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Better than Nothing isn’t Good Enough: Integrating Improved Biosurveillance Technology with Scenario-Based Planning for Public Health Emergencies

The views expressed are those of the author and do not necessarily reflect the views of ASPA as an organization.

By Nathan Myers
November 17, 2021

During the COVID-19 pandemic, many have speculated about when the United States and the rest of the world can return to normal. The different waves and permutations of the pandemic suggests emergency situations and normal situations are not a simple dichotomy. Rather, we need to think of circumstances as a continuum and plan for what personnel, resources and measures will be needed for each scenario along that continuum. For this to be effective, we must have ways of monitoring for biological threats that will quickly alert us to a change in status. A strong biodetection capability is essential.

While federal failures during the COVID-19 response are well-documented, the system had serious vulnerabilities prior to the emergence of the latest coronavirus. One issue, as highlighted in a recent report of the Bipartisan Commission on Biodefense, is Biowatch. This biotection system is expensive while operating with limited accuracy and speed. Nevertheless, the Biowatch system has persisted over the last two decades. According to the report, the program continues because a suitable replacement has yet to be identified. The United States must make improving our capacity to detect and identify a biological threat a major national priority.

The Bipartisan Commission’s recommendations include taking advantage of the improvements made in PCR technology over the last 20 years to create more effective mechanisms for open air genomic sequencing as well as portable, real-time sequencing. Such technology could be especially valuable for detecting threats not previously encountered. DARPA tested such a system at the Indianapolis 500 in 2019. Another benefit of utilizing sequencing technology is that, in conjunction with machine learning, it can help determine whether a biological threat was manufactured in a lab or evolved in nature.

In a separate report focused on protecting critical infrastructure, the commission also addressed the need for improved biodetection around areas of critical infrastructure and national events. Current inadequacies have spurred larger cities like New York to move forward with developing their own systems. In this same report, the Bipartisan Commission also calls for scenario-based planning to develop strategies for different biological threats including COVID-19, the 2009-2010 H1N1 influenza and the 2001 anthrax events. Such planning would involve estimating the need for essential medical equipment, including personal protective equipment (PPE).  

The concept of scenario-based planning has been advanced by other groups seeking to bolster pandemic preparedness as well. A key aspect of the framework for resilient cooperative procurement as advocated by the Continuity of Supply Initiative is for purchasers and suppliers of PPE to use four scenarios based on different levels of demand for and availability of goods to establish pricing for each of those scenarios. Recognizing the likelihood of such scenarios and planning accordingly in the procurement process should help to avoid future situations of contracts being broken or prices significantly increased during an emergency. As we review both our emergency and non-emergency systems after COVID-19, we must reckon with the fact that low-probability, high-consequence events are no longer low probability and that regular disruption must be accounted for.

However, scenario-based systems are not valuable if we don’t learn we are in a particular scenario until it is too late. This makes fast and accurate biodetection more important than ever. Genomic sequencing can be a potent tool in acquiring this capability, but the United States is surprisingly lacking when it comes to its deployment. In an article published in The Conversation on March 31, 2021, Alexander Sundermann, Lee Harrison and Vaugh Cooper note that the United States ranked 34th among developed countries in regard to genomes sequenced per number of cases. They further noted the wide variation in sequencing among states, ranging from Tennessee (0.09%) to Wyoming (5.82%).

The fact that the variation is significant between two states considered to be more politically conservative is indicative of the fact that the issue of genomic sequencing is one of the few that remains relatively bipartisan. Also in March 2021, Senator Angus King (I-ME) and Senator Bill Cassidy (R-LA) sent a letter to CDC Director Rochelle Walensky with a number of queries regarding steps the CDC is taking to improve its capacity for genomic sequencing. The two senators note current policy gaps, such as lack of federal law mandating the sharing and privacy of sequencing data, as well as challenges involved in coordinating all of the actors required for biosurveillance. While I did not find a direct response from CDC to that letter, the agency does have a page devoted to their efforts regarding genomic surveillance, including leading the National SARS-COV-2 Strain Surveillance System and establishing the SPHERES consortium.

The United States has been and should continue to be a leader in regard to biotechnology. This expertise must be better utilized for the purposes of biodetection in order to avoid unnecessary loss of life. This technology can also help to change the mindset of preparedness from an emergency/normal operations dichotomy to a more scenario-based approach. However, to realize the true benefits of this approach, we must be able to maintain a realistic picture of where we are along the spectrum at all times. Improving our genomic sequencing capability will be key to this situational awareness.

Author: Nathan Myers, Ph.D. is a Professor in the Department of Political Science and Director of the Master of Public Administration at Indiana State University. His areas of research include public policy, public health emergency preparedness, and the governance of biotechnology. He is the author of “Pandemics and Polarization: Implications of Partisan Budgeting for Responding to Public Health Emergencies.” Myers serves as an academic advisor to the Continuity of Supply Initiative and assistant director of Indiana State’s Center for Genomic Advocacy.

[email protected]; Twitter: nagremye1980

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