FEATURE
“ We have to care about what ’ s going on outside our borders . Monkeypox didn ’ t originate here , yet here we are ,” said Lucy Maryogo-Robinson , MPH , APHL director of Global Health . “ Surveillance is really the best tool we have .”
Well into the third year of the COVID-19 pandemic and staring down an uncertain autumn , the timing is right to build on the momentum of support for public health laboratories , to further strengthen laboratory systems and their place in ongoing global surveillance efforts .
“ I think that we are at a turning point now ,” said Sébastien Cognat , PharmD , MSc , head of the Public Health Laboratory Strengthening unit of the
World Health Organization ( WHO ). “ We need to think of how to make sure that all the investments , the momentum , the recognition of the role of laboratories is sustained , … that laboratories are not seen only as a tool to support patient care or as a tool to support surveillance , but truly as a key element .” At the same time , there is an opportunity to harness that progress to integrate efforts across multiple health sectors toward a more unified , One Health approach that is ready and able to detect future threats .
Centering Surveillance
Even as more testing is now shifting out of the laboratory to clinic and at-home testing , public health laboratories still have a key role to play . Ongoing COVID-19 monitoring — as well as experiences with Ebola and , increasingly , monkeypox — shows that laboratory data can be a useful real-time tool for surveillance .
The team trained laboratorians from more than 40 countries and coordinated partnerships with governments , companies and national and international organizations to mobilize support and supplies . They provided laboratories with guidelines , technical assistance and quality assessment .
At the same time , Africa CDC built capacity for next-generation sequencing ( NGS ), mobilizing funding and manufacturers to enable molecular surveillance at a network of laboratories across the continent . In 2019 , just seven national public health institutes had sequencing capabilities ; now 37 countries can do in-country sequencing and the rest can access sequencing support through regional hubs .
“ The next step for us will be how to sustain this program , which means applying these technologies beyond COVID-19 .”
Similarly , laboratorians in Southeast Asia are thinking about how significant investments in NGS infrastructure and expertise can now be used to support genomic surveillance for multiple pathogens and disease threats , including acute febrile illness , antimicrobial resistance and priority zoonotic diseases such as influenza , rabies , nipah virus and more . Disease-agnostic approaches are an important strategy to improve efficiencies and integrate a One Health focus that spans sectors to simultaneously support human , animal , food and environmental health .
“ Right now , we have really good opportunities to develop infrastructure [ and ] human resources that will last to help with other diseases ,” said Ong-orn Prasarnphanich , DVM , MPH , DACVPM , chief of
US Centers for Disease Control and Prevention ( CDC )
Thailand ’ s One Health Branch . One example in the region is wastewaterbased SARS-CoV-2 surveillance , which is being expanded beyond humans to monitor the environment in Thailand , wildlife in Vietnam , and both bats and the animal-human interface in Indonesia .
Many laboratory systems are now leveraging the substantial pandemicdriven investments in infrastructure and capacity to bolster ongoing surveillance efforts . In Africa , for example , when COVID-19 was declared a public health emergency of international concern , only two national laboratories on the continent had validated testing protocols for SARS-CoV-2 — in South Africa and Senegal . Over the following months and years ,
Africa CDC spearheaded an effort to build laboratory capacity across the continent .
A scientist loads samples for testing in Kenya ’ s Kakuma Refugee Camp . APHL collaborated with CDC and the International Rescue Committee to bring molecular testing for SARS-CoV-2 to the camp ’ s laboratory ( see story on p . 18 )
6 LAB MATTERS Fall 2022