…it showcases that even in a state like China, where you can enact these measures, maybe 19th century public health responses just don’t work, and maybe we need a drastically different approach.

Dr Cassidy Nelson

COVID-19 (previously known as nCoV) is alarming governments and citizens around the world. It has killed more than 1,000 people, brought the Chinese economy to a standstill, and continues to show up in more and more places.

But bad though it is, it’s much closer to a warning shot than a worst case scenario. The next emerging infectious disease could easily be more contagious, more fatal, or both.

Despite improvements in the last few decades, humanity is still not nearly prepared enough to contain new diseases. We identify them too slowly. We can’t do enough to reduce their spread. And we lack vaccines or drugs treatments for at least a year, if they ever arrive at all.

This is a precarious situation, especially with advances in biotechnology increasing our ability to modify viruses and bacteria as we like.

In today’s episode, Cassidy Nelson, a medical doctor and research scholar at Oxford University’s Future of Humanity Institute, explains 12 things her research group think urgently need to happen if we’re to keep the risk at acceptable levels. The ideas are:

Science

1. Roll out genetic sequencing tests that lets you test someone for all known and unknown pathogens in one go.
2. Fund research into faster ‘platform’ methods for going from pathogen to vaccine, perhaps using innovation prizes.
3. Fund R&D into broad-spectrum drugs, especially antivirals, similar to how we have generic antibiotics against multiple types of bacteria.

Response

4. Develop a national plan for responding to a severe pandemic, regardless of the cause. Have a backup plan for when things are so bad the normal processes have stopped working entirely.
5. Rigorously evaluate in what situations travel bans are warranted. (They’re more often counterproductive.)
6. Coax countries into more rapidly sharing their medical data, so that during an outbreak the disease can be understood and countermeasures deployed as quickly as possible.
7. Set up genetic surveillance in hospitals, public transport and elsewhere, to detect new pathogens before an outbreak — or even before patients develop symptoms.
8. Run regular tabletop exercises within governments to simulate how a pandemic response would play out.

Oversight

9. Mandate disclosure of accidents in the biosafety labs which handle the most dangerous pathogens.
10. Figure out how to govern DNA synthesis businesses, to make it harder to mail order the DNA of a dangerous pathogen.
11. Require full cost-benefit analysis of ‘dual-use’ research projects that can generate global risks.

12. And finally, to maintain momentum, it’s necessary to clearly assign responsibility for the above to particular individuals and organisations.

Very simply, there are multiple cutting edge technologies and policies that offer the promise of detecting new diseases right away, and delivering us effective treatments in weeks rather than years. All of them can use additional funding and talent.

At the same time, health systems around the world also need to develop pandemic response plans — something few have done — so they don’t have to figure everything out on the fly.

For example, if we don’t have good treatments for a disease, at what point do we stop telling people to come into hospital, where there’s a particularly high risk of them infecting the most medically vulnerable people? And if borders are shut down, how will we get enough antibiotics or facemasks, when they’re almost all imported?

Separately, we need some way to stop bad actors from accessing the tools necessary to weaponise a viral disease, before they cost less than $1,000 and fit on a desk.

These advances can be pursued by politicians and public servants, as well as academics, entrepreneurs and doctors, opening the door for many listeners to pitch in to help solve this incredibly pressing problem.

In the episode Rob and Cassidy also talk about:

  • How Cassidy went from clinical medicine to a PhD studying novel pathogens with pandemic potential
  • The pros, and significant cons, of travel restrictions
  • Whether the same policies work for natural and anthropogenic pandemics
  • Where we stand with nCoV as of today.

Get this episode by subscribing to our podcast on the world’s most pressing problems and how to solve them: type 80,000 Hours into your podcasting app. Or read the transcript below.

Producer: Keiran Harris.
Transcriptions: Zakee Ulhaq.

Highlights

Test for all known and unknown pathogens in one go

At the moment, the most common types of testing are PCR testing, which is polymerase chain reaction, and it allows you to detect a pathogen that has a certain section of its genetic code match this test that’s very limited in terms of anything new that comes out. You always have to know about the pathogen beforehand, have to have designed and validated a test against that.

In the last few years though, some new technologies that have come out that are based on metagenomic techniques, which are pathogen agnostic diagnostics. So you don’t need to know anything about the pathogen beforehand. You can put a clinical sample on and it will tell you all of the DNA that is in that sample. And so you’d be able to do things like bioinformatics testing on this and be able to actually work out, “Oh, it matches against my RSV or CMV or other known viruses, or this is completely new and it doesn’t match anything in my bioinformatics data set…

It sequences everything. So you’d imagine like 98% of it is just human DNA, but bioinformatically you just push that out and you usually don’t care about the human DNA, and then everything that’s left over you’re able to analyze…

This would mean that not only would you be able to have a reliable diagnostic from the get-go before an outbreak begins and then for those first few cases, you might actually be able to instead… on average globally, we have about a 20 day lag in between first outbreak cases and detection of an outbreak for new emerging diseases. That’s way too long. If you could detect those first handful of cases of a new disease, you’re much, much more likely to be able to contain it.

Vaccines are slow to come

…At the moment, the way that we’re designing vaccines, we have a pathogen in mind and we develop a vaccine that’s able to go against that. If you’re able to take a step back and think through ways in which we could have more underlying platforms that would be able to apply across a range of different viral species, you would be many steps ahead when, for example, you have a new coronavirus come out and we already know about other coronaviruses and we would hopefully be able to have some vaccine candidates that would be more readily adjustable to be able to apply to these…

And there have already been some initiatives that have looked at ways you can actually get new vaccines to licensure a lot more quickly than the 10 to 15+ years that we see for most vaccines. One of the most prominent ones at the moment is CEPI, which is the Coalition for Epidemic Preparedness Innovations. They were announced in 2017 and currently have a 16 week target from detection of a new pathogen and a candidate vaccine that they can be contesting.

They then have a 30 week target for a million doses of that being manufactured. I have two mindsets about this. 1) That’s aspirational and has never been done before. It’s never been done by them or anyone else before. We’ve never had a vaccine for a novel pathogen released in those types of time frames. So it’s good. At the same time, I also don’t think it’s fast enough. I think having a million doses in 30 weeks after your first few cases for, especially the types of pandemics I worry about… it’s too long.

Robert Wiblin: So both impossible and insufficient…

Where nCoV could end up going

My personal view based on this data is that it’s not likely that we are going to be able to contain it in the same way that we contained SARS, for example, where we were able to stop transmission completely just over 8,000 cases. We’ve already obviously massively exceeded that in terms of just the confirmed case numbers.

What I think is possible is that we either get to a stage where the outbreak peaks and then dies off completely in the places where it already is established. And there haven’t been good examples yet of outside of China, a very much sustained transmission. Whether or not that’s going on and it’s going on undetected is an open question, and I have suspicions that that might be the case and I’ll get to that in a moment with regards to how we’re actually detecting cases.

But, if it does just peak in China and then go off, it might completely disappear and so we don’t have cases anymore in a year or so time. The other outcome that we need to consider and that some have already raised in the biosecurity community, is that this might become endemic. Just like we have other coronaviruses, including seasonal coronavirus that we see come up every wintertime and you actually have peaks and waves of an outbreak, it’s quite possible that this is an emergent coronavirus species that ends up going down the endemic route…

Articles, books, and other media discussed in the show

Cassidy’s Papers

More about Cassidy

nCoV

Horsepox

DNA synthesis screening

Other

Related episodes

About the show

The 80,000 Hours Podcast features unusually in-depth conversations about the world's most pressing problems and how you can use your career to solve them. We invite guests pursuing a wide range of career paths — from academics and activists to entrepreneurs and policymakers — to analyse the case for and against working on different issues and which approaches are best for solving them.

The 80,000 Hours Podcast is produced and edited by Keiran Harris. Get in touch with feedback or guest suggestions by emailing [email protected].

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