When my Johns Hopkins Center for Health Security colleagues and I were working on our pandemic pathogens project, the report of which has been released, one of the more contentious issues we had to face was separating the task of pandemic preparedness from viral discovery and cataloging. One of the participants in our round table meeting on the topic colorfully referred to viral cataloging as "stamp collecting"!
On its face, it might seem very reasonable to believe that knowing all the viruses "out there" will by design lead us to new pathogens that have the capacity to cause pandemics, but that is not a foregone conclusion for two main reasons:
- Most viruses on the planet are innocuous to humans and do not have the capacity to cause damage
- While it is most likely that pandemics in the modern age are exclusively the province of viruses, it is possible a non-viral agent could, under certain circumstances and in certain contexts, be the cause of a pandemic
For pandemic preparedness purposes, we proposed focusing on ensuring specific diagnosis and enhanced surveillance of infectious syndromes such as respiratory infections, sepsis, and central nervous system infections in all parts of the world. By focusing on what has unequivocally demonstrated the ability to infect humans -- what would be level 2 and 3 pathogens according to an insightful paper by Woolhouse, the yield of uncovering a potential pandemic pathogen will be much higher. Such activities will have salutary effects on other activities such as antibiotic and antiviral stewardship as well as improving the epidemiology around well-characterized pathogens.
It is undeniable that viral discovery will enormously advance our understanding of virology and is very valuable but it is not synonymous with pandemic preparedness -- it is distinct.
A new commentary published in Nature by three eminent researchers in the field, Eddie Holmes, Andrew Rambaut, and Kristian Anderson, provides some additional validation for the above conclusion we drew. The piece, entitled "Pandemics: spend on surveillance, not prediction," makes the point that:
“Broad genomic surveys of animal viruses will almost certainly advance our understanding of virus diversity and evolution. In our view, they will be of little practical value when it comes to understanding and mitigating the emergence of disease.”
Pandemic preparedness is a daunting task with many facets and varied approaches. It is only in the modern era with the sharp tools of biology coupled to advances in information and communication technology that we are even able to truly prepare for pandemics. It is essential that these powerful tools be directed at the right task.