What would you do if you had 6 months' lead time?

In March 2015, Brazil reported a large outbreak of a mysterious illness causing fever and rash. The cause was soon confirmed to be from Zika – a mosquito-borne virus new to the Western Hemisphere. Within a short time period, Zika’s introduction into new territory sparked its rapid spread between people and mosquitoes across much of Brazil, including the large urban centres of São Paulo and Rio de Janeiro. 

And it was to spread even further. On January 14th 2016 a study published in The Lancet analysed and integrated diverse data on the global movements of airline travellers who could inadvertently transport Zika virus in their bloodstream to other parts of the world, the ecological niche of Aedes mosquitoes capable of ingesting the virus after biting infected travellers, and local climatic conditions required for infected mosquitoes to transmit the virus back to another person. Prior to the World Health Organization declaring Zika a public health emergency, that study anticipated that an outbreak was likely forthcoming on the shores of Florida. Six months later, a local outbreak was declared in Miami and  followed by other parts of the state. 

All of which underlines the importance of a simple question:

What would you do if you had 6 months of lead time on the next dangerous outbreak?   

Time is everything when you are facing a rapidly moving outbreak. But imagine being able to anticipate where and when essential countermeasures – infectious disease diagnostics, therapeutics, and vaccines – would be needed most. You could use that lead time to forge stronger relationships with distributors to ensure that supplies of those countermeasures are optimally allocated to meet local needs. You could use the time to engage healthcare providers with the vital information they need to safely and effectively make use of available vaccines and therapeutics that protect lives. And you could have the time to raise public awareness about what is forthcoming and empower local communities with the knowledge they need to protect not just themselves, but also their families and communities. 

Driven by a confluence of factors from climate change and urbanisation to global travel and human encroachment on wildlife ecosystems, infectious disease outbreaks are now appearing with greater frequency and severity, spreading farther and faster, and expanding their geographic range.  

Understanding where and when the next disruptive outbreak will occur is not a simple undertaking, especially in a world where antiquated surveillance systems are commonplace. It requires a highly specialised set of scientific and technological skills, coupled with a complex array of global data and advanced analytics – consequently, very few entities are equipped to produce such insights. And while advanced intelligence solutions now exist, many organisations continue to use conventional approaches to monitor global infectious disease threats, anticipate which threats demand our immediate attention, and inform timely actions that protect lives and communities around the world.  

Awareness

Outbreaks move fast, but information moves faster. Artificial intelligence enables machines to continuously process vast amounts of online content across the world’s many languages to rapidly identify worrisome illnesses anywhere in the world that might indicate a dangerous new outbreak. This capability, when combined with infectious disease experts who can evaluate these and other data, provide context and exercise judgment, allowing for more precise identification of dangerous signals.

The key to more timely awareness lies in gathering as much information from as many sources as possible. This is essential because official reporting of outbreaks from government public health agencies has significant limitations. Delayed detection, delayed reporting, and even active concealment of outbreaks negatively impact our timely understanding of the true burden of disease. This, in turn, can impede our ability to assess risk, and consequently distribute and deploy essential vaccines and therapeutics to the places that urgently need them. 

Anticipation  

To borrow a phrase from the famous hockey player Wayne Gretzky, “A good player plays to where the puck is. A great player plays to where the puck is going to be.” 

Conventional infectious disease surveillance systems capture what has happened in the past. Artificial intelligence coupled with human intelligence can help us understand the present. But in a world where infectious diseases can leap across international and even intercontinental borders in hours, this is inadequate. To up our game and get ahead of outbreaks, we have to look into the future by anticipating what is coming next.  

Anticipating outbreaks involves the transformation of diverse data into predictive intelligence and its rapid global dissemination. COVID-19 provides a useful example. The world’s first peer-reviewed study on COVID-19 – published even before it was known to be from a novel coronavirus or had a name – analysed worldwide airline ticket sales data to anticipate which international cities the mysterious outbreak of pneumonia in Wuhan, China was expected to spread to first. That list would have real-world impact, notably for Taiwan, as Taipei was identified among the top five international cities at risk of receiving infected travellers from Wuhan. This timely intelligence was used to inform Taiwan’s Centers for Disease Control response to immediately put traveller screening protocols in place across their ports of entry. Ultimately, this resulted in one of the most effective international responses to the COVID-19 pandemic, dramatically reducing its domestic health, economic, and social consequences. 

Anticipating disease spread and impacts are not restricted solely to novel respiratory diseases like COVID-19, where forecasts typically look weeks to months ahead. As previously noted, climate change is already impacting, and will continue to impact, the global landscape of infectious diseases spread by mosquitoes and other insect vectors. As such, long range climate change models can be integrated with infectious disease forecasting models to look years into the future to anticipate how the global landscape of vector-borne infectious diseases will evolve.

Action

Time is a gift when used wisely. With the right data, analytics, and technology, we can mass produce and disseminate timely, contextualised intelligence that is actionable for a multitude of organisations, and for a wide variety of purposes. For example, pharmaceutical and life sciences companies can arm themselves with valuable intelligence to inform how clinical trials and other research studies can best be designed to bring infectious disease countermeasures in development to market faster. For countermeasures that are already in market, this intelligence can inform where and when essential vaccines and therapeutics will be needed to meet the demands of local populations.   

As a frontline physician, I can attest that many of my healthcare colleagues are overwhelmed, overloaded, and under-resourced three years into the COVID-19 pandemic. This makes it exceedingly difficult for us to pay attention to things that are not immediately in front of us. Which means we lack the mental bandwidth needed to think about infectious diseases that may be circulating in our local communities, let alone a dangerous outbreak appearing on the other side of the world. Coupled with the fact that most healthcare providers have very little training in global infectious diseases, our inexperience in recognising, diagnosing, and effectively managing such diseases puts us, our colleagues, our families, and our communities at risk. 

There lies an opportunity. Case studies often describe the “astute clinician” who diagnosed and skilfully managed a dangerous communicable disease, essentially stopping an outbreak in its tracks. In a world where we need more globally aware and clinically astute healthcare providers, trustworthy, contextually relevant, and unbiased intelligence — delivered at just the right time — is essential.  

The world has undeniably entered a new era of epidemics and pandemics, and in it infectious disease outbreaks are becoming more frequent, more disruptive, and more dangerous. In the past 14 years, the World Health Organization has declared seven global public health emergencies, two of which were pandemics. Until now, we have been trying to catch up to outbreaks and get ahead of their destructive paths. But without awareness we cannot respond, without anticipation we cannot plan, and without action we cannot protect. It is the combination of these factors that will empower us to better protect lives and communities around the world.

About the author
Dr Kamran Khan is an infectious disease physician, Professor of Medicine and Public Health at the University of Toronto, and CEO of BlueDot. He founded BlueDot in 2013 to help organisations prepare and respond to emerging infectious diseases through the use of artificial and human intelligence. His work has led him to advisory roles with the World Health Organization and the White House. Dr Khan received a Governor General’s Award for his innovative work combining clinical medicine, public health, big data, and artificial intelligence.