Boosting India's surveillance potential for pandemic preparedness
The piece has been authored by Dr Bruce Gellin, chief of Global Public Health Strategy, Health Initiative, The Rockefeller Foundation and Dr Rakesh Mishra, director, Centre for Cellular and Molecular Biology
As the Covid-19 pandemic continues and more variants of Sars-CoV-2 emerge like the Omicron one, each may have the potential to further disrupt public health systems and slow progress to end the pandemic. There is an emerging global consensus that continuous pathogen surveillance and robust genomic sequencing is vital to our understanding of the trajectory of this pandemic and will also lay the groundwork for preventing future ones.
India recognised the critical need for enhanced surveillance early in the pandemic but like most nations, took time in substantially scaling up of these efforts across the health system. The nation has augmented its pandemic response on multiple fronts, with the recent launch of the Prime Minister Atmanirbhar Swasth Bharat Yojana (PMASBY) -- an investment to upgrade the country’s public health infrastructure to rapidly detect, investigate, prevent, and combat public health emergencies and disease outbreaks. This complements the launch of the Indian Sars-CoV-2 Genomics Consortium (INSACOG) earlier this year -- the country's only public multi-agency consortium tasked to undertake genome sequencing of the Sars-CoV-2 virus and sharing of the data for public health benefit. With efforts underway to strengthen and update capacity and infrastructure for public heath for disease surveillance, there is a tremendous opportunity to leverage new technologies and scientific approaches to leapfrog to a data-driven outbreak prediction and prevention system of the future.
While the current momentum is promising, it is just the first step toward ensuring that this ambitious vision is realised in time to prevent the next pandemic. A consultation report, Strengthening the genomic surveillance ecosystem for India, supported by The Rockefeller Foundation, summarises recommendations from leading Indian scientists and public health thought leaders, and identified four guiding principles that are the foundation of that future system: integrating and scaling sequencing as a component of disease surveillance, integrated genomic analysis into broader bioinformatics, building a data system that fosters innovations in data science for forecasting or predicting disease outbreaks, and facilitating responsible data sharing to democratise scientific inquiry while building trust.
The country’s leadership and scientific community is already making efforts to systematically bolster bioinformatics capabilities to analyse the wealth of data and rapidly find signals of disease threats and react accordingly. Recently, India has detected sub lineage of the Delta variant (referred to as AY.4.2 or Delta Plus), which is responsible for recent surges in the United Kingdom and the United States. While it has been detected in a very small portion of the population so far, this has enabled authorities to enhance testing and tracing in these geographies to quickly assess its impact and target containment strategies. This is exactly the value and impact of data-driven surveillance; and it is this aspect of an early warning system of the future that will guide timely and informed public health response as well as timely and effective countermeasure development.
As indicated in the report, the sustainability of surveillance systems now being enhanced requires key action. It is critical to secure the development of a core scientific infrastructure, a skilled workforce, and decentralised technologies essential to serving the broader population health needs of India.
Going forward, States need to complement current efforts and strengthen key processes and policies to enable timely and targeted response against any surge of this current pandemic as well as future outbreaks. The reduction of turnaround time between clinical specimen collection and pathogen sequencing as well as linking pathogen genomic data to epidemiological and clinical data is essential. Given rapidly emerging applications of genome sequencing in mainstream diagnostic and primary health at population scale, ensuring consistency and national self-sufficiency of critical supply chains will address concerns around availability, affordability, and equity of access.
Building a national health data ecosystem that is interoperable and strategically integrates with existing systems is foundational to not only address immediate challenges of Covid-19 but also to enhance public health management and pandemic preparedness globally and locally. However, these efforts need to be built on principles of transparency, collaboration, and responsible data sharing.
The Rockefeller Foundation’s Pandemic Prevention Institute (PPI) was recently initiated to establish a global, federated ecosystem to detect, prevent, and mitigate pandemic threats to achieve containment as quickly as possible. With a growing global network, the PPI is building collaborations to harness data to drive decision-making that prevents pandemics, following its guiding principles: See the signal. Speed the response. Stop the outbreak.
In India, the PPI has partnered with a coalition, led by the CSIR-Centre for Cellular and Molecular Biology, of leading INSACOG member institutes to accelerate and institutionalise pathogen genomics capabilities as part of a robust public health outbreak surveillance. This effort has been designed to work closely with local governments, hospitals, clinics, and ministry of health’s National Centre for Disease Control (NCDC) to expand sampling strategies and harness genomic data for actionable insights against pathogen outbreaks in India.
As India moves forward from the deadly surge of infections from the summer of 2021, it is imperative that the lessons learned, innovations fostered, and capabilities built are leveraged for a sustainable, resilient, and responsive early warning system. To achieve this, many sources of data will be the basis of such a system of the future that includes partnerships across government, industry, scientific community, and public health -- essential to sustaining current developments and proactively equipping the country to fight future outbreaks.
( The piece has been authored by Dr Bruce Gellin, chief of Global Public Health Strategy, Health Initiative, The Rockefeller Foundation and Dr Rakesh Mishra, director, Centre for Cellular and Molecular Biology)