Tools and possibilities

A consequence of Covid-19 has been the development and implementation of new systems of disease surveillance, data sharing and diagnostic manufacturing in not just high income countries but also in countries with more modest economies. Some of these systems and tools were already in place and reasonably well developed, but our appreciation for their utility has only been highlighted during the pandemic. Among the approaches that are now being used widely is wastewater and sewage surveillance. Since the onset of the pandemic, sewage and wastewater surveillance has been used as a marker to predict (with somewhat reasonable accuracy) the likelihood of a spike in infection. These surveillance tools have been used not just by academics but also by public health officials in towns, large and small, in both high income and middle income countries to forecast the onset of a new wave of infection. The applications of wastewater surveillance, of course, go well beyond Covid-19 and the number of researchers globally employing these tools for a variety of disease applications has exponentially grown in the last two years.

Similarly, we have seen politicians, policymakers and public institutions creating easy to use portals to share data about disease burdens in their communities and provide up to date information regarding the progression of the disease. The underlying infrastructure to create these portals were already well developed — yet their utility was appreciated when communities were anxious, misinformation was widespread and policymakers were under pressure to demonstrate that their actions were rooted in real evidence, and that on a day-to-day basis, they were trying to get things under control.

A third area that saw an increased momentum was development of locally made equipment — whether the basic PPE, rapid tests or more sophisticated ventilators. Established companies and new startups, including in Pakistan, showed that they were eager to help (and create new streams of revenue).

These developments and many other innovations are a positive outcome from what has been unimaginably difficult period for so many. These developments also hold tremendous promise for continued challenges due to Covid-19 and other ailments for which the local and global indicators paint a grim picture.

Globally, important gains made over decades in several diseases have been reversed due to limited funds, lack of attention or diversion of resources. Drug resistant TB is just one of many such cases. After continued decline in cases of drug resistant TB, the last two years have seen a substantial increase in TB patients globally. Covid-19 has also resulted in increase in other antimicrobial resistant infections. The tools and systems discovered, polished, adapted or deployed during Covid-19 can help us address some of these challenges and put us back on the right track. Yet, despite their promise and utility, we are already seeing the tools and systems starting to lose their efficacy. The dashboards are no longer active or updated, the data for new and recurring infectious diseases seems to be in the ethers of the universe and the interest in developing surveillance systems or diagnostic equipment has started to collapse.

As I see the opportunity squandered, I am reminded of a sight familiar to many who have seen the state of research in the country. Every few years, our departments and institutions across the country would get a new piece of expensive equipment with much fanfare, only for it to be placed behind locked doors with keys firmly in control of the head of the institute. Sometimes, that equipment would not even come out of its original packaging. It would gather dust, fall in a state of disrepair, and eventually people would forget about it. Ultimately, no one would benefit from it.

The tools and systems that we have received, built or optimised during Covid-19 have the potential to go beyond the pandemic. They can do plenty to forecast epidemics, to safeguard health and to build trust. All they need to function is a little imagination and a recognition of possibilities.

Published in The Express Tribune, November 15^th, 2022.

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