Abstract
This is the first of a 2-part special feature that focuses on threat agnostic approaches for the early detection of naturally occurring or humanmade biological threats, which are critical for a robust biodefense and public health response.
Infectious diseases will continue to spread and pose threats to human, animal, and plant health, as well as economic and national security. A critical component of prevention and response to communicable disease outbreaks is early detection of a circulating pathogen. Both in clinical practice and in public health, any methods that enable earlier identification of a pathogen can significantly improve outcomes for patients and the community. Traditional methods for pathogen identification are often time consuming and delay development of therapeutics, diagnostics, and other interventions. The beginning of the COVID-19 pandemic demonstrated how useful genomic sequencing can be for identification of a causative agent. However, significant legal, policy, and technical gaps remain for streamlined implementation of genomic sequencing for widespread and continuous real-time monitoring for infectious diseases. One avenue for decreasing the time necessary for a robust response is to first focus on partially characterizing an agent, rather than awaiting full identification of the agent. Rather than exclusively prioritizing finding the exact species, determining characteristics of the agent and infection could lead to a quicker response. Analyzing host response or agent behavior under certain conditions could be viable options for quickly determining key attributes needed for aspects of an effective response. Such characterizations of novel threats early after emergence could reveal functional features such as transmission route, tissue tropism, cellular or molecular mechanism(s) of action, or susceptibility to available drugs, which would enable better and faster decisionmaking.
Approaches that focus on characterization rather than complete identification could be considered “threat agnostic.” Rather than focusing on any one threat, threat agnostic approaches would be broad enough to cover a wide range of agents because they are able to focus on the attributes of a microbe and how it is impacting the host. Such threat agnostic approaches (ie, that do not rely on determining the identity of the agent or pathogen) show early promise—which will only increase—for improving biodefense and public health preparedness and response.
The 6 commentaries featured in Part 1 of this special feature discuss the use of threat agnostic technologies for biodefense and public health preparedness and response. Specifically, this issue focuses on how surveillance and situational awareness can be augmented by a threat agnostic approach.
The commentaries included span several important aspects of this technological approach at different levels of granularity. For example, Knight and Sureka 1 and Awan et al 2 present a broad philosophical approach to the problem in their respective pieces on biological intelligence and the value of information framework. Also included are tactical pieces: Hick et al 3 focus on the information needed during all healthcare threats while Goldberg et al 4 look specifically at the now almost routine practice of wastewater collection and sequencing as a way to proactively monitor potential public health threats. The piece by Adams et al 5 focuses on what types of information public health agencies would value from a threat agnostic perspective, which complements the article by Morton et al 6 discussing the challenges and opportunities in pathogen agnostic sequencing for public health surveillance and the Global Emerging Infections Surveillance Program.
As a whole, this collection of commentaries can be thought of as laying the foundation of the value proposition of threat agnostic approaches that, when coupled with other more specific pathogen approaches, will engender greater resiliency to infectious disease threats—whatever their nature.