On January 1, 2020, U.S. public health officials woke up to the news that a strange new virus had emerged in China.
They didn't know what to make of it, but at Columbia University in Manhattan, Dr. Ian Lipkin was already nervous.
Lipkin, a virologist, spent his career studying pathogens, hoping to prevent the arrival of new pathogens.
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He has long pushed for the closure of live animal markets of the type that may have been the source of what is known as SARS-CoV-2. He later claimed that there was no need for Wuhan's insecure labs to study dangerous pathogens, and that “the story is over” whether it was the cause of the pandemic or not.
Now, four years after that fateful moment, Lipkin and his team at the Mailman School of Public Health are one of many groups working around the world to prevent the next global pandemic.
They have developed a system to rapidly analyze known and unknown viruses, bacteria, and fungi found within a patient's body.
If hospitals in Wuhan, China, had installed this system in late 2019, when the first patients started showing respiratory symptoms, they would have been able to analyze blood and find slimy patients coughing within hours. You may have realized that you are dealing with some new and dangerous disease.
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“This method, these assays, are so easy to use and so inexpensive that you can look at blood, sewage, respiratory disease in the clinic and do continuous monitoring, and you can pick it up and do something… You could tell right away that something new was going around,'” Lipkin said.
“It would actually give us what I like to describe as a holistic immune system.”
The eight countries that have adopted this surveillance system, called GAPP, are: Global Alliance to Prevent Pandemicsagreed to release information promptly.
Such early information and prompt publication should be able to stop new outbreaks before they spread around the world.
And there will be a next time.
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Nita Madhav, head of epidemiology and risk analysis at Concentric, the biosecurity arm of Ginko Bioworks, said: recently published an analysis The Center for World Development indicates that there is a 2% to 3% chance of a global pandemic occurring each year over the next quarter century. That means there's a 50-50 chance that Taylor Swift will have another album by the time she turns 60 in 2049.
“These events are going to happen,” she said. “It's not as rare as people think.”
the time in between
Ginko is trying to prevent such situations by remaining vigilant about the pathogens that travelers carry.
The company is currently under contract with the federal government to analyze airplane wastewater at seven international airports, including New York's JFK and San Francisco's SFO, to detect up to 30 pathogens that may have been left behind by air travelers. I'm investigating. They are also building biosecurity programs in Rwanda, Ukraine, Qatar, and Panama.
Like everyone else, Gingko wants to know what viruses are circulating during “normal times.”
“Part of the solution is to keep the system running and constantly monitoring it,” Madhav said. “It allows us to establish a baseline and better understand what is abnormal.”
Madhav, Lipkin and others said one of the keys to stopping the next pandemic is putting processes in place that work in non-crisis situations. Otherwise, it will be too easy for governments and others to cut funding when the outbreak is over.
Even with the devastating coronavirus pandemic, which is so recent and should be remembered, the world recently saw New Zealand public health official Sir Ashley Robin Bloomfield attend a gathering of public health officials. The world is suffering from what it describes as a “rapid-onset collective global amnesia”. . ”
Most of the funding for COVID-19 has ended. Officials moved on. The public doesn't want to hear any more about the pandemic.
Madhav said the U.S. government recently renewed its contract with Ginkgo, but there is a lack of sustainable funding for biosecurity infrastructure in general.
“Are we going to maintain the systems that were built and put in place during the coronavirus pandemic, or are we going to forget all the lessons and dismantle it all?” she said. “You'll know which side I'm on.”
work towards a solution
Lipkin's team provided three weeks of training to public health workers in Mexico, Liberia, Mali, Nigeria, Bangladesh, Zambia, Zimbabwe, and Germany, teaching them how to use tools to rapidly identify pathogens from genetic sequences.
The idea is to build expertise at home so that Americans don't have to parachute in when a problem is discovered. This takes too long and reeks of colonialism.
“This is really about Zambians helping Zambians in Zambia,” said Ken Wicker, a clinical biochemist and executive director of the GAPP program. “They can decide how they want to deploy and adopt this technology, and we become collaborators and cheerleaders.”
So far, the program has uncovered unexpected cases of measles and cases of polio in wastewater, allowing countries to respond more quickly and efficiently than they otherwise could, Wickiser said. Stated.
Currently, countries are joining the GAPP program for training, and the program is expanding to Africa, the Americas, Central Asia and the Pacific, he said.
“Every time someone new asks me for help or asks for training, I know we’re doing something right,” said Wicker, who was West Point’s associate dean for research when the pandemic began. Mr. Zar said.
His uncle died from the coronavirus in a hospital in 2020, which motivated Wicker to quit, saying, “It was a very comfortable and meaningful job. I wanted to be part of the solution.”
Building a holistic immune system
Al Ozonoff likes the metaphor of building a holistic immune system.
That includes the labs where he works at the Broad Institute at Harvard University and the Massachusetts Institute of Technology in Cambridge, Massachusetts.He is a US director sentinel programis working with collaborators in Nigeria to track hemorrhagic fevers like Ebola and Lassa fever.
In some ways, these viruses pose less of a global threat than respiratory viruses like SARS-CoV-2, which causes COVID-19.
of Largest Ebola outbreak More than 11,000 Africans were killed between 2014 and 2016, but only two people in the continental United States were infected, both of whom recovered. Unlike COVID-19, Ebola patients are not contagious until they show symptoms, so they can be isolated and treated with people wearing protective gear to avoid contracting the virus.
But nothing seems possible until it actually happens, he said, “and then you'll say you should have done more.”
Additionally, the risk from these viruses is likely increasing because climate change and other factors are increasing people's contact with animals that carry hemorrhagic fevers.
“We should have learned from past outbreaks, but we haven't put those learnings into practice,” said Ozonoff, who is also chief of staff in the Sabeti lab at Broad College and an associate professor of pediatrics and a scientist in the department at Harvard Medical School. says Mr. Department of Infectious Diseases, Boston Children's Hospital.
Mpox (formerly known as monkeypox) was also considered a low-probability global event before it spread from Africa a year and a half ago. More than 31,000 Americans infected, 55 deadhe pointed out. If more had been done to stop the virus, which has been circulating in countries like Nigeria for years, it would never have spread to the United States.
But mpox also showed that the overall immune system started working.
Thanks to a collaboration that began during COVID-19, more than a dozen African countries have come together to identify the genes of mpox that have spread across the continent during recent pandemics, Ozonoff said. They say they were able to analyze it.
Like the human immune system, the global immune system is not centralized. Our body's nervous system is controlled solely by the brain. The immune system involves the bone marrow, spleen, thymus, tonsils, mucous membranes, and skin.
Similarly, there is no single central authority governing all efforts to prevent the next pandemic. That's a good thing, Ozonoff says.
technical solution
Ozonoff and others said it's an exciting time to be in the surveillance business.
Technology has made it possible to track incredible amounts of data, and now, thanks to the falling cost of genetic sequencing, it is increasingly possible to track pathogens as they move through populations. It's getting more realistic.
This “will be the basis for infectious disease surveillance for the rest of this century,” Ozonoff said. “In general, the more sequence data we have, the more robust our response will be if needed.”
Advances like this could change the way we fight all diseases in the future.
“Humanity has decided that a certain level of disease is a cost of doing business, and we don't really question that,” said Gingko's Madhav. “We're at a point now where technology can really change that.”
Ozonoff likened it to a weather forecast.
It wasn't that long ago that forecasters could hardly predict the future. Now that people can see a hurricane coming days in advance, they can prepare, strengthen natural defenses, and evacuate ahead of the storm.
“That's really our goal,” Ozonoff said of pandemic preparedness. “The more we understand what happened and develop the ability to predict or predict what will happen, the better prepared we will be when something happens.”
Karen Weintraub can be reached at [email protected].
