Helping Detect and Prevent the Next Global Health Threat

The Opportunity

For some, the COVID-19 pandemic seems far in the rearview, but the reality is that we are not in a post-health emergency era. COVID-19 reminds us that infectious disease threats do not simply disappear; they continue to persist, evolve and place pressure on public health systems.  Beyond that, there are continuing and ongoing public health threats that we see around the world every day— measles, anti-microbial resistance, and the impacts of climate change, to name a few — that make the next global health emergency only a matter of time. The inter-connectedness of humans, animals, and the environment — the One Health approach — further highlights the need to be able to detect new and emerging pathogens that are moving from animals to humans (like the avian flu) more frequently. The next pandemic is not a question of if, but when. Traditional surveillance systems often detect outbreaks only after people become seriously ill and the healthcare systems begin to feel the strain. To better protect Canadian communities, we need a proactive approach that can identify emerging health threats and the risks they pose earlier, monitor how diseases spread, and provide public health leaders with the information they need to act before outbreaks become crises. We currently have different ways to test for pathogens that accomplish different tasks, but what if we could combine them to harness the very best technology, allowing us to stay one step ahead of new health threats? That is what the PAN-ONE (Pathogen-Agnostic Network for One Health Early Detection) project from our partners at the BCCDC hopes to achieve.

The Solution

The BCCDC Public Health Laboratory is the primary public health and reference diagnostic testing facility for British Columbia. The current conventional laboratory methods used are designed to detect specific pathogens, meaning, the lab needs to know what they are looking for, to test for it. For example, if a child presents with measles-like symptoms, the lab will test if the sample taken from the child is positive or negative for measles. The PAN-ONE system combines three testing methods — wastewater surveillance, metagenomic sequencing, and seroepidemiology. By combining these methods, they will be able to test for novel or unexpected threats, meaning, the suspected cause of the illness does not need to be known in order to run the lab test. In fact, PAN-ONE will even be able to detect if a pathogen identified through testing has ever been detected in the population, or if it is something new that needs to be more closely monitored. PAN-ONE will also provide information on how protected the population is against infection and how much spread there is within a population. This tool has the power to allow for earlier detection and accurate assessment of population-level risk of the next viral health threat, allowing for better preparation, control methods, and ultimately, helping to stop a new pathogen from spreading rapidly, which can help save lives here and around the world. The BCCDC’s own Dr Natalie Prystajecky is a leader in wastewater surveillance in Canada, with knowledge and expertise far surpassing other provinces. Moreover, Dr Agatha Jassem, who trained at the National Institutes of Health, has taken the study of seroepidemiology to a new level in Canada, even collaborating with Harvard University to adapt their methods for use here in BC. Dr. Catherine Hogan completed a fellowship at Stanford and brings deep expertise in metagenomic sequencing and pathogen detection, strengthening the team’s ability to identify novel and unexpected threats across human, animal, and environmental samples. These groundbreaking scientists are collaborating on this project to create a better system of global threat protection in the future.

Wastewater surveillance allows for surveillance of pathogens shed in our waste in entire populations of people. It also allows for agnostic surveillance, meaning the pathogen does not need to be identified through clinical testing, making it able to detect emerging threats at the population level.

Metagenomic sequencing is the sequencing of all genetic material in a sample. It can allow the detection of a novel (new, never-before discovered) pathogen in a human or animal sample.

Seroepidemiology tests the level of antibodies against a pathogen in the population; it determines if the population has been exposed to a novel pathogen without relying on testing only at acute stage of disease when symptoms are present, and helps to determine the risk of infection to a population from previous immunity with related infections or vaccinations.

All of these methods can be used to test for novel or unexpected threats, meaning, the suspected cause of the illness does not need to be known in order to run the lab test. This allows for patients with rare symptoms to be diagnosed quicker, and for new and emerging illnesses or diseases to be identified sooner.

The Impact

PAN-ONE takes an upstream approach to infectious disease management — strengthening our ability to prevent local outbreaks from becoming future pandemics. This combined technology allows the lab team to identify and address emerging infectious disease threats earlier, before they result in widespread transmission, severe illness, and burden healthcare services. This tool will continuously monitor population level signals, allowing public health experts to investigate unusual signs when they are first detected, identify the affected population, and guide response measures to reduce more serious and widespread health and social outcomes. Everyone, all over the world, was impacted by the COVID-19 pandemic, and the mitigation factors that were put in place to help stop the spread of the virus. By moving from a reactive model to a proactive one, we can help protect families, healthcare systems, and economies from the devastating consequences of emerging infection diseases. We hope that supporting this work, and sharing the expertise of the researchers and their methods, will help us be better prepared to respond when, not if, we face another global health threat.