New Duke-Affiliated Center Boosts Preparedness in Outbreak Hot Spots

Infectious disease physician and Duke Professor Paul Pronyk remembers watching helplessly in the late 1990s as HIV-exposed patients entered a clinic in South Africa where he could not provide the quick diagnoses required to begin treatment. The availability of a new rapid test was a game changer, he said, allowing clinicians to immediately determine patient status and offer treatments to HIV-positive pregnant women to protect their babies. Now, as head of the newly established Duke-National University of Singapore (NUS) Medical School Centre for Outbreak Preparedness, he sees the possibility of similar breakthroughs on a wider scale in South and Southeast Asia. “I’ve never been so excited about the potential for things to transform in a very fundamental way around not just how we approach the detection of new diseases and variants but overall control of communicable diseases in low- and middle-income countries,” he said.

Because of its population density, climate, and increased and more varied human/animal contact, Asia is a hot zone for outbreak risk. The Centre for Outbreak Preparedness (COP) creates a network of researchers and national public health officials, working with partners from the private sector and the World Health Organization, that will establish rapid pathogen identification and diagnostic tools. In developing the network, the center will draw on long-established Duke-NUS resources related to translational medicine, regulatory excellence, human and animal disease surveillance, health systems strengthening, and the school’s 134 academic medical programs across 16 countries. “Really, it is a synthesis and kind of pulling together of capacity that’s existed for a very long time in the region but applying that in a coordinated way toward addressing key priorities,” Pronyk said.

The first step is mapping key stakeholders in the 13 participating countries and bridging capacities of academic medical institutions and national public health programs. Using this baseline assessment of platforms, country priorities, and preparedness gaps, Pronyk said, the COP can “make sure that we’re applying these early detection systems in ways that make sense and are responsive to the needs of countries.”

Although countries in the region tend to be fairly autonomous and independent, COP’s network approach has had a positive reception as leaders strive to contain the current pandemic and enhance preparedness. “We cannot afford to take our eye off COVID-19. Neither can we afford to take the foot off the pedal in preparing for the next pandemic,” Singapore’s Deputy Prime Minister Heng Swee Keat said at the June launch of the center. “If we are distracted from this pandemic and in preparing for the next one, the repercussions can potentially be devastating,”

The COP’s flagship program, the Asia Pathogen Genomics Initiative, backed by the Bill & Melinda Gates Foundation, supports accelerated capacity development for genomic sequencing and bio-informatics – the process of identifying a pathogen from genetic data--that can be deployed in multiple settings in every country. The initiative is enhancing and disseminating knowledge around the full range of technologies and platforms on the market, so countries can make informed choices about how to adopt and scale this approach to early detection. While some platforms are large, expensive, and highly specialized, others are no bigger than a thumb drive, can process as many as 100 specimens at once, and produce genetic data within hours. An impressive research tool, the technology’s ability to quickly pinpoint infectious agents also will be a huge advance for countries struggling with anti-microbial resistance, drug resistant tuberculosis, and other endemic diseases. “During COVID, countries that had the capacity to do their own surveillance testing, and vaccine development did a lot better than countries without that capacity,” Pronyk noted. The COP will facilitate coordinated, affordable access to genomic sequencing, ensure it applies to both priority and novel pathogens, and link human, animal, and wastewater surveillance.

Beyond its technological focus, the COP aims to boost enabling environments through regulatory strengthening. For example, it works with countries to translate WHO policies related to genomics and surveillance into guidelines, supported by domestic financing and standard operating procedures, that are aligned across countries. It also hopes to address some of the market failures plaguing low- and middle-income access to testing, equipment, and vaccines. Other efforts will shed light on the drivers of disease, including wet markets and human consumption of wildlife, that create close human contact with new kinds of animals and offer more opportunities for species jump. The goal, Pronyk said, is to understand and work within cultural contexts, rather than pushing prohibitions that likely will serve only to drive potentially risky practices underground.

After more than two decades on the frontlines of infectious disease outbreaks through UNICEF and other organizations, Pronyk hopes the COP’s work will put lower resource settings on a more equal footing for the next major outbreak. “We are in a situation where wealthy countries do well and poor countries are left to pick up the pieces,” he noted. While fully realizing its potential may take as long as a decade, Pronyk is certain the COP can make significant progress in turning that dynamic around while providing all countries with an early warning system for the potential pandemics of the future.