Had earlier information been acted upon, Covid vaccine development might have been initiated faster, say some experts, after documents released last week showed that the genetic sequence of SARS-CoV-2 was submitted to a National Institutes of Health database a fortnight before its release by the Chinese Government.
Delays in data-sharing and other critical lessons learned from the pandemic could affect the global response to a potential as yet unknown ‘Disease X’, which the world may face in the future, said delegates at the World Economic Forum in Davos last week.
In the case of the Chinese information not being followed up, the sequence “doesn’t indicate the origin of the coronavirus but undermines the Chinese Government’s claims about its knowledge of the information”, one expert told CNN – and could have cost critical weeks in the development of a vaccine against the virus.
On 28 December 2019, virologist Dr Lili Ren, of the Institute of Pathogen Biology at the Chinese Academy of Medical Sciences & Peking Union Medical College, had submitted the genetic sequence to GenBank, a “genetic sequence repository that collects, preserves and provides public access to assembled and annotated nucleotide sequence data from all domains of life”, according to a letter that Dr Melanie Egorin, assistant secretary of legislation at the US Department of Health and Human Services, sent to House Energy and Commerce Committee Chair Cathy McMorris Rodgers last month.
GenBank is managed by the National Centre for Biotechnology Information, part of the US National Institutes of Health.
Ren’s submission “was incomplete and lacked the necessary information required for publication”, the letter says.
She was sent a resubmission request three days later, but “NIH never received the additional information”. The submission was removed from a processing queue on 16 January 2020, and “the sequence was never made publicly available on GenBank”.
Yet a different submission of the genetic sequence that was “nearly identical” to Ren’s was published on GenBank on 12 January, Egorin said, one day after the World Health Organisation said it had received the sequence from China.
Subpoenas
The committee said it had received the new information almost two months after informing the NIH of intent to issue subpoenas for copies of documents related to any early coronavirus sequences, early Covid-19 cases or other pertinent information.
Dr Jesse Bloom, a virologist at the Fred Hutchinson Cancer Centre, said that an analysis of Ren’s submission showed it “clearly falsifies the Chinese Government’s claim that the causative agent of the Wuhan pneumonia outbreak still had not been identified near the end of the first week of January 2020”.
The earlier submission “would have provided adequate information to initiate vaccine production in late 2019 if it had been made public”, he said, noting that Moderna “used the spike sequence to design its Covid-19 vaccine” within two days of the 12 January release.
However, he added, the genetic sequence “is unlikely to represent the first virus that infected humans” and “does not provide any new insights into the origin or early spread of SARS-CoV-2 in Wuhan”.
“The belated discovery of the submission underscores the importance of rapid data-sharing during outbreaks, since immediate public release of the sequence could have accelerated by several weeks the development of vaccines that saved thousands of lives weekly in the US alone,” he said.
The documents should be read in the context of hindsight, said Dr Kristian Andersen, an evolutionary biologist and director of infectious disease genomics at the Translational Institute.
In late 2019, nobody knew that a pandemic would later ensue, he said.
“A really critical part most people seem to forget… is that nobody knew then that a never-before-seen coronavirus only distantly related to SARS-CoV-1 was causing ‘mysterious’ illnesses in patients associated with a wet market in Wuhan – and would later spark a devastating pandemic.
“Should the sequence have been released at the time and (marked) as preliminary data? Sure, that would have been great, and is a good example of where we could do better in the future,” he said.
“But whoever reviewed the sequence at NCBI over the holiday period in 2019 would have had no way of connecting this sequence to a ‘mysterious’ illness in Wuhan – because it was yet to be reported.”
Better responses vital
However, the global experts at Davos said more efficient data-sharing and improving disease surveillance were imperative, as was strengthening primary healthcare and being able to expand quickly during a crisis, if the world were to brace itself for a potential, and as yet unknown Disease X.
“Disease X is a placeholder for unknown diseases,” said WHO director-general Dr Tedros Adhanom Ghebreyesus. “You may even call Covid the first disease X, and it may happen again.
“We lost many people (during Covid) because we couldn’t manage them. They could have been saved, but there was no space. There was not enough oxygen. So how can you have a system that can expand when the need comes?”
Many countries spend large amounts on their healthcare but this does not always translate into superior outcomes, reports Health Policy Watch.
“It’s not just about spending more: it’s also spending smarter. A shocking statistic, for instance in OECD (Organisation for Economic Cooperation and Development) countries, is that the average spend on prevention is 3% of the budget of health systems. And obviously, if you spend so little on prevention, you end up spending most of your budget on hospitalisation or only treatments,” said Michel Demaré, board chair of AstraZeneca.
Tedros said the reason for poor outcomes was also that expenditure was focused on tertiary healthcare, meaning some countries struggled with basics like contact tracing during the pandemic, as they ignored primary healthcare.
“To prepare countries, I think renewed commitment to strengthen primary healthcare is very important,” he said.
Collaboration
A big lesson from the pandemic was the benefit of collaboration, said Demaré, whose company distributed more than 3bn doses of vaccine at no profit, mainly to low- and middle-income countries.
“We were not a vaccine company at the time. We just decided this was a call for action, that we had to try to use our know-how and our networks to help.
“So we signed a licence agreement with the University of Oxford. We put together a network of more than 20 contract manufacturing organisations to which we transferred technology and skills to basically help build the vaccine.”
Quick action and quick decision-making were extremely important but the partnerships were the most important aspect, he added.
“We have partnered with academia, obviously with governments, with regulators, third-party commercial contractors, and with NGOs.”
Pandemic toll on healthcare workers
The healthcare sector is facing a huge shortage of staff and the situation is worsening. An estimated 115 000 healthcare workers died during Covid, which has also highlighted the dangers facing those delivering care.
“The lack of skilled manpower is a global shortage. We do not have enough doctors and nurses to heal the world,” said Preetha Reddy, vice-chairperson of the private Indian healthcare provider, Apollo Hospitals.
But her group found digital tools helpful during the pandemic. “Within two weeks we were able to train 150 000 workers on ventilator management,” she said.
Push for agreement
Tedros made a push for the pandemic agreement currently being negotiated by member states. with the May World Health Assembly as their deadline.
Much of the text of the agreement on technology transfer, pricing and transparency has already been watered down.
“The agreement can bring all of the experience and challenges we have faced, and the solutions, into one, and help us to prepare for the future in a better way, because this is about a common enemy,” he said.
Health Policy Watch article – At Davos, Lessons from COVID Help Prepare for ‘Disease X (Open access)
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