With workplaces reopening, businesses resurging and travel resuming, a return to normality is seemingly within our grasp. But it would be foolhardy to become complacent after the suffering of the pandemic and, as we look to finally live with Covid-19, we must have an eye on the horizon to prevent the next one.
We have the unique opportunity to make disease outbreaks much less likely or catastrophic. We have this opportunity because, three years into this pandemic, we have been able to design, deploy and begin to scale sophisticated disease-monitoring systems.
But we face the real and serious risk of missing this opportunity as the focus shifts away from Covid-19, which has been politically and conveniently transformed from a health to an economic problem.
This continued short-sightedness will leave us unprepared to face the next inevitable threat. Over the past 20 years, we have seen outbreaks of Ebola, MERS, SARS and Zika, which is why the new book by Bill Gates, How To Prevent The Next Pandemic, is an important and timely intervention.
Of particular importance to eliminating the possibility of a pandemic as a threat, Gates says, is a global disease-surveillance system that can pick up health threats before they become pandemics and then mobilise regional and international responses to quickly snuff them out. Genomic sequencing – the eyes and ears of the global Covid-19 response – is the key component of this surveillance system. It is uniquely effective and widely available, has revolutionised disease surveillance, and transformed pandemic prevention and response, but it still needs to be universally embraced. In a previous paper, we outlined what genomic sequencing is and why it matters, and we will be publishing more detailed material on genomic pathogen surveillance in the near future.
This technology is critical to implementing our vision of an improved global disease-monitoring system that detects, responds and mobilises.
Aligning the components required to transform disease surveillance and response, and bringing them together from the sub-national to global level is complex and fraught with acute and chronic challenges. While it is also expensive, the cost of the status quo – or even creating ad-hoc and misaligned systems – would be more expensive by an order of magnitude. The Covid-19 pandemic is projected to cost $13.8 trillion to the global economy over five years in comparison to an estimated cost of only $150 billion for building the infrastructure to prevent another one. This is still a huge sum to find among competing spending pressures, but it would be extraordinarily short-sighted to tighten the purse strings now. As Gates says, “we need to spend billions to save trillions”.
It is inevitable that further infectious diseases will emerge – either post-pandemic or concurrent with Covid-19. Some of these are known, such as Ebola, MERS and Zika, but other future pathogens, currently unknown to us, are equally likely to arise.
There is also the real possibility of an engineered pandemic where the accidental or intentional release of a deadly pathogen leads to global and uncontrolled chaos. Despite regulation of biosafety standards in laboratories, there are no enforced universal standards, and with more than one million scientists working in laboratories around the world, there remains a significant biosecurity risk. The Biological and Toxin Weapons Convention is poorly funded and does not have the ability to police standards, in stark contrast to the Chemical Weapons Convention that is policed by the Organisation for the Prohibition of Chemical Weapons, is well funded and has removed significant numbers of chemical weapons from the world.
While we may be limited in our ability to stop outbreaks from emerging, technology is our fastest and most effective tool to bring them under control and save lives if the worst-case scenario were to occur. We have the ability to prevent outbreaks from rapidly turning into a pandemic.
Our research during the Covid-19 pandemic has explored how governments, researchers, health systems and technologists must work together going forwards to build post-pandemic resilience and future pandemic preparedness. This includes coordinated activity across the government, academic, and clinical sectors to advance a wide range of technologies and capabilities, including epidemiological surveillance, digital health and drug discovery. Revolutionary technological advances will change the way we do things, but we also require governance structures and public-health investments at the national and international levels to implement new technologies, coordinate their use and realise their benefits.
Genomic-sequencing capabilities built up over the past two decades have been integral to the international Covid-19 response. In future, a coordinated genomic pathogen surveillance network is key to realising a global disease-monitoring system. The benefits of sequencing extend well beyond Covid-19 and could transform the way we respond to threats across health, agriculture, food safety and more. It could act as an early-warning system to identify the spread and mutation of pathogens; transform the practice of clinical microbiology through the sure diagnosis and treatment of patients; complement vaccine-development efforts; and support development of diagnostics and therapeutics.
Capabilities are improving by the day, and the capacity to perform sequencing is more widely available than ever. It is now possible for data to be routinely generated for public-health surveillance to monitor epidemic and pandemic threats and enable decision-makers – at national and international levels – to take informed and concise actions.
But to make effective use of this revolutionary technology, we need a coordinated set of governance structures and investments in capacity building to implement, coordinate and set standards at the global level. It’s no surprise that the World Health Organisation is encouraging countries to use genomic sequencing as part of a global genomic-surveillance strategy to forecast, detect and assess epidemic and pandemic risks, so that they can take rapid decisions to prevent future health emergencies. The new WHO Hub for Pandemic and Epidemic Intelligence in Berlin will coordinate, govern and set standards for international genomic-surveillance activity, playing a role that was not available during the Covid-19 pandemic. Similarly, the G7’s International Pathogen Surveillance Network – or Global Pandemic Radar – will establish regionally located but globally interconnected genomic centres to share information on known and emerging diseases before they become pandemics.
During Covid-19, we benefitted from investments into local genomic-sequencing capabilities made over the prior five years, including the Africa Pathogen Genomics Initiative, the US CDC and WHO’s Field Epidemiology Training Programme, the Seq&Treat project and indeed grants from the Bill and Melinda Gates Foundation across the world. These initiatives build on over a decade of international efforts to incentivise systematic, ethical, genomic data collection and sharing captured in the 2010 Nagoya Protocol. Continued investment and coordination via these new structures will strengthen the global pathogen-surveillance framework in response to the challenges experienced during the Covid-19 pandemic, its first true test.
The UK is a world leader in genomic sequencing, and there are two homegrown British technology initiatives that illustrate the potential to transform threat detection and response. Rolling out such solutions globally would help to enable an effective global genomic-surveillance system that – to use an analogy – could operate as a floodlight for potential threats, apply a spotlight to an event of concern and then take a laser-focused approach to response.
First, the floodlight. As well as signals such as those from clinicians working in intensive care units (and therefore likely to encounter pathogens of concern), technology such as Kromek’s Automated Pathogen Early Warning System can also enable early detection. Though developed for biological threat detection, its scalability, autonomy and in-built communications network also make it ideal to protect against pandemics. A broad-area surveillance tool, it works by detecting pathogens in the air in near-real time in locations such as airports or urban centres (an approach already deployed nationally for the monitoring of nuclear and radiological material in the UK). The system can thereby enable earlier identification of a potential threat (whether a previously recognised or new one), rather than relying on the testing of individuals or development of symptoms.
Once a potential outbreak is identified, we can focus a spotlight by using targeted sampling and analysis to confirm the threat, its location and behaviour. Here the Global Pathogen Analysis Service toolset can provide and share accurate, contextual and near-real time information for health and policy decision-makers. Built from deep research at Oxford University and powered by the scale of Oracle Cloud Infrastructure, the not-for-profit, accessible, accurate, secure and standardised system processes, analyses and compares genetic-sequenced material thousands of times faster than before.
With this assured intelligence, we are then able to design and deploy laser-focused responses, including highly targeted non-pharmaceutical interventions and the development of vaccines and therapeutics.
This proposed system of approach is an example of the type of endeavour that will enhance WHO’s ongoing work around the Global Pandemic Radar and ensure solutions can be delivered consistently to laboratories, hospitals and public-health organisations around the globe.
At this inflection point in the pandemic, there are two choices: learn the lessons from the past and shape a pandemic-free world or continue to under-invest in the preparatory structures and tools needed to save lives and livelihoods. We have the surveillance technology needed to prevent the next pandemic. The question is whether we are committed enough to put it in place.