers) makes two vaccine formulations every year; one for the Northern, and one for the Southern Hemisphere.
A universal flu vaccine is flu vaccine that is effective against all influenza virus strains regardless of the virus subtype or viral genetic drift. Hence it should not require modification from year to year. As of 2017, there was no approved universal flu vaccine for general use, but several have been in development.
Laurence Gostin in his article At Law: Swine Flu Vaccine: What Is Fair? writes that "…the swine flu affair fails to tell us whether, in the face of scientific uncertainty, it is better to err on the side of caution or aggressive intervention." There is not even complete agreement about the causal relationship between the swine flu vaccine and Guillain-Barré syndrome, as noted in Gina Kolata's book "Flu: The story of the great influenza pandemic of 1918 and the search for the virus that caused it.". She writes that the CDC did not have a "specific set of tests and symptoms to define Guillain-Barré" and that doctors who reported cases already knew that a link was suspected, so a bias in reporting was introduced. She quotes Keiji Fukuda, "...if a new virus gets identified or reappears, you don't want to jump the gun and assume a pandemic is happening."
Norway was notable among the Scandinavian countries for a high number of swine flu deaths—29 deaths as of January 4, 2010. All 19 counties of Norway had confirmed cases, and deaths occurred in five of the counties. Only Svalbard (an archipelago midway between Norway and the North Pole) had no reported cases of swine flu. About 10 million doses of flu vaccine were ordered from the pharmaceutical industry when the World Health Organization declared a pandemic. The first vaccination campaign started in Bergen, on October 22, 2009, with several hundred people queuing up. The flu was given widespread media coverage and the Norwegian government published a tally of laboratory-confirmed cases of swine flu, but made clear that this was an underestimation.
The usual seasonal flu vaccines give little or no immunity against the new strain of flu. There is an international program to produce a vaccine which will be effective against the new H1N1 strain. The chief medical officer Sir Liam Donaldson said on 25 June that it seemed likely that the UK would receive the first batches of vaccines slightly earlier than expected, possibly from August rather than the autumn as first expected, although some industry sources do not expect supplies to be available so soon. The government has contracts for 132 million doses. There are risks involved in shifting resources to the new vaccine: it will not be possible to produce the seasonal flu vaccine, and it is possible that the virus will mutate to make a vaccine developed before the mutation ineffective.
In 2008, Acambis announced work on a universal flu vaccine (ACAM-FLU-ATM) based on the less variable M2 protein component of the flu virus shell. See also H5N1 vaccines.
On February 13, 2013, U.S. Food and Drug Administration (FDA) Chief Scientist Jesse Goodman predicted that a universal flu vaccine was still at least 5 to 10 years away. When asked about the prospects of a universal flu vaccine in a hearing before House Energy and Commerce Subcommittee on Oversight and Investigations, Goodman replied "Nature is very tricky and as this is a very crafty virus, so I'd be very hesitant to predict... I think the earliest we'd begin to see something with clinical benefit might be 5 to 10 years."