It’s a difficult moment in the global pandemic. As many cases were diagnosed in the past two weeks as in the pandemic’s first six months—led by Brazil and India, where more than half of those cases occurred. India, in particular, is recording more than 400,000 cases per day, and officials fear that’s a vast undercount. Even in the United States, where cases are subsiding, vaccination has slowed down too, pushing any decisive end out of reach.
That the pandemic is escalating, 16 months after it started, lends urgency to a handful of efforts to extract the lessons of this crisis in time to prevent the next one. Some are political, pointing out ways countries and the World Health Organization could perform better. Others are commercial, posing opportunities for tech firms. And some are big-ticket foundation-sponsored efforts. All aim to make this a moment of long-term change by enumerating the vulnerabilities this pandemic exposed—and confirming that this kind of opportunity has been squandered before.
“These are the same conversations we heard after the 2003 SARS outbreak, after the 2009 flu pandemic, after the 2014 Ebola and 2016 MERS and 2018 Ebola outbreaks,” says Rick Bright, the former director of the US government’s Biomedical Advanced Research and Development Authority (BARDA), who resigned from the federal government to protest how the Trump administration was handling Covid. “We keep having the same conversations—What lessons do we learn? What do we do better next time?—and we still keep missing it.”
In March, Bright became senior vice president of pandemic prevention and response at the Rockefeller Foundation, where he is tasked with building a “pandemic prevention institute” as part of a $1 billion investment toward recovery from Covid. Bright’s institute is one of the first highly funded efforts to try to make something new out of the detritus of Covid: an analytics hub that will sift through national repositories of genomic and social data to find global patterns.
But a different big-ticket effort seems likely to be the first to write some checks. Next month the Trinity Challenge, a competition based at Cambridge University in the UK, will make its first awards for novel approaches to harnessing public and privately held data: a top prize of £2 million, with several runner-up prizes of £1 million each. (That’s about $2,777,000 and $1,398,000, respectively.) The teams have been asked to aim for one or several goals: identifying new epidemics as early as possible; developing affordable, equitable measures to reduce transmission and spread; or addressing how outbreaks hit poor nations and disadvantaged groups hardest, while making health care systems more resilient to those shocks.
The challenge is the creation of Sally Davies, a physician and the former chief medical officer of the United Kingdom, who became the master (or head) of Trinity College in late 2019. “What we have been missing is not just health data—numbers infected and in the hospital and getting better—but behavioral data, economic data, mobility data,” Davies says. “They will all impact how we should make policy, how we should interpret our response, and how we could recover. Yet that data is not accessible to governments and public health agencies. It’s the big tech companies who hold it. So how do we tap into that? I thought: a collaboration—bringing together academics, who can ask the questions with rigor, with the people who hold the data and have the great engineers—to sponsor a public challenge asking people to come in with their solutions.”
To do that, she recruited sponsorship and technical support from major tech companies including Facebook, Google and Tencent—along with media companies, drug firms, and research universities. The partners contribute to the total prize pool of £10 million and also make their staffs’ expertise available to the small teams who apply. It’s a fast-moving effort: The first round of submissions opened in February and closed in April. The entries, which are public, include networked rapid diagnostic devices, algorithms that monitor social media to parse the mood of the public, models that track the global supply chain of needles, and mapping of the distribution networks in rural areas of women who sell health products.
Throughout the pandemic, many conversations among public health experts have focused on building new surveillance networks—systems for identifying pathogens as they leap between animal species, and then monitoring them as they move around the globe and into humans. But Hala Audi, the Trinity Challenge’s CEO, says part of the goal is to find ways to leverage existing data. “It’s a waste having information that could be used that doesn't get used,” she says. Take, for example, the problems facing two very different supply chains: the distribution of drugs in the developing world before the pandemic, and of PPE products everywhere during it. Both choked on the same problem: Governments and would-be purchasers had no access to granular data showing what was being manufactured, where it was being transported, and where stocks were held. Accessing that data “should not be complicated,” Audi says. “But for a lack of focus, and the right leadership, it just doesn’t get done.”
The sense that there are things that can be built now, with knowledge that is already accessible, pervades this round of projects. The lessons of what to do next aren’t hard to find, says Thomas R. Frieden, a physician and the director of the Centers for Disease Control and Prevention during the Obama administration. Since then, he’s been the president and CEO of the nonprofit Resolve to Save Lives. One of the group’s projects, called Prevent Epidemics, is meant to provide Covid-19 technical assistance to health departments in the US and governments abroad. Last week, they released a study of eight prior disease emergencies that did not spin up into epidemics because key actions were taken at the right time. These ranged from the Brazilian government forestalling a yellow fever epidemic in 2017 because they had planned for the possibility of dramatically scaling up vaccine production capacity, to Uganda’s leadership preventing an Ebola outbreak in 2019 by using their emergency response and disease surveillance network to spot when a family harboring the infection crossed the border.
Those examples and six others—four of them occurring during the Covid pandemic in countries that controlled the disease successfully—show that we already know what to do, Frieden argues. “Success is possible if we get three things right: technical rigor, good operational management, and political savvy and commitment,” he says.
Those three requirements provide a menu for what needs to come next. Frieden recommends finding a way to give the WHO more power, so that its leaders can make swift decisions without being hampered by political pressure—from powerful member states like China, or from tiny nations whose votes have equal weight. But he also recommends that improvements—in organizational skills, field epidemiology knowledge, and funding—be created within individual nations, particularly in the global south. “The most important progress has to be at the country level,” he says.
Strengthening that ability to detect and respond is the specific focus of Ending Pandemics, a group spun off in 2018 from the Skoll Global Threats Fund, part of a portfolio of organizations created by Jeff Skoll, the first president of eBay. The nonprofit was named, before Covid arrived, for the possibility of future pandemics. But the arrival of this one reinforced its staff’s commitment to building technology that lets emerging diseases be reported at the most local level possible. That includes, for instance, a smartphone and web app in Thailand that allows volunteers to report unusual illnesses in either people or animals, and a free hotline in Cambodia that lets anyone report similar problems to a dashboard viewed by personnel in the animal and human health ministries. (It includes a voice transcription function if the person sending the report is illiterate.)
“We believe early detection is an achievable goal—and a cost-effective way—to prevent threats from becoming pandemics,” says Nomita Divi, the group’s director. “We apply direct community engagement to transforming disease surveillance.”
The organization’s projects, which were built with the intention of detecting the earliest cases of animal-only and animal-to-human diseases—think foot-and-mouth disease among cattle or H5N1 avian flu— got repurposed during the past year as reporting and information-seeking channels for Covid. According to Mark Smolinski, a physician and president of Ending Pandemics, the Cambodian hotline went from about 600 calls a day pre-Covid—about 30 of which required follow-up from a health professional—to 18,000 daily calls. “It became the primary source of information to the public,” he says. “And it also became the way Cambodia identified 90 percent of cases during its first wave of Covid.”
Part of the group’s work has been building regional consortiums, which serve as early warning systems and which let staff within health and agriculture ministries and research universities share information with neighboring countries in a non-politicized way. Cross-border cooperation that doesn’t disrupt a country’s sovereignty over its own data is one of Bright’s goals at the Rockefeller Foundation as well. He describes it as establishing connective tissue between national ministries, along with an alphabet soup of transnational efforts such as Gavi, the Vaccine Alliance; the Norway-based Coalition for Epidemic Preparedness Innovations (CEPI); and the Global Influenza Surveillance and Response System (GISRS), the World Health Organization–supported effort that links influenza detection labs around the world.
That detection and prediction effort will require dipping into many information streams, he says. It could include collating viral sequences and epidemiological reports, and catching disease signatures identified in air and wastewater sampling, as well as collecting statistics on people’s health care utilization, travel decisions, or consumer spending. It will also depend on that data not getting siloed between, or within, governments and industries—the kind of stumbling block Ending Pandemics avoided when it pulled personnel from both human and animal health agencies into their programs.
And it will demand a more equitable distribution of technology. The countries most at risk of emerging diseases are in the global south, but the tools to pinpoint any new pathogens that lie concealed in their data are mostly held in the rich nations of the north. If a novel infection arose, that would leave parts of the globe hostages to one another.
The answer, Bright thinks, is a global coordination center. He envisions it as being incubated at the Rockefeller Foundation, but then spun off as an independent nonpartisan entity that would leave the world better protected against the inevitable next time. “With the right data sets and the right partnerships, we believe an early warning signal can be received, we can trigger action, and we can halt a pandemic in the making within the first 100 days,” Bright says. “And that would be amazing.”