Pandemic Prevention: All Nations Should Build Emergency Medical Stockpiles
All nations should have stockpiles of medical resources e.g. masks, PPE, multi-purpose medicines and therapeutics, and various vaccines (smallpox, H1N1, etc). At the slightest hint of danger, these resources should be distributed to every part of the country. There should be enough stock to protect the people for as long as is required to get resupplied.
The Australians have a national medical stockpile and they started distributing masks from it in January 2020 in response to the Covid-19 outbreak. The French used to have a national stockpile of masks, but they decided it would be more ‘efficient’ to get rid of it, reasoning that if there was an emergency, they could just buy masks from China. Sacre bleu!
Stockpiling is a general-purpose risk management technique which also works for other emergencies such as terrorism, fires, nuclear fallout, and war. If you want to survive in the long-run, you need to build stockpiles!
Pandemic Prevention: We Need Comprehensive Surveillance Testing At All Major Airports
If a Pandemic-Potential Pathogen is to spread internationally, it will have to pass through a national port of entry. If it does, then it will likely leave a trace. Since the air travel network is the major risk for spreading PPPs, we should test airports regularly: wastewater, sewerage, surfaces, and (voluntarily) passengers. Major nodes such as Heathrow, Schipol, Changai, and Dubai should be especially vigilant. If all developed countries were performing comprehensive surveillance testing at their main ports of entry, we could find novel PPPs much quicker and before they had established themselves overseas. This would greatly reduce the risk of all future PPPs, and for pennies in the dollar (if even) when compared to the cost of a pandemic.
Another idea we are exploring is to sample wastewater in military barracks. Since our military go to several countries for various interventions. They represent an important group too in the process. However, optimization of metagenomics processes and cost is critical.
Interesting. That makes sense. The military are often ‘guinea pigs’ for testing and experiments.
I expect the cost of this testing would fall over time as our technology improves and we become more precise and efficient in our use of it. But, that is an assumption.
I also think that if we can put these policies in place in the developed world then fewer of these pandemic-potential pathogens will reach the developing world. Had the EU and the USA reacted faster and more competently to Covid, the likes of India and South America could have been spared a lot of cost and suffering.
Pandemic Prevention: Surveillance Has a Higher Return on Investment Than Vaccines
If you’ve got money to spend on pandemic preparation, put it into better global surveillance, not better vaccines. Surveillance is our radar for novel pandemic-potential pathogens (‘PPPs’). The better our radar, the sooner we find the PPP, the smaller the outbreak will be at the time, and the quicker, easier, and cheaper it will be to eliminate it. Vaccines, in contrast, are one of our last lines of defence. If we are to protect ourselves from PPPs in the long-run, we’ll need stop them long before we need to resort to global vaccination.
This would surprise me. Surveillance is a very expensive ongoing cost, and the actions you should take upon detecting a new microbe which could potentially be a pathogen are unclear. Have you got a more detailed version of why you think this?
1 Do you have any estimates for that? The cost of annual surveillance is surely a pittance compared to the cost of a Covid-19 pandemic every 20-30 years. We have an insurance industry for this reason. One would also expect the cost of that surveillance to fall over time, and the quality of the info it provides to improve too.
2 The cost of developing, trialling, manufacturing, and distributing 8bn doses of an unproven vaccine to every corner of the world every time a novel PPP is discovered (!!) would surely be more than the annual surveillance costs. It also offers worse health outcomes. Plus vaccines are our last line of defence. If we aim to defend ourselves there, then it is only a question of time before we lose. Global vaccination is, to be frank, an insane approach to pandemic risk management. This, thankfully, is starting to be understood by some prominent epidemiologists:
“the actions you should take upon detecting a new microbe which could potentially be a pathogen are unclear”
First you alert the world to the fact that there is an unidentified / novel pathogen circulating. Then you implement your national pandemic prevention plans. Remember, this is not a scientific matter. Making decisions in uncertain environments is risk management, not science. Real world planning, preparation, resource management, and tactical decision-making in uncertain environments are required to protect humanity from pandemics, but they are not scientific skills. They are not taught to, or by, scientists, so the methods of science are of little value in a crisis. A scientist can tell you what a hurricane is, whereas a risk manager can tell you what to do about it. That’s the key difference. But, that’s also a major hurdle that we’ll need to overcome, as scientists are very influential but also VERY unwilling to recognise the inadequacies of their methods.
“Have you got a more detailed version of why you think this?”
Speed. If an outbreak is growing at 3x per week, then every week saved in finding the outbreak cuts it in size by a factor of 3. The smaller the outbreak when we find it, the more local it will be, and the quicker, cheaper, and easier it will be to contain and eliminate it. Covid had at least a 10-week head start on us, and then we sat around for another month or two before we did anything substantial. The outbreak had increased by many orders of magnitude before we even got started with our responses. With better surveillance we could have picked it up in November 2019, it would have been 1⁄10,000th the size when we responded, and the outbreak would have been over by spring 2020 with little disturbance outside of China and a few cities in the EU/USA. Surveillance is speed, and speed is our greatest leverage over PPPs.
Could we create an epidemic ‘game’ and then trial different scenarios and measures to see which worked best? Something like an ‘in silico’ RCT for pandemic responses. If so, why have we not done it yet? It would be vastly superior to table top exercises, and seems like it would be as good a use as any for our finite supercomputer capacity.
Pandemic Prevention: All Nations Should Build Emergency Medical Stockpiles
All nations should have stockpiles of medical resources e.g. masks, PPE, multi-purpose medicines and therapeutics, and various vaccines (smallpox, H1N1, etc). At the slightest hint of danger, these resources should be distributed to every part of the country. There should be enough stock to protect the people for as long as is required to get resupplied.
The Australians have a national medical stockpile and they started distributing masks from it in January 2020 in response to the Covid-19 outbreak. The French used to have a national stockpile of masks, but they decided it would be more ‘efficient’ to get rid of it, reasoning that if there was an emergency, they could just buy masks from China. Sacre bleu!
Stockpiling is a general-purpose risk management technique which also works for other emergencies such as terrorism, fires, nuclear fallout, and war. If you want to survive in the long-run, you need to build stockpiles!
Pandemic Prevention: We Need Comprehensive Surveillance Testing At All Major Airports
If a Pandemic-Potential Pathogen is to spread internationally, it will have to pass through a national port of entry. If it does, then it will likely leave a trace. Since the air travel network is the major risk for spreading PPPs, we should test airports regularly: wastewater, sewerage, surfaces, and (voluntarily) passengers. Major nodes such as Heathrow, Schipol, Changai, and Dubai should be especially vigilant. If all developed countries were performing comprehensive surveillance testing at their main ports of entry, we could find novel PPPs much quicker and before they had established themselves overseas. This would greatly reduce the risk of all future PPPs, and for pennies in the dollar (if even) when compared to the cost of a pandemic.
Another idea we are exploring is to sample wastewater in military barracks. Since our military go to several countries for various interventions. They represent an important group too in the process. However, optimization of metagenomics processes and cost is critical.
Interesting. That makes sense. The military are often ‘guinea pigs’ for testing and experiments.
I expect the cost of this testing would fall over time as our technology improves and we become more precise and efficient in our use of it. But, that is an assumption.
I also think that if we can put these policies in place in the developed world then fewer of these pandemic-potential pathogens will reach the developing world. Had the EU and the USA reacted faster and more competently to Covid, the likes of India and South America could have been spared a lot of cost and suffering.
Pandemic Prevention: Surveillance Has a Higher Return on Investment Than Vaccines
If you’ve got money to spend on pandemic preparation, put it into better global surveillance, not better vaccines. Surveillance is our radar for novel pandemic-potential pathogens (‘PPPs’). The better our radar, the sooner we find the PPP, the smaller the outbreak will be at the time, and the quicker, easier, and cheaper it will be to eliminate it. Vaccines, in contrast, are one of our last lines of defence. If we are to protect ourselves from PPPs in the long-run, we’ll need stop them long before we need to resort to global vaccination.
This would surprise me. Surveillance is a very expensive ongoing cost, and the actions you should take upon detecting a new microbe which could potentially be a pathogen are unclear. Have you got a more detailed version of why you think this?
“Surveillance is a very expensive ongoing cost”
1 Do you have any estimates for that? The cost of annual surveillance is surely a pittance compared to the cost of a Covid-19 pandemic every 20-30 years. We have an insurance industry for this reason. One would also expect the cost of that surveillance to fall over time, and the quality of the info it provides to improve too.
2 The cost of developing, trialling, manufacturing, and distributing 8bn doses of an unproven vaccine to every corner of the world every time a novel PPP is discovered (!!) would surely be more than the annual surveillance costs. It also offers worse health outcomes. Plus vaccines are our last line of defence. If we aim to defend ourselves there, then it is only a question of time before we lose. Global vaccination is, to be frank, an insane approach to pandemic risk management. This, thankfully, is starting to be understood by some prominent epidemiologists:
https://www.oecd-forum.org/posts/entering-the-age-of-pandemics-we-need-to-invest-in-pandemic-preparedness-even-while-covid-19-continues
“the actions you should take upon detecting a new microbe which could potentially be a pathogen are unclear”
First you alert the world to the fact that there is an unidentified / novel pathogen circulating. Then you implement your national pandemic prevention plans. Remember, this is not a scientific matter. Making decisions in uncertain environments is risk management, not science. Real world planning, preparation, resource management, and tactical decision-making in uncertain environments are required to protect humanity from pandemics, but they are not scientific skills. They are not taught to, or by, scientists, so the methods of science are of little value in a crisis. A scientist can tell you what a hurricane is, whereas a risk manager can tell you what to do about it. That’s the key difference. But, that’s also a major hurdle that we’ll need to overcome, as scientists are very influential but also VERY unwilling to recognise the inadequacies of their methods.
“Have you got a more detailed version of why you think this?”
Speed. If an outbreak is growing at 3x per week, then every week saved in finding the outbreak cuts it in size by a factor of 3. The smaller the outbreak when we find it, the more local it will be, and the quicker, cheaper, and easier it will be to contain and eliminate it. Covid had at least a 10-week head start on us, and then we sat around for another month or two before we did anything substantial. The outbreak had increased by many orders of magnitude before we even got started with our responses. With better surveillance we could have picked it up in November 2019, it would have been 1⁄10,000th the size when we responded, and the outbreak would have been over by spring 2020 with little disturbance outside of China and a few cities in the EU/USA. Surveillance is speed, and speed is our greatest leverage over PPPs.
Could we use a supercomputer to model epidemics?
Could we create an epidemic ‘game’ and then trial different scenarios and measures to see which worked best? Something like an ‘in silico’ RCT for pandemic responses. If so, why have we not done it yet? It would be vastly superior to table top exercises, and seems like it would be as good a use as any for our finite supercomputer capacity.