Disease knows no boundaries. And nothing made that more painstakingly clear than the COVID-19 pandemic. Information wasn’t always shared in a timely manner across countries and between public and private laboratories.
Sometimes it wasn’t shared at all.
“COVID-19 really forced us to solidify some otherwise loose coordination that was in place,” said Lucy Maryogo-Robinson, MPH, director of APHL’s Global Health program. “But now, thanks to the stress test that was COVID-19 around the world, we've been able to really improve that.”
Where We Are Today
COVID-19 may have shone the brightest light on the lack of laboratory coordination around the world, but there were flickers of problems before.
Consider Africa and the Ebola outbreak of 2014. Not every country on the continent had the capacity to test for Ebola, and when they did, they didn’t always have laboratories equipped to process the tests. Sending those tests to places that could properly analyze them—like the US Centers for Disease Control and Prevention (CDC)—was extraordinarily expensive, further handicapping the sharing of information.
Fast forward to 2024, and things look different, Maryogo-Robinson said.
“We now have, for example, the Africa Centres for Disease Control, and that group, which was stood up only four years before COVID-19, serves as a coordinating body to help facilitate response,” she said. “Countries now have a sense of who has what capability/capacity and who has what resources that they can broker. They also can follow that up with workforce development, so laboratory staff can implement testing that they had never done before. A lot of this infrastructure and coordination didn't, unfortunately, exist pre-pandemic.”
And if coordination was challenging before COVID-19, so was global collaboration.
“COVID-19 highlighted the need for sharing information on both sequencing data and logistical issues—like source availability for supplies and reagents,” commented Kayla Laserson, ScD, director of CDC’s Global Health Center. “Strong coordination encompasses a strong community of practice among public health laboratory scientists to share the application of emerging technologies, best practices and lessons learned. We [CDC] support an open culture of sharing data and solving public health problems within a national public health system and the global community.”
Coordination Challenges
Despite the progress, there’s still an urgent need for improvement, even here in the US, say experts.
“We need to have a better approach to how we engage laboratories, how we resource those laboratories and how we form stronger public/private partnerships,” said Chris N. Mangal, MPH head of APHL’s Public Health Preparedness and Response program.
And it all starts, she said, with sustained funding.
“In the US especially, one of the things we see is that there's a lot of money thrown at public health and at laboratories, either in the middle of a major issue or after the major issue,” Mangal said. “We saw it with anthrax, H1N1 and certainly with COVID. The amount of funding that came through for the COVID response was unprecedented. But what happens is once that public health emergency is over and the threat is at the back of everyone’s mind, those funds essentially go away. We don't have that sustained approach to how we resource laboratory coordination, both domestically and globally.”
One of the places where that funding is essential is in workforce recruitment and retainment. Spending time and resources training people only to have them turn around and offboard isn’t a good business model for any industry or organization.
“A lot of that has to do with salaries and the total compensation of what laboratory professionals are offered,” Mangal said. “Funding the workforce is a challenge we face.”
A focus also needs to be placed on workforce development—and not just technical training on new instruments and techniques, which is undoubtably important, but also on essential skills like communication, leadership, emergency response and advocacy.
“We’ve moved beyond just training in a method or platform,” Mangal noted. “We're also looking at micro credentialling and how to partner with academic institutions to strengthen laboratorians skillsets and knowledge base.”
“More opportunities for laboratory scientists to pursue professional development, leadership growth and placement among cross-disciplinary leadership positions will strengthen the entire system,” added Laserson, who noted the need for laboratory scientists to be proficient in a plethora of skills, from biosecurity to quality management to laboratory governance. “Adequate support staff for ancillary laboratory management and operations are also needed to allow laboratory scientists to participate in a global community of knowledge to build skills for professional development and outreach.”
Maryogo-Robinson echoes those thoughts while also pointing out the need for adequate funding in infrastructure development.
“If we're rolling out Ebola testing, for example, here within the US, there's training that would happen across the country,” she pointed out. “There are standard operating procedures that are pulled together. There is a mechanism for communication and reporting. Operating a laboratory response network efficiently takes time, money and resources, which may be difficult to access in some countries.”
Bringing together bands of highly trained scientists from multiple disciplines can be challenging, acknowledged Laserson, but necessary for the exchange of ideas and insights that naturally strengthen public health endeavors.
“It takes a concerted effort and a culture of integration to ensure that problems are addressed with all perspectives accounted for—laboratory, epidemiology, clinical, veterinary/animal health, data science, response, etc.,” she said. “Every opportunity to see your work from a different perspective benefits the entire health system.”
Another key to global laboratory coordination is policy—how, when and where countries need to sound an alarm on public threats. And thankfully, that policy is becoming clearer.
“The steps it takes to officially declare an outbreak of concern are better understood now,” Maryogo-Robinson said. “Countries are much more aware of how to go about doing it—there’s more clarity. There’s been a lot more education about what constitutes a public health emergency.”
She used mpox as an example. Not too long ago, one African country declared an outbreak. Shortly thereafter, Africa CDC declared it a public health emergency of continental security, and soon after that, the World Health Organization (WHO) declared it a public health emergency of international concern.
Yet even when laboratories have people and policy, they don’t always have products—another roadblock to global laboratory coordination. Supply chain disruptions can make it difficult for laboratories everywhere to acquire assays, sequencers, reagents and other necessary components of laboratory work. And without supplies, surveillance stands still.
“It can be very difficult for global laboratories to get all the supplies they need at any given time,” said Sara Vetter, PhD, D(ABMM), laboratory director at the Minnesota Department of Health. “Sometimes things get stuck through customs, and that’s a really hard issue to work through. Sometimes it's just that a product isn't available.”
What’s the remedy? Enlisting the help of APHL and other partners to develop relationships with manufacturers and convince them that there’s a need in a region is a start, said Vetter, who noted that APHL can help laboratories develop the language they need to communicate with manufacturers about the importance of their mission.
“That’s good for the manufacturers, who can see there’s a market for something, and it’s good for the laboratories and for public health in general,” she added.
The Road Forward
Global laboratory coordination is closer than ever, but silos still exist. More investment in training, infrastructure, data and technology sharing will be key.
“At CDC, we always say, ‘A disease threat anywhere is a disease threat everywhere,’ so we are truly only as strong as our weakest link in the public health system—and that system is global,” said Laserson. “Equitable access to technologies and training, along with a culture of continual quality/learning/improvement and supportive leadership, will yield high quality testing in any laboratory in the world.”
Focusing on a One Health lens will also be essential.
“Oftentimes, our investments are going into human health and we’re underappreciating the importance of how animal health and environmental health impacts it,” Maryogo-Robinson said. “And we often don’t get the full view. We know one affects the other, and we need better communication between them. There’s still a gap there today but acknowledging that we need that kind of dialogue is moving in the right direction.”