The Sunday Telegraph
We can choose to shoot for the Moon again and protect the world from all future pandemics
We have right technology to extinguish threat within a decade, say experts, but politicians have to unite
It is almost six decades since President John F Kennedy delivered his “Moon speech” in Houston, a rousing attempt to build popular support for America’s fledgling space programme.
“We choose to go to the Moon in this decade and do the other things, not because they are easy, but because they are hard,” JFK told his audience at Rice University, as he pledged huge resources to turn a far-fetched dream into a concrete reality.
Sure enough, before the Sixties were out, Neil Armstrong had become the first man to step on the Moon, a “giant leap for mankind” that was broadcast across the world and helped to fire up a new age of socioeconomic progress and technology.
Now, even as the pandemic continues to rage, scientists and other innovators are proposing another moonshot – the creation of a “global immune system” that would protect the world from all future pandemics.
“It’s exactly the same time frame – we can do this within a decade if we are committed to doing it,” says Dr Richard Hatchett, chief executive of the Coalition for Epidemic Preparedness Innovations (Cepi).
“The technological foundations for being able to eliminate pandemics are essentially available… we know what we need to do, it’s a question of will and mustering the global resources.”
Dr Hatchett is worth listening to. He was not only one of a small group who can legitimately claim to have seen the threat of a pandemic in advance, but also someone who did something about it.
Working for the Bush and Obama administrations, he collaborated with colleagues to help to refine and promote the first computer models to track new viruses, including the model developed by Imperial College London.
He also helped to devise a social distancing strategy that – had it been deployed – could have saved tens of thousands of lives across America and Europe when Covid-19 broke out.
In late January last year, as officials in Washington and London dithered, he released millions of dollars from Cepi to get early trials of several of the vaccines in use today up and running – including those made by Moderna and Oxford/AstraZeneca.
It was a big call that could have ended his career. Cepi’s donors, which include the British Government, were sceptical. If Covid turned out to be a damp squib – another swine flu, for instance – the money would be wasted, they warned.
“I was getting a hell of a lot of heat inside Cepi that I had my hair on fire and had gone over the edge,” recounts Dr Hatchett in a recently published book, The Premonition by Michael Lewis. Nevertheless, he made the call and released the cash – money that is now enabling countries across the world to slowly reopen.
Now Dr Hatchett and others are turning their attention to the next pandemic and the moonshot needed to prevent it. This is how they see it and intend to make it a reality.
Global surveillance – a new early-warning radar
Covid-19 – or Sars-Cov-2 – was spotted early by China but not soon enough. The virus was isolated and sequenced within two to three months of the first known cases in Wuhan, but by that time it had already escaped.
In northern Italy, for example, there are now cases that can be dated to November 2019 and were missed by doctors at the time. What appeared to them as just another case of pneumonia turned out, on closer inspection, to have been Covid-19.
Dr Joe DeRisi, the biochemist who first sequenced the Sars virus in 2003 and a pioneer in genetic sequencing, speaks for everyone who is anyone in pandemic planning when he says that the world needs a new “early-warning radar” for the detection of new pathogens. A system that is both global in reach and independent of governments.
“What’s frustrating about this pandemic is right before the pandemic we were in the initial stages of building what I would like to see – a global early-warning radar or weather map to identify and track new microbes,” said Dr DeRisi last week.
“It’s a network of laboratories and surveillance nodes that would be constantly sampling the range of sick people and animals across the world, and which aggregates that data centrally so we get an early heads-up.”
Advances in genetic sequencing and cloud-based computing technologies mean such a system can be built today.
Indeed Dr DeRisi had already set up nodes in 11 countries, including Bangladesh, Vietnam, Nepal, Cambodia, Kenya and South Africa, when Covid broke out. If it had been 100 countries or more the present day would feel very different. That’s the “sad part”, he says.
The system works by giving clinicians the ability to rapidly sequence and identify the microbes that are causing illness and feed them into a central, searchable database. As existing microbes mutate or entirely new ones emerge they can be monitored and tracked by thousands of independent scientists around the world via a single, open-source interface.
Doctors on the ground would use it, says Dr DeRisi, not only because it would help others identify new pandemic threats but also because it helps with their day jobs – to know whether a patient with tuberculosis has a straightforward infection or one that is resistant to certain antibiotics, for instance.
The open-source nature of the project is also vital because it provides transparency. Instead of a few nervous local government officials looking in, you would have thousands of expert eyes from around the world.
New and evolving viruses would be an obvious focus of such a surveillance system but genetic sequencing technology would allow any RNA or DNA based pathogen to be tracked.
Dr DeRisi, like others, is intensely aware of the “impending disaster” caused by bacteria that are becoming resistant to antibiotics, for example.
Even funguses and other microbes that cause disease in trees and crops could be monitored – perhaps providing an additional financial incentive to get the system properly rolled out.
“The only thing that would fall outside of the realm of sequencing are prion diseases like scrapie or mad cow disease, but I would call that an edge case,” says Dr DeRisi.
Tony Blair, the former prime minister, has championed such a system and believes that we should also be using the capacity of the security apparatus to help with the surveillance of new outbreaks.
“We have a lot of capability in that area,” he said last week. “We should be picking up the escape of new pathogens very fast. We can’t afford to do what we did with Covid.”
New suppression strategy – buying time for a vaccine
Spotting a new pathogen early is one thing. But buying the time to suppress it while vaccines and treatments can be developed is equally vital.
The great bulk of the global cost of Covid – estimated by the International Monetary Fund at $28trillion (£21.5trillion) – will be picked up by countries that failed to put those countermeasures in place before the outbreak.
Countries such as Britain and the US that had to scramble to purchase PPE and establish test and trace capacity after the fact. Countries that did not prepare their businesses and schools to operate remotely in advance.
Countries that did not invest in enough spare health capacity and ended up having to close their hospitals to normal business.
“We have been taught a hard lesson about social distancing measures etc,” says Mr Blair. “I think it’s reasonably easy to see how you would do things differently. You know, it’s just incompetent if we don’t get that right next time – and may have been incompetent not getting it right this time.”
Prof Sir Peter Horby, the inaugural director of Oxford University’s new Pandemic Sciences Centre and joint chief investigator of the UK’s successful Recovery Trial, agrees.
“It’s clear that the prior model of pandemic planning did not work,” he said last week. “One of the key lessons is that technocratic box-ticking is not a fair reflection of how resilient a system is.”
Prof Horby’s new faculty at Oxford will focus not simply on the pure science of surveillance and viral evolution, but on the social and political issues that we now know can make or break a pandemic response.
“You can have the best data and the best awareness of what’s going on, you can have the best interventions, the best diagnostics, the best drugs. But if you don’t have the sort of political and social structures to implement them at the right time, in the right place and people will accept them, they’re not going to work,” he says.
To some extent, planning a successful suppression strategy will be a matter of copying and pasting large chunks of other countries’ pandemic plans into our own. South Korea, Taiwan, Singapore and New Zealand all had detailed suppression strategies mapped out in advance and most have proved reasonably successful at limiting, not only the spread of Covid, but also the economic and social damage that came with it.
But well intentioned plans are not enough – new tools to implement them and make them operational will need to be designed.
Dr Charity Dean, a frontline infectious disease specialist who helped to scramble California’s Covid response into action against the odds, is now leading a Silicon Valley startup that aims to enable local public health departments and companies to better respond to new outbreaks.
Called the Public Health Company, it aims to codify the long-held knowledge of frontline public health professionals into digital tools, so systems for suppressing the spread of new pathogens can be more quickly and effectively deployed at a local level.
The idea is to cover everything from community testing to track and trace and the deployment of social distancing measures and other non-pharmaceutical interventions.
“I see viruses very much like a machine,” she said. “And yet we’re trying to beat a machine with these manual processes.”
The aim, she adds, is to “empower local health officers” the world over so they can take the initiative and are no longer reliant on distant and sluggish centralised bureaucracies.
With a new pathogen detected and its spread temporarily suppressed the final challenge – alongside developing tests and drugs – will be creating a vaccine quickly to kill it off.
Experts such as Dr Hatchett and Sir Jeremy Farrar, director of the Wellcome Trust, believe in the next pandemic a jab could be rolled out globally within 100 days given the right forward planning and investment.
The plan – first reported in the UK by The Telegraph in December – received a big boost last week when leaders at the G7 summit in Cornwall “welcomed” the initiative and pledged to work towards making it happen.
The idea, which is being spearheaded by Cepi, is to create prototype vaccines for all the known pathogens with pandemic potential (roughly 25 viral families) in advance of an outbreak and effectively stockpile them.
Final human trials and manufacturing would be undertaken in parallel around the globe in the 100 days after a new pandemic pathogen was identified and confirmed.
Dr Rajeev Venkayya, president of Takeda Pharmaceutical’s vaccines business and a Cepi board member, likens the challenge to having the answer to climate change.
If we had a solution for climate change “we’d be all over that, no question,” he says. But to tackle pandemics, a comparable challenge, we now have the technology to “take the threat off the table for future generations. That’s the power of this moment.”
Cepi has outlined a $3.5 billion plan to kick-start the project but the effort will require wider commitments and a lot more money, probably at least 10 times as much.
“It’s at least a couple of tens of billions of dollars that will need to be spent to do this globally, at scale, over five to 10 years,” says Dr Hatchett.
If that sounds like a lot of money, think again. The new HS2 train link between London and Manchester is expected to cost in excess of £100billion by the time it is finished.
For perhaps less than half the price of that troublesome project, the best scientists in their fields are saying they can remove the threat of future pandemics forever.
The only real question is this: will it be China or the West that takes the moonshot?
‘What’s frustrating is that right before the pandemic we were in the early stages of building a global earlywarning radar’
‘We have the technology to take the threat off the table for future generations’