Lab Matters Fall 2022 | Page 5

CHIEF EXECUTIVE OFFICER ’ S MESSAGE

At the beginning of August , I attended the International Conference on Emerging Infectious Diseases in Atlanta , GA . While there , I had the opportunity to not only reconnect with colleagues and peers in the public health community , but to talk about the future of public health laboratories post-pandemic .

APHL ’ s overarching strategic goal for the next two years is to guide public health laboratories into the next normal after the pandemic . But it feels a little like déjà vu — we ’ re back in early 2020 : a new infectious disease sweeps the globe and we are forced to react “ on the fly ” to quickly changing parameters . Public health laboratories , once again , find themselves on the forefront of the response , at least initially .

As we saw — and continue to see with COVID-19 — public health has a critical need for information . We have systems that encourage detailed fact-gathering to ensure the integrity of data that are collected . And that data is put to good use … eventually . When the first cases of monkeypox were discovered in Massachusetts , a test was already available through the Laboratory Response Network ( LRN ). As LRN laboratories stood up that testing , they also provided training to commercial laboratories on the CDC 510 ( k ) test to assure that there was accuracy and consistency across both the five commercial labs chosen to test by CDC , and the LRN labs .

Created in 1999 to respond to biological and chemical threats and other public health emergencies , the LRN includes state and local public health , veterinary , military and international laboratories . The LRN was built to be ahead of the curve , but there have been so many curves since 1999 ! Two decades ago there was no communication of health information ( or disinformation ) by social media , partisan politics remained in the background of the overall public health mission , and the effects of climate change and movement of humans into animal ecosystems was not as widespread . Our world has accelerated at a pace that was unheard of 20 + years ago , and it continues to do so .

But clinicians requesting testing do not want to go through what is seen as bureaucratic governmental public health agencies — filling out multiple questionnaires — they want to test and give quick results to their concerned patients . The monkeypox test that LRNs have relied on for decades is a labor-intensive manual extraction test , costing more time inside and outside of the domestic laboratory system — and yet monkeypox has been endemic internationally for a very long time . So why didn ’ t we take the time to modernize this test ? Because there was not a pressing need for it in our country .

Public health laboratories should be the place to modernize and streamline laboratory testing and processes : they are connected through CDC to assist with pathogen identification and characterization , are able to provide broad testing at early stages in disease diagnostics , and have built-in redundancies to avoid a single point of failure . As a community , we need to address the tension between the gatekeeping function and the urgent need for broad testing in these situations . Our laboratorians would like nothing more than to make their systems more accessible and flexible . And in a world where most everything is “ on demand ,” why should laboratory testing be any different ? The question is how to be faster and more efficient , but to also gather all the information needed at the start of a new outbreak .

We need to re-imagine our laboratory systems to encompass multiple players and partners in the public , private and healthcare sectors , and the academic community . Not only do we need to do it

Scott Becker , MS Chief Executive Officer , APHL

[ I ] n a world where most everything is “ on demand ,” why should laboratory testing be any different ?”

now , we need to think more globally about what surveillance is required in other countries to provide an early warning . We never know when the next pathogen — old or new — will present itself , and as we know all too well , disease knows no borders . We must be prepared to do everything in our power to engage and support our communities both inside and outside of the laboratory . No one group can do this alone . It really will take all the partners in our public health community to ensure a healthier world through quality laboratory systems . g