Broad viral surveillance is essential in pandemic prevention to allow for detection of potential threats and the immediate early launch of health protocols against pathogens. Yves Dubaquie, senior vice president of diagnostics, PerkinElmer, Inc., investigates how this could work.
As demonstrated with COVID-19, surveillance efforts have been key in the identification of SARS-CoV-2 variants, helping direct medical aid and related resources where they were needed most. The enduring challenge is the current lack of a universal programme or tool to allow for the real-time viral monitoring needed to prevent outbreaks entirely. Herein lies the opportunity.
To deliver a global surveillance model for pandemic prevention, international health and scientific communities must continue to work with governments, corporations and other vested interests to advance current efforts to combat the spread of COVID-19. A comprehensive model based on existing and future efforts should follow a three-level approach:
- hard data from hospitals and labs on confirmed cases
- population-level screening
- individual-level screening.
For this model to be effective, it is essential to include confirmatory testing and timely, accurate case reporting, particularly in relation to population-level and individual-level screening.
Hard data from health systems
The hard data from hospitals and labs around SARS-CoV-2 follows very strict and clear criteria established by bodies such as the World Health Organisation (WHO) or the Centres for Disease Control and Prevention (CDC) about which cases should be reported based on morbidity and mortality. Such reports provide a clear picture on the spread of the disease, contributing heavily to local and global surveillance efforts. However, while this data has immense, undeniable value, some outbreaks could be missed if, for instance, people with mild symptoms may decide to isolate and not seek follow-up medical attention – meaning their infection goes unreported. Similarly, asymptomatic individuals may not get tested at all. This is a cofounding parameter to consider during data analysis.
Broad approach to population-level screening
Wastewater surveillance proves a viable and effective method to detect outbreaks as it allows for pathogens to be spotted before a given population presents symptoms, helping to inform fast-response strategies. Researchers at the University of California in San Diego recently published findings from a study that asserts wastewater genomic surveillance is a scalable solution that allows for early detection of SARS-CoV-2 variants. Their team uncovered wastewater spikes that reflected an uptick in confirmed COVID-19 cases in the population studied, and potential SARS-CoV-2 variants of concern weeks before they showed up in the clinical genomic surveillance setting.
In England, the UK Health Security Agency (UKHSA) led the Environmental Monitoring for Health Protection (EMHP) SARS-CoV-2 wastewater monitoring programme, paused at the end of March 2022, which provided coverage of approximately 74% of the population. The programme helped identify not only where the virus was circulating, but also detected mutations, including those associated with known variants of concern (VOCs) and variants under investigation (VUIs). UK-wide wastewater monitoring was also delivered through coordination between the EMHP team and other programmes in the devolved administrations. Deployed at a global scale, wastewater monitoring efforts such as this could be an extraordinary alert mechanism – helping protect against new variants of existing viruses and other potential threats.
With continued improvements in this PCR-based method for surveillance, wastewater analysis has the capacity to target hotspots of interest, such as areas prone to zoonotic spillover, specific communities, or an even more targeted approach (e.g., focus on homes for the elderly). Zoonotic spillover deserves special attention, as most human infectious diseases (60 to 75%) are derived from pathogens that originally circulated in non-human animal species. In the U.S., the Oklahoma Pandemic Center for Innovation and Excellence (OPCIE) was organised to focus on the entire ecosystem (i.e., humans, animals, and the environment), to study the COVID-19 pandemic and prepare for emerging ones, using a multi-omics approach. The state’s public health lab within the OPCIE uses state-of-the-art automated technology to monitor, research, and address public health concerns before they arise.
Innovation in individual-level screening
The next generation of individual surveillance tools and technologies needs to be inexpensive, non-invasive and digitally reportable to increase the chances of a truly global adoption. Sonde Health, for example, offers a mobile app that analyses a user’s voice to detect subtle changes associated to a number of potential health concerns, ranging from respiratory infections to neurological disease. Wearable devices, such as smart watches with temperature sensors and blood pressure monitoring capabilities, could also become useful devices for simple daily screening.
Easy-to-access tools that monitor key biomarkers could be especially promising in the surveillance quest for pandemic preparedness – if they are deployed globally and there is a broad uptake. This becomes a challenge when considering rural and remote communities, particularly in low and middle-income countries.
Improving access to confirmatory testing
As with SARS-CoV-2 surveillance efforts, follow-up confirmatory testing should take place once a person or group are likely to have been infected. This would, of course, be applicable to potential cases detected via the screening methods mentioned previously.
Confirmatory testing must be accessible to all people, and neither cost nor availability should be limiting factors. To improve access and circumvent supply chain issues experienced with global distribution of COVID-19 tests, public and private sector groups could make contingencies to support local manufacturing and stockpiling of test materials. In a future pandemic scenario, once a virus is identified, resources would already be on-hand and more readily available to manufacture the tests needed to detect it.
Reporting and information sharing
Indisputably, data is an extremely important element of surveillance programmes. The fact remains that there is no clear knowledge about how well data is being reported. While wastewater analysis or innovative individual screening methods could become increasingly reliable and widespread surveillance methods in the future, a robust reporting system should also be deployed to achieve success.
IT solutions such as contact tracing apps rely on accurate data reporting to effectively monitor and control the spread of COVID-19 and will be a key element of future surveillance models. To be successful, these too require quality data. Another aspect worth highlighting in this context – in terms of data gathering, analysis and sharing – is the importance of having fully integrated, connected departments working towards the same goal. In this respect, having nationalised health systems, such as the NHS, could be advantageous.
While we may still have a long road ahead before we manage to put together all the elements needed for a global surveillance model, the efforts deployed across the world during the COVID-19 pandemic provide a strong foundation for it. Ensuring that every country in the world has access to population and individual-level screening tools like those described here will certainly be a challenge for international health and scientific communities to overcome.