The Center for Disease Control and Prevention (CDC) recommends that every year, all individuals above six months of age receive the flu vaccine, with few rare exceptions. The severity of the flu season varies each year due to the presence of different strains, necessitating the yearly development of a specific, altered vaccine (two, technically). But what if there was just one vaccine, and it didn’t require this yearly process? 

I had the privilege of learning about flu vaccine development from Dr. Florian Krammer, Endowed Professor of Vaccinology at Mount Sinai’s Icahn School of Medicine. Having worked in both seasonal and now universal flu vaccine development, Dr. Krammer has been at the forefront of this issue, providing enlightening insight into the field of vaccinology and modern science in general—the ever-present dangers of continued misinformation and funding cuts, coupled with the overarching necessity of passion in the evolving field of science.

This interview has been edited for concision and clarity.

Esther Gould: What is the current way in which scientists develop and choose what strains of the flu to target with a vaccine? How long is this process?

Dr. Florian Krammer: Remember, there are two vaccines, actually: One is for the Northern hemisphere, and one is for the Southern hemisphere, because the winter seasons are different. For the Northern hemisphere, the World Health Organization (WHO) collects data, that means mostly viruses and virus sequences of different influenza viruses. In February, there is a big meeting and it is basically a bunch of people in a room [who] look at Excel sheets and look at the data, and then they decide if the current vaccine strains are still good and cover the strains that are circulating, or if they need to be changed. After the meeting, they tell the vaccine manufacturers what to put in the vaccines. For influenza, we always have an H1, an H3 and an influenza B strain in the vaccine, and then this gets manufactured—that takes a while, typically the vaccine manufacturers start to make the vaccine in March, and then they are basically ready with it in September, and that’s when people start to get vaccinated. 

EG: What is this meeting like? Who is there, and what is the scale? Do you look over the previous year?

FK: It’s about 50 people that are the core people who decide, and they’re influenza scientists, virologists, epidemiologists, [and] immunologists that are usually representatives from different countries and different organizations. The CDC used to be part of it, but it’s not clear if they can participate anymore because the [current] administration withdrew from the WHO, and this is a WHO process. 

EG: How does the virus vary from year to year?

FK: There is a lot of variation. The first variation is, of course, which strains cause most infections.​​ This year was dominated so far by H3N2, but now there are also a lot of influenza B cases. How well the vaccine works in a specific year depends on what virus is prevalent, and it depends on how well the circulating virus matches the strains in the vaccine.

EG: I have heard a lot about this year’s [flu season], and I was wondering what makes this year different?

FK: It wasn’t that different. It was a strong H3N2 season so far, as opposed to H1N1 or influenza B—that did also circulate, but specifically in the US, it was dominated by H3N2. We had a similar season last year, maybe not as strong, but we did have that. Often, you have a few years where there are a lot of infections, and then maybe there’s another year where it’s less … Usually, if H3N2 dominates, it’s worse than if H1N1 dominates. What you often see is there is a tail end with influenza B but that’s not there every year. So that’s a lot of variation. 

EG: Okay. I also wanted to ask about the universal flu vaccine, and how the development of that varies.

FK: That’s really early in clinical development, and the idea there is that you target parts of the virus that don’t change. The problem is that influenza viruses change constantly, and that’s why we always play catch-up with the virus with the current vaccines. People have tried several approaches to develop a universal influenza vaccine where the virus variation would not matter. Some trials have failed, there are still some candidates in development that are very promising. But there are issues right now because the funding for things like that is going away. But basically, the idea is to find weak spots that the virus cannot mutate and target those. That would then give you immunity to many different strains—all of these changing strains—but also to strains that sit in the animal reservoir, in birds, in other mammals that could cause pandemics in the future. 

EG: Would it be like other vaccines that we just get a dose [of] once?

FK: Exactly. The idea is to have something that is more like the measles vaccine, so you get your two doses, and then you’re good. So you wouldn’t have to get it every year, you would get it once, maybe then one or two booster doses, and that’s it. If that is possible, in the end, is a different story. But that’s the goal. And we have to try.

EG: I also was about to ask about funding, and how much that has impacted [the development of the universal flu vaccine], if you can expand a bit on that?

FK: I can give you an example—my laboratory used to have about 30 members. We’re now cutting that to eight. 

EG: Wow.

FK: There is a lot of funding that has been cut for vaccine development. It also has affected Mount Sinai. There are some projects that were completely canceled, some were made smaller, some don’t have a clinical trial scheduled anymore, so there’s a lot of impact on vaccine research and development.

EG: How would you inform people about the importance of vaccinations from more of a scientific standpoint? Because I know that isn’t often included in people’s arguments in the government, for instance.

FK: A lot of the information about the importance of vaccines is out there. The CDC still has very good information about vaccines, there are other online sites that provide good information, you can also talk to your doctor. There’s a lot of reliable and good information. It’s just that there’s also a lot of wrong information and people believe it. I think that vaccines always kind of had a struggle; since the beginning, when vaccines were first introduced, there were people who didn’t like them, who thought that, by interfering with infectious diseases, you’re interfering with the plans that God had with you, for example. There’s also an argument that it’s unnatural. The anti-vaccine movement has existed for a long time. Sometimes it’s stronger and sometimes it’s less strong. 

Another point about vaccine hesitancy is, I believe, a psychological one. If you are sick, you go to the doctor’s office and you get medication. You want to get that because you don’t feel good, you want to feel better, you want to improve, you want to get healthy again. But with vaccines, it’s different. You get vaccines when you’re healthy and you’re getting them to avoid a risk that might not be a problem in the end. If you never get exposed to the virus, why get vaccinated? You don’t know if you’ll need it in the future. And so it’s a perception difference. 

And then you have this other issue, that if you go back 70 years, there were a lot of devastating infectious diseases around. People got infected, they got polio, all of a sudden they couldn’t walk anymore. There were a lot of deaths due to infections, and because of vaccines, all of that went away. And so people don’t see that anymore, because of vaccines. I think, in a way, vaccines are almost the victim of their own success, so to say. Nowadays, people think measles is fine, right, because you don’t know people who had been affected by measles. People think polio is not a problem because we don’t see people who have disabilities because of polio. And of course it doesn’t help if government officials who should care about our health don’t and provide false information.

EG: Yeah, that’s a very interesting point, how vaccines have been so successful that people don’t know life without them, so they just think, “Well, why am I getting a shot each year?” I also know another misconception, or something that people often say, especially with the flu vaccine, is that they get the flu from the vaccine—what would be your response to that?

FK: That’s true, that’s something you hear quite often. The problem is also that when you get a flu vaccine, it protects against influenza—influenza viruses. But should you get exposed to rhinovirus or one of the many other viruses which also cause common colds, it’s not going to help you. But you got the vaccine and then you got sick and you’re like, “Ah, the vaccine doesn’t work,” right? And of course there is some truth that flu vaccines don’t always work, and the most important point about flu vaccines is not to not get influenza, but to not get severe disease—because in contrast to all the other common cold viruses, influenza can cause life-threatening infections.

EG: Do you have any message for readers that you think is important for them to know, whether that’s about going into our future careers, about the flu season, flu vaccines—anything that you think is important?

FK: One thing that I would say is get vaccinated. That’s important. Specifically for people who are trying to choose a career path in STEM, there are a few more things I have to say. The most important thing is that you are curious, that you are burning [with curiosity] for science, research, and for discovering new things, and that you are happy to put in the work that it needs. I wouldn’t be worried just because you hear stories of lost funding and this and that right now. These things change again, and we need bright young people in science. And I think if people have the curiosity and are really interested in the topic, they should go for it. That’s the important thing. We need young people who carry science forward—that’s my main message. And it’s sometimes hard, but it’s worth it.