Making us pandemic-ready

How does it feel to get your sprint back? How does it feel to ease back into your daily routines and activities? How does it feel to be with your family and friends again? Yes, the world is recovering, and so are you!

With Covid-19 leaving its mark in many more ways than one, we, humans, have become more vulnerable and exposed.

Doctors and nurses worldwide worked tirelessly, many times putting their families at risk of spreading the disease despite all efforts. Yet, they stood out in handling the pandemic with due diligence, despite the limitations in resources and manpower. Increased workload, heightened media attention, uncertainty about the newer medicines, frequently changing guidelines on treatment protocols have taken a toll on the mental health of healthcare workers.

While the world is still reeling from the aftermath of the pandemic, public health and emergency management experts are already preparing for the next one. Biologists are certain that another dangerous new pathogen will emerge sooner or later.

Thus, public health researchers who are engaged in both leading the disaster response and evaluating emergency management have come up with five strategies that will give the world a head start and maybe even help prevent the next outbreak or epidemic from blowing up into a pandemic.

Shore up the systems already in place

The identification of a new outbreak shows how critical surveillance and reporting are for rapidly responding to and containing infectious diseases. Clinicians, public health practitioners and labs all around the world send disease reports to groups like the WHO’s Global Outbreak Alert and Response Network. It aggregates all that data and helps identify outbreaks of new infectious diseases and their pandemic potential.

One practical way to be prepared for a future pandemic is to ensure that all these systems and structures remain stable, which means maintaining funding, training and personnel for a rapid global response even when no pandemic threats are visible on the horizon.

Prepare the public to do its part

Effective pandemic response requires a clear, consistent voice and an actionable message that reflects best practices based on sound science. Messaging and data that clearly explain how each individual has an important role in curbing the pandemic — and that it might evolve as the pandemic unfolds over time — are critical. Science and risk communication scholars have started talking about the best ways people can manage the flood of information during a pandemic. Lessons from what’s been called the infodemic of COVID-19 news — some trustworthy but some certainly not — can inform new strategies for sharing reliable info and fostering trust in science.

Get coordinated

Emergency managers and healthcare leaders have long recognised that a coordinated response by diverse teams is critical for public health emergencies. Like a fire drill, they bring together community stakeholders to walk through a hypothetical disaster scenario and hash out roles and responsibilities. These practice sessions include people who work in public health, emergency management and healthcare, as well as federal, tribal, state and local frontline responders.

Prep up infrastructure

After every major disaster response, all of the different groups involved — law enforcement, fire, emergency management, public health, search and rescue and so on — conduct what are called “after-action reviews.” They can improve plans for the next time around. A thorough review of the response to the current Covid pandemic at all levels will identify gaps, challenges and successes. Those ‘After Action’ findings need to be integrated into future planning to improve preparedness and response for the next pandemic.

Build on the new normal

No doubt Covid triggered some rapid changes that will last and help us be ready for future events. It’s been easier to adapt to the necessary lifestyle changes due to this pandemic, thanks to the ways technology has changed the workplace, the classroom and the delivery of healthcare. Business analysts predict the quick move to video teleconferencing and remote work for offices in 2020 will be lasting legacies of COVID-19. Some of the sudden changes to norms and behaviours like the use of face masks in public may be among the easiest strategies to keep in place to fend off a future pandemic from a respiratory virus.

‘The Lancet’ states that international airports can also have a key role in screening, detecting, and mitigating cross-border transmission of SARS-CoV-2 and potentially other infectious diseases. With aircraft passengers representing a subpopulation of a country or region, aircraft-based wastewater surveillance can be a promising approach to effectively identifying emerging viruses, tracing their evolution, and mapping global spread with international flights. Therefore, the development of a global aircraft-based wastewater genomic surveillance network has been proposed with the busiest international airports as central nodes and continuing air travel journeys as vectors. This surveillance programme requires routinely collecting aircraft wastewater samples for microbiological analysis and sequencing and linking the resulting data with associated international air traffic information. With the creation of a strong international alliance between the airline industry and health authorities, this surveillance network will potentially complement public health systems with a true early warning ability to inform decision-making for new variants and future global health risks.

In all this, what can prove crucial in tracking and understanding the emerging and circulating respiratory viruses are the genomic tools.

A group of scientists at the Wellcome Sanger Institute (Cambridgeshire, UK) in collaboration with the UK Health Security Agency (UKHSA; London, UK) are currently involved in such research.

The project, known as the Respiratory Virus and Microbiome Initiative (RVI), aims to provide a global genomic surveillance strategy that could be incorporated by public health departments all over the world to act as an early warning for potential outbreaks.

Building upon expertise gained during the COVID-19 pandemic when the Sanger Institute sequenced millions of SARS-CoV-2 genomes in collaboration with the Covid-19 Genomics UK (COG-UK) Consortium, the RVI team aims to use lessons from the pandemic to develop a standardised approach to sequencing multiple respiratory viruses in a single assay. Such an approach could be used in any laboratory.

“In many labs around the world, people have smaller sequencing machines and cannot sequence as many samples as we can at the Sanger. So, we want the system to work equally well on those machines as it does here on our large volume devices,” the leader of the Sanger Institute’s genomic surveillance unit, John Sillitoe was quoted as explaining. Project leader Ewan Harrison went on to add “the crucial point is that we have got to develop a system that uses inexpensive reagents, does not require teams of highly-trained technicians and can be used at scale. Then we can really make a difference.”

The technology being developed includes a targeted assay that can detect co-infections of multiple common respiratory viruses from a single nasal swab, including influenza, respiratory syncytial virus (RSV) and Coronaviruses.

Genomic sequencing has had a huge impact on the global response to COVID-19, and the technology has improved as more researchers put it to use to better understand the viral origin, outbreak dynamics, transmission, and evolution. Understandably then, the integration of genomics and other technologies has played a crucial role in the development of new diagnostics, therapeutics, and vaccines.

According to Jason Sahl, PhD, associate professor in the Department of Biological Sciences at Northern Arizona University: “The Covid-19 pandemic in many ways represented the culmination of sequencing and analysis that had been building for years. We wanted to highlight that although interest in the pandemic has waned, other threats still exist, and maintaining our momentum while also building new infrastructure will be vital for improving public health responses to existing and emerging threats.”

Sahl and fellow associate professor Jason Ladner, PhD, along with colleagues at the Pathogen & Microbiome Institute, are working on applying and analysing innovative genomic technology in the study of pathogens, and have studied various infectious agents, including Ebola, Zika, Yersinia pestis (which causes plague), anthrax, and Burkholderia pseudomallei (which causes melioidosis, an infectious bacterial disease).

In their essay, they focus on the history of pathogens and genomic sequencing to help readers understand that the patterns we see now aren’t new. In the 1960s, scientists thought infectious diseases had been resolved with the development of vaccines, antibiotics, personal hygiene, sanitation norms, and more.

“What we did not fully appreciate at the time, however, was the incredible diversity of human pathogens, their capacity for rapid evolution, and the dynamic nature of interactions between pathogens and their hosts,” Ladner and Sahl write. “Combined, these factors have substantially complicated our attempts to mitigate the impacts of infectious disease.”

Sixty years later, pathogens remain complicated. The biologists provide a roadmap for various stakeholders in preparation for the next pandemic: highlighting deficits in research for scientists to address; pointing out the critical need for collaboration and investment for policymakers; and explaining the history of pathogen genomic sequencing to public health officials, media, philanthropists, and others so they can understand the full potential of pathogen sequencing for public health.

Although Covid remains a threat, interest in the pandemic has faded. However, antimicrobial resistance still represents a significant public health threat. The sequencing infrastructure built during the pandemic will need to be supported by sustained federal investments, or society will return to pre-pandemic capacity and will be unable to quickly respond to the next public health threat.

Views expressed are personal