Over the past century, advances in science and technology have helped reduce the threat from infectious diseases. Advances in genomics, robotics, imaging, geographical information systems, and other areas have changed development of diagnostics, vaccines, and therapeutics. They have also changed processes such as those for health surveillance interventions to prevent, treat, and control infectious diseases. These innovations range from small, community-based pilot projects to large-scale applications of advanced technologies using cutting-edge data analytics. Specific examples include use of mobile health applications to improve service delivery on the ground and to navigate the continuum of care (see Chapter 4); predictive modeling to inform infectious disease surveillance and outbreak response; and the use of unbiased metagenomics sequencing to counter microbial threats (see Chapter 3). Despite these advances, infectious diseases continue to cause significant morbidity and mortality worldwide. Some important questions must be answered to make the most of the innovations of the past decades. Many lifesaving innovations are not reaching those who need them (Roscigno et al., 2012). Even when they do, change can be slow to take hold because of social and cultural barriers, weak health care and data infrastructure, poor communication, limited regulatory and enforcement capacity, and other problems. Wide and lasting uptake of any intervention depends on community engagement (Roscigno et al., 2012).
There is also a problem of incentives for innovation. Some interventions, such as medical product development, have obvious appeal to industry and academia, but many do not. Changes in incentive structure for neglected
areas may be needed. For example, in the United States reimbursement for diagnostics is calculated in reference to the cost to the laboratory of running the test, not the end value of the diagnostic information gained (Dzau et al., 2016). Changes to incentive structures could spur innovation and combat infectious disease.
People today live in a time of unprecedented global connection. The extent and reach of global communications, travel, manufacturing, and distribution systems have improved quality of life around the world. They also allow microbial threats to escalate at a speed that far outpaces the ability of scientists’ or policy makers’ countermeasures. The recent coronavirus pandemic has made this point abundantly clear. As diverse stakeholders from different sectors and disciplines continue to discover, develop, deliver, and adopt innovations to counter microbial threats, collaboration and sharing of best practices are important to push the field forward. More specifically, a One Health1 approach is important for the successful implementation, uptake, and impact of advancements to combat microbial threats.
On December 4–5, 2019, a planning committee under the auspices of the Forum on Microbial Threats at the National Academies of Sciences, Engineering, and Medicine held a 1.5-day public workshop titled Exploring the Frontiers of Innovation to Tackle Microbial Threats.2 The workshop examined major advances in scientific, technological, and social innovations against microbial threats. Such innovations include diagnostics, vaccines (both development and production), and antimicrobials, as well as nonpharmaceutical interventions and changes in surveillance. Workshop speakers and discussants drew from government, academic, private, and nonprofit backgrounds. Specifically, this workshop featured invited presentations and discussions on the following topics:3
1 One Health is a collaborative, multisectoral, and transdisciplinary approach with the goal of achieving optimal health outcomes. One Health requires collaboration at the local, regional, national, and global levels and the recognition of the interconnection between people, plants, and their shared environments (CDC, 2020).
2 The planning committee’s role was limited to planning the workshop, and the Proceedings of a Workshop was prepared by the workshop rapporteurs as a factual summary of what occurred at the workshop. Statements, recommendations, and opinions expressed are those of individual presenters and participants, and are not necessarily endorsed or verified by the National Academies of Sciences, Engineering, and Medicine, and they should not be construed as reflecting any group consensus.
- Detection and diagnostic tools that empower early treatment and other beneficial steps;
- Methods and tools such as predictive modeling, digital platforms, and precision public health, and how they might be best used;
- Methods that account for social and behavioral factors related to microbial threats;
- Communication and structural strategies to improve access to and use of behavior change for preparedness and response;
- Data and modeling insights for practitioners in diverse settings, particularly at the community level;
- Models and indicators that measure the extent to which innovations are successful; and
- Ways to stimulate meaningful collaboration and communication among multilateral organizations, national governments, the private sector, and civil society.
In accordance with National Academies policy, the workshop participants did not venture conclusions or recommend actions, focusing instead on lively discussion. This report summarizes said discussion. Specifically, Chapter 2 presents the workshop’s two keynote addresses, using examples of polio and Ebola virus disease to illustrate how sharp changes can alter the course of an outbreak. Chapter 3 features case studies on global vector control, predictive modeling, metagenomics sequencing, and mobile health diagnostic tools. Chapter 4 examines barriers to timely data sharing and ways to facilitate behavior change among health workers and patients and in communities. Chapter 5 explores strategies for spurring innovation in surveillance systems, antibiotic discovery, and diagnostic tests, as well as regulatory tools to tackle antimicrobial resistance. Chapters 6 and 7 focus on translating innovative ideas to action, with Chapter 6 giving highlights from the panel on barriers to innovation and new forms of partnership and Chapter 7 summarizing the panel on accelerating research and development. Chapter 8 provides visionary statements on priorities for innovation.
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