In infectious disease research and surveillance, it is not a matter of “if” but “when” the next highly contagious pathogen like SARS-CoV-2 will emerge. The challenge is that to date, most viral surveillance efforts have been retroactive-monitoring for known pathogens and variants. Fortunately, recent innovations in pathogen detection technologies have shown promise for enabling proactive measures that can be incorporated into broader surveillance models used for pandemic preparedness and prevention.
Foundational elements for effective surveillance models
There are at least three elements necessary for an effective global surveillance model: reporting infrastructure, population-level screening, and individual-level testing.
We know from experience an effective reporting strategy is difficult to execute. Asymptomatic infections and continuous viral evolution only make matters worse. But what if diagnostics developers could harness data to predict variant strains of known viruses? This would be a significant step toward creating pandemic prevention systems that could then adapt accordingly. Current technology platforms that integrate research insights and artificial intelligence are at the cusp of realizing this approach.
Promising developments in population-level screening of pathogens include the use of CRISPR-Cas systems to improve the effectiveness of existing next-generation sequencing (NGS) technologies for viral analysis. Like a pair of “molecular scissors,” CRISPR-Cas powered technology removes uninformative molecules before sequencing, paving the way for an infectious disease testing strategy starting on day zero. The Biomedical Advanced Research and Development Authority (BARDA) in the US has welcomed such technology in their pathogen detection program to strengthen biosurveillance efforts.
Finally, clinical laboratorians should watch for increased interest, use, and innovation in the areas of point-of-care and direct-to-consumer testing. The COVID-19 pandemic has popularized direct-to-consumer testing due to the emergence of home-collection devices. This trend in diagnostic testing could be especially helpful in combating rising rates of sexually transmitted infections (STIs), democratizing testing among a larger population and accurately mapping and controlling infection. Testing must be accurate, cost-effective, and convenient, as well as protect a patient's privacy from specimen submission to result reporting. Clinical labs should anticipate rapid evolution of home-collection techniques, higher consumer engagement in the interpretation of laboratory testing results, and the importance of clinical diagnostics.
Proactive global surveillance combined with the use of innovative tools will better position us to tackle future threats to public health.