Outbreaks of life-threatening infectious diseases such as Ebola in West
Africa, Zika in South America, Avian influenza in China, and Nipah in
India are occurring with increasing frequency. These emerging and
re-emerging infections and their potential to spread across borders pose
serious threats to public health and development. Responding to such
threats necessitates identifying emerging health trends, conducting
surveillance, diagnosing infections, and providing treatment for
patients.
This roundtable convened scientists and industry experts to identify how
preparedness and response to pandemics can be improved, including the
capabilities that industry and the research community can offer to help
governments tackle adverse biological events. The discussion was
moderated by Gagandeep Kang, executive director of the Translational
Health Science and Technology Institute.
- Disease Reporting in India: Participants
highlighted that the ability to sequence pathogens has transformed the
ability to detect infections. High-throughput sequencing data can be
used to understand preparedness and predict disease outbreaks, they
explained. Participants added that this data can also be used to develop
medical countermeasures—vaccines, diagnostic kits, and other treatment
options. However, they emphasized, the development of preventive and
treatment measures depends on effective and accurate disease reporting.
Some participants raised serious concerns about infrastructure and human
resource capabilities needed to accurately detect and report an
outbreak. Noting that India only mandates a few institutions to report
disease outbreaks, participants explained that reporting a higher number
of infected cases is not a bad thing. Adequate information regarding
the number and kinds of disease incidences in the country can be used to
develop a comprehensive disease surveillance model. Therefore, more
actors—both from the public and private sector—should be brought into
this network, they underlined.
- Disease Surveillance in India: Participants pointed
out that India has a skewed data collection model where multiple
organizations across the local, state, and national levels collect data
for the same disease. Since these organizations use differing case
definitions, standards, and practices, and have little or no
coordination (and often turf battles), this leads to different disease
numbers being reported under different programs, participants explained.
They highlighted that this results in the creation of a weak
surveillance infrastructure, poor detection of outbreaks, an
overburdened healthcare force as diagnostics is impaired, along with a
convoluted, uncoordinated, and ineffective disease mapping mechanism. To
overcome this, participants drew attention to the need to harmonize
data collection tools and develop common reporting standards for all
primary healthcare centers in India. In addition to developing domestic
standards, participants also emphasized the importance of optimizing and
working with international organizations to have common methods and
protocols to facilitate cross-border data sharing. They added that to
the extent that nations develop common data standardization, each would
benefit from the resultant possibility of improving international
cooperation in diagnostics and development of vaccines and/or
treatments.
- Epidemiological Model of Diseases: Participants
suggested engendering greater collaboration among scientists,
academicians, industry, and data scientists to develop epidemiological
models for diseases, which could help predict the location and timing of
outbreaks. They argued that this model should also consider
socio-economic circumstances, environmental conditions, and geographical
terrains that are associated with disease occurrence. They highlighted
that since this model can provide adequate background information on
naturally occurring diseases, it will facilitate the recognition and
prediction of unusual outbreaks. For diseases that manifest unusual
symptoms, participants proposed that a horizontal network of primary
healthcare should be created to detect and respond to such infections
quickly. While participants recognized that training people to diagnose
an infection and sequence the pathogen has proven quite feasible in
India, they noted that retaining trained personnel in the absence of an
outbreak is challenging. Therefore, they emphasized that the development
of an epidemiological model of diseases can create career opportunities
that might help retain talent.
- Centralized Repository for Diagnostics: Participants
determined that diagnoses are impeded by the lack of data
standardization and centralized collection. Therefore, they proposed
that a centralized repository of standardized data to which all
actors—including those in the nongovernmental sector—have incentives to
provide data would significantly strengthen diagnostics. They
underscored that this repository should contain genome sequences of
pathogens and samples linked with the clinical histories of
patients—without any personal identifiers—to identify, diagnose, and
respond to diseases. As a result, they maintained that this repository
can lend insight to disease epidemiology, pathogen evolution, infection
trajectory, and help qualified laboratories perform and validate
diagnoses. Participants added that this information should be available
upon request for interested organizations, with some charges/fees, if
necessary.
- Role of Scientists and Industry Experts:
Participants underscored that a robust and effective technology
ecosystem—from scientific innovation to commercialization—is needed to
detect, understand, and respond to pandemics. They stated that while
researchers can develop medical countermeasures for known pathogens,
this can be scaled-up by industry experts to develop on-site diagnostic
kits, vaccines, drugs, and other therapeutic options. India should also
set aside funds to stockpile vaccines for rapid response to emergency
outbreaks, participants added. However, some participants emphasized the
need to focus on passive immunization—where antibodies are artificially
introduced to a nonimmune individual—to protect against outbreaks as
vaccination may take longer. Given the high mutation rates of viral
pathogens, some participants also suggested developing broad spectrum
antiviral drugs. Participants recognized that it is difficult to develop
vaccines for flu prospectively. However, they emphasized the importance
of creating a pipeline for vaccine development so that it can be
generated rapidly in case there is an outbreak. Further, participants
highlighted, for new epidemics by known or unknown pathogens, it is
important to fast-track validation and accreditation mechanisms for
point-of-care rapid diagnostic kits without compromising its safety.