Already now during the current COVID-19 pandemic, we should consider how we might use current experiences for the many new pandemics we will certainly experience in the years to come.
It might be provocative to write, but I have been struck with the fact that, even for a pathogen with very simple epidemiology, basically just human-to-human transmission, we have still struggled to get a global overview of the COVID-19 pandemic and to implement targeted control measures. Classical control measures such as good hygiene and physical and social distancing have been the key measures implemented.
I am also struck how we, while focusing on a single pathogen, have basically ignored that many other infectious diseases are also (if not more) important.
However, while many things certainly will become clearer in the coming years, I think several points we hopefully have learned from this wake-up call should be taken forward in preparing for the next pandemics as well as the continual control of endemic and epidemic diseases.
Utilizing the full potential of open data sharing and sequencing
During the current pandemic, we have seen an unprecedented rapid sharing of information. However, it has also become increasingly clear that we lack a common format for identifying cases and especially sharing sequencing information. Most sequencing information is not shared, and it is mainly assembled sequences and not raw data. Further, data have been shared on platforms that are not created to cover all infectious diseases and are mainly accessible to the somewhat closed virus expert communities.
We still do not have an unbiased surveillance system in place
Tremendous resources have been devoted to COVID-19 surveillance. However, I also think most observers see that the criteria for data collection over time have changed and are not really comparable between countries, and good or even relevant data are lacking from many countries. Further, while focusing on a single pathogen, we have almost completely ignored all the other circulating pathogens, several of which kill many more people than COVID-19.
Everybody wanted a piece of the pie – public health systems wanted control
When disruptive events happen, people with great ideas quite logically come forward and provide novel solutions. These innovative people need funding and, of course, access to data to develop their solutions. There have, however, been examples in which public health institutions and governments have seemed to give priority to keeping the data under control rather than enabling other scientists to scrutinize and explore the data. This, of course, allows people to keep control, but as a society we are also missing the opportunity for novel input.
There can also be problems with giving everybody access to data. Suddenly everybody is an expert, and distinguishing between those who just want money and those who actually provide novel insight can be difficult.
More and more open sharing will still be beneficial, and if we want to prepare for the next time, we do need to explore the potential to improve more rapid and open data sharing, improve the global overview of all infectious diseases and their drivers and explore possibilities to set priorities for the limited public resources being made available.
A nonexhaustive list of potential remedies for improvement
There is and should be a multitude of solutions for controlling infectious diseases and improving global public health. I do not have all the answers, but I do believe it is paramount to allow global creativity and thus provide systems that are, as much as possible, precompetitive and enable the involvement of as many people as possible and as many ideas as possible.
We need improved global capacity and possibilities for identifying infectious diseases
It is vital that if we want global data in the future, including those from low- and middle-income countries, then we also need to ensure that scientists in these countries have the capacity to analyse their own data and access to publish them before sharing them publicly.
Ensuring continuous education and capacity-building for all potential novel disease events will not be feasible, but what we might do is to focus resources on open science, noncommercial web-based solutions that will allow relatively inexperienced scientists to complete simple analyses of their data and thereby take part in the research on global issues and not simply see their data being exploited by others.
Through my own research group, we have participated in such initiatives and currently provide web-based analytical tools for next-generation sequencing data for bacterial species free of charge, including identification of species, subtypes, clonality and antimicrobial resistance (https://cge.cbs.dtu.dk/services). Further expanding something like this, including being easily able to share data and including all pathogens (viruses and parasites), would in my opinion have the potential to drastically improve the availability of data, especially from low- and middle-income countries.
We need a continuous agnostic global surveillance system that includes endemic diseases
Basing continuous surveillance on human clinical cases can be very biased over time. This is evident for COVID-19 but, perhaps more important, during the past year, many countries have given lower priority to clinical surveillance for many or all other pathogens. Further, most clinical surveillance focuses on already known pathogens, and we miss out on all novel events.
In my opinion, some type of sampling that represents the human microbiome (bacteriome and virome) needs to be collected in a comparable way over time and between countries. This material should be analysed in a way that would enable immediate reanalysis if new diseases emerge.
For me, human sewage or waste from long-distance airplanes and metagenomic analyses using next-generation sequencing seem to be the obvious choices. We are already exploring this (www.globalsurveillance.eu) and would very much like to see this continued in a long-term sustainable way. Sampling sewage relieves scientists of ethical and General Data Protection Regulation concerns because the sample is already anonymized.
We need to support neutral data-sharing platforms
Currently, most COVID-19 data, whether sequencing data or other types of data, are kept locally at individual computer servers, and I am unfortunately convinced that we will see major issues regarding patchy individual analysis and problems with comparing studies and data between countries.
The world does in fact already have an established, global, neutral data-sharing platform in place: www.insdc.org. This resource is unfortunately not fully utilized. As also seen during COVID-19, many of the sequencing data, especially the early data, were shared in an assembled format through GISAID, which might be good for a closed viral community but is not a platform supporting other infectious disease agents.
Rather than (re-)inventing different local or pathogen-specific and temporal solutions, I think we should focus on improving the existing platforms.
We need to focus public resources where there is a limited private business plan
Public funding cannot pay for everything. Private industry also has a tremendous amount to offer. I find it optimal if public money and initiatives based at public research institutions and universities are those in which commercial potential is limited, and then the activities in which a profit can be made are left to private industry. Natural basic research should still take place in academia, but during a pandemic, it would perhaps have been wise to leave the development of diagnostic tests, vaccines and treatments to the primary experts: the pharmaceutical industry, which naturally also needs open access to all the data.
I personally hope that researchers, public health workers, industry, politicians, funders and all others globally will take the best lessons forward and become much better at understanding and controlling infectious diseases, both those we face every day and novel ones that will emerge.
Since we cannot predict what the next threat is going to be and we need to ensure that as many researchers as possible can rapidly come forward with novel ideas and solutions globally, I think we need to focus on some precompetitive open science solutions, such as those mentioned above, including much easier access for inexperienced scientists to perform easy analysis, especially if we want to engage with low- and middle-income countries. Doing so will save lives, time and money.