Health systems lacking surveillance capacity to respond to pandemic-related public 

Mehar Angez, Malika Sachdeva, Nicolás Tascón, Coco Zhen. 

Sharing and caring: the construction of collaborative genomics networks

Main elements: Four elements regarding the lack of surveillance capacity to respond to pandemic related public health crises have been identified: 

• Regulation: The IHR have significant gaps regarding collaborative genomic networks, definitions for dangerous pathogens, information sharing, among others. At a local level, the operationalization of regulations regarding flow of goods and people (transportation, handling, inspection) remain burdensome for fast pandemic response. 
• Collaboration: Currently, there is a need to improve prevention, preparedness, and response to upcoming pandemics through collaborative genomic networks. There is a lack of cooperation between particles of these networks worldwide. Contributing to this are the facts that there are low incentives for the creation and sustainment of such networks, as well as for the dissemination of knowledge without incurring in malpractice or criminal offense.
• Communication: There is a lack of communication between countries around genomic data sharing of infectious diseases. Albeit its efforts of routine risk assessment,WHO needs to do  more to efficiently deliver pathogen information to countries.  This results in delay of rescue time and development of prevention methods. Moreover, although there is a growing need in monitoring the mutation of SARS-Cov-2 variants within countries themselves, communication between official parties (hospitals and government agencies) is still not enough. Additionally, data sharing options currently ranges from open access databases without any restrictions (US GenBank and European Nucleotide Archive) to databases with restricted access, like the Global Initiative on Sharing Asian Influenza Data (GISAID)(Moodley et al., 2022). Restrictions are usually caused by existing issues in different legal systems as well as ethical concerns that vary between countries. Hence, communication of genomic sequencing between countries is challenging. Furthermore, calls for diversity in genomics have motivated new global research collaborations across institutions with highly imbalanced resources. The discordance between the greatly acknowledged benefits of diversity in genomic studies versus the lack of partnerships between high-income and low- and middle- income countries is a great issue
• Inducements: Financial and professional incentives are oftentimes cited as a source of weakness in healthcare systems capacities. Only 37% of countries shared the variants of concerns they had identified with 25% of these countries sharing less than 25% of the genome sequence. Two of the main issues identified were the following: 1) there is no correct incentive for sharing the information if you are a scientist; and 2) there is low participation of researchers in the final applications of their research. 

Which policy measures should be taken? (Write the solution)

Solutions are offered for each of the causes identified: 

1. Regulation: 
   1. Momentum should be seized to promote the definition and expansion of “pathogens of interest”, “pandemic”, and “pandemic tools” in the International Health Regulations. Pathogens of interest should at least include diseases with high spread risk, like respiratory conditions. 
   2. IHR should provide governance to information sharing, with a hub established and run by WHO, linking with individual agencies at a country level. Responsibilities of both the WHO secretariat and the 
   3. There is a need for revision of the Nagoya Protocol, to speed up the handling of pathogens considered by the IHR as “of interest”. 
   4. Country based regulations should be adjusted to comply with IHR’s modifications for speedier processes regarding transportation and handling of physical pathogenic samples. 
2. Collaboration:
   1. Perform actions including: fostering global partnerships, creating cooperative research networks, improving data sharing, increasing capacity, and fostering openness and trust. 
   2. International collaboration should help coordinate efforts to strengthen Collaborative Genomics Networks. Their creation will allow researchers to share genomic data and research findings that can lead to the development of more effective vaccines and treatments for infectious diseases. 
   3. The tracking of infectious disease transmission and the development of targeted responses can both benefit from improved data sharing and coordination between public health organizations and research institutions
3. Communication:
   1. Internationally, setting up a system where the information about the most dangerous pathogens is shared. Scientists will get recognition for their work without it being subjected to individual country constraints or private funding.
   2. The legal framework between countries should be made flexible enough to quickly respond to situations of emergency.
4. Inducements:
   1. Alongside improved international collaboration, investing in genomics surveillance is critical to preventing and preparing for future pandemics and providing incentives to researchers can facilitate this process. 
   2. Academic institutions should promote data sharing by providing promotions and tenures to researchers. Moreover, academic recognition and other professional rewards can be seen as meaningful encouragement for scientists. 
   3. Financial benefits by prioritizing funding and grants for researchers can equally provide incentives to researchers to share relevant data. 
   4. Intellectual frameworks can be redesigned to allow for open-access policies for research related to pandemic surveillance and preparedness. 

Who should act in Switzerland?

After reviewing the former, the following recommendations for Switzerland ensue: 

• Switzerland’s cantonal work on hospital data collection could be complemented with IA tools for data sharing and early epidemic alerts.
• Promoting transparency and trust is essential to effective collaboration. Switzerland can add value to this goal by engaging in meaningful dialogue, and establishing common goals and objectives with its partners 
• At the national level, creating a functional network that involves national public health institutes, academic institutes and the private sector.
• Through Collaborative Genomics Networks, Switzerland and the international community can strengthen their collaboration efforts to prevent, prepare for, and respond to future pandemics by implementing these measures.

Yearly Vision from 2024 to 2040: 

• Vision: 2040: The IHR have been modified to centralize pandemic information within the WHO secretariat and countries count with dynamic pandemic response units that feed a centralized WHO database. The IHR have been modified to include pandemic, pathogens of interest definitions, the formalization of Collaborative Genomics Networks, and sets of incentives to disseminate trustworthy knowledge, aiming to strengthen countries’ healthcare systems pandemic preparedness infrastructure.
• 2030: Work should draw from new frameworks and experience on the development of Collaborative Genomic Networks to consolidate data sharing efforts and mechanisms as the ones proposed above. 
• 2026: Work should concentrate on the creation of Collaborative Genomics Networks, from professional development incentives to capturing financing sources from capital markets. 
• 2024: Work needs to be done in the legal sphere. At a national level, policy should be focused on creating the dichotomy of normality-emergency, and lessons should be drawn from COVID-19 to establish which processes could be flexibilized without compromising the quality, safety or efficacy of final products. Work should carry on regarding modifications of IHR.