A consensus statement on dual purpose pathogen surveillance systems: The always on approach

Introduction

The COVID-19 pandemic progressed pathogen surveillance, from improved wastewater surveillance expertise and infrastructure, increased genomic sequencing capacity, to better integration between large datasets that informed policy decisions. Yet current systems are inadequate for a future facing frequent pandemics threats [1]. There is inequitable access to pathogen surveillance globally, with existing infrastructure favouring high-income countries resulting in blind spots for collective health resilience [2]. We are concerned that political attention and investment in pandemic preparedness is waning, with missed opportunities to respond to the concurrent crises posed by antimicrobial resistance.

Articulating the always on approach

We propose Always On - an approach that incorporates pathogen surveillance for pandemic threats with infrastructure that supports routine clinical care and public health. See Table 1 for a summary of the Always On approach. This uses surveillance data as the starting point for detecting new disease outbreaks (through tracking pathogens and identifying new variants) and monitor for emerging and re-emerging diseases but then also including a second utility to clinical care. These clinical applications include identifying drug-resistant pathogens, seasonal outbreaks of viral illnesses that may influence decisions on the use of antibiotics, for difficult-to-identify infections, and to inform public health priorities [3]. Pathogen discovery (essential for pandemic preparedness and the development of novel diagnostics, therapeutics and vaccines) can be bridged with universal or targeted pathogen detection (which could support clinical care) through sharing systems resources. This dual approach aligns with the WHO’s global genomic surveillance strategy, concepts such as collaborative surveillance and existing approaches to pathogen genomics for resource-limited settings [1, 4, 5].

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