We Must Seize the Moment for a Global Pandemic Surveillance and Response Scheme

No more pandemics — this is the ambitious goal set by the Independent Panel for Pandemic Preparedness and Response, whose report reviews the international community’s response to COVID-19 and identifies lessons learned. COVID-19 has shown that our lack of globally accurate, real-time data on outbreaks is a matter of life and death. A leading group of scientists and experts, from every part of the world, must come together urgently to create a new, neutral, and trusted digital system that can revolutionise how data is gathered and used globally.

We have done this before with weather, and more recently with predicting tsunamis through a global system of sensors. The resulting information rich environment enables all of us to adapt to the forecast. To prevent the next disease outbreak becoming a global crisis, we need similarly routinised data flows to generate epidemic intelligence and alerts.

Digital technologies, particularly artificial intelligence (AI), are now mature enough to sift the signal from the noise in the mass of mobility data, social media posts, and clinical reports. AI can weigh data across human, animal, and plant health and spot patterns. It can help derive intelligence from unusual data sources such as sewage samples or empower citizen scientists to report unusual events using mobile phones. Democratisation of molecular biology, such as serology or next-generation sequencing of the genomes of pathogens, has opened up new avenues for monitoring risks.

But bringing this together globally won’t be easy for three reasons.

First, our existing health data systems are fragmented and plagued with gaps. Their architectures are based on a narrow foundation of a few disciplines. You cannot simply wire them together.

Frameworks to pool information across international organisations dealing with One Health — animals, humans, plants, and their shared environment — have been created, but lie dormant without adequate workflows. Despite laudable initiatives such as the World Health Organization’s Global Outbreak Alert and Response Network, the Global Health Security Agenda, or the Coalition for Epidemic Preparedness Innovations, a winning coalition has never come together to support a truly global and coordinated response.

Mistrust in global institutions is rife. Nations do not share information in a timely and complete manner despite legally binding obligations under WHO’s International Health Regulations. Current reporting obligations require an outbreak to be reported through a labyrinthine bureaucratic chain before it reaches a global agency, days or even weeks after it was reported by a local clinician.

The second challenge is privacy and digital trust. Many countries lack data protection laws or fail to enforce them. Few people have basic data literacy and struggle with partial information or misinformation about what happens with their data. Technological solutions could help, including new techniques for protecting data and preserving privacy such as distributed learning, but it is equally important to engage the community in the development of these solutions in order to gain acceptance. The infrastructure for hosting outbreak data, should also be neutral and not beholden to any government or corporate interest. As far as possible, raw data should stay local and contribute to the global picture, without having to leave national jurisdictions. Winning the trust of the public will take time and concerted effort.

A third challenge is politics. An agenda set up by a narrow group of countries or disciplines will not result in a critical mass of international support or win the trust of the general public. A global, science-based, digitally enabled, and end-to-end pandemic surveillance and response scheme needs to be built out collaboratively. Its data architecture and information sources need to be examined from a multi-disciplinary perspective across epidemiology and public health, molecular biology, social and behavioural sciences, complex systems, networks and computer sciences, environmental sciences, gender, ethics and governance as well as health economics and policy. The new generation of researchers from the Global South now emerging should play a role in their design so that its deployment is feasible in all income settings.

Mutual suspicions and reluctance to collaborate, need to be overcome among government, academia, the private sector and civil society. An innovative governance structure tiered to accommodate contextual specificity for data access and data use in different countries would be essential. It should rest on principles such as trustworthiness, transparency, fairness, equity, independence, and neutrality. Investments in data infrastructure, and capacity development of the health workforce, will be needed.

We should begin by convening a globally representative group of scientists to examine how this could work in practice and to suggest a research and development agenda, ensuring that, as the Independent Panel warned, their report does not gather dust on a shelf, but sparks immediate and transformative global action. We have the tools to prevent the next pandemic before it starts, and cannot afford delay in putting them to work.

Acknowledgements

The principal author acknowledges the contribution of the following members of the International Digital Health and Artificial Intelligence Research Collaborative (I-DAIR) Pandemic Scientific Group:

Anurag Agrawal (Council of Scientific and Industrial Research, India); Gershim Asiki (African Population and Health Research Center (APHRC), Kenya); Hala Audi (Trinity Challenge, UK); Marc Choisy (University of Oxford, UK, and Oxford University Clinical Research Unit (OUCRU), Vietnam); Sara (Meg) Davis (Graduate Institute of International and Development Studies, Switzerland); Ayman El-Mohandes (City University of New York (CUNY), United States of America); Antoine Flahault (University of Geneva, Switzerland); Emma B Hodcroft (NextStrain, United States of America, and University of Bern, Switzerland); Ashish Joshi (CUNY, United States of America); Olivia Keiser (University of Geneva, Switzerland); Sylvia Kiwuwa-Muyingo (APHRC, Kenya), Jeffrey V Lazarus (University of Barcelona, Spain); Sam Makau (WACI Health, Kenya); Malebona Precious Matsoso (University of the Witwatersrand, South Africa); Rosemary Mburu (WACI Health, Kenya); Bruce Mellado (University of the Witwatersrand, South Africa); Vinh-Kim Nguyen (Graduate Institute of International and Development Studies, Switzerland); Patrick Okwen (eBASE Africa, Cameroon); James Orbinski (York University, Canada); Tavpritesh Sethi (Indraprastha Institute of Information Technology-Delhi, India); Serge Stinckwich (United Nations University, Macau SAR); Le Van Tan (OUCRU, Vietnam); Yik Ying Teo (National University of Singapore, Singapore); Guy Thwaites (University of Oxford, UK, and OUCRU, Vietnam); Andrea Sylvia Winkler (University of Oslo, Norway, and Technical University of Munich, Germany); and Peiling Yap (I-DAIR, Switzerland)

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This article was first published by The BMJ Opinion. Read the original article.