In a pandemic, we are only as strong as our weakest link.

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Once the United States develops these capabilities for itself, there is also a substantial export market, in the developed and developing world, and through security assistance to allies. There is a particular need for surveillance technology constantly monitoring novel pathogens since as we all experienced, they can come from anywhere.

Inequality stifles pandemic response.. Particularly within low and middle income countries (LMICs), which are often neglected.According to data from the World Bank, as of April 15, 2022, high income countries had administered COVID-19 vaccines at about 200 doses per 100 population, in comparison to 22.3 doses per 100 population in low-income countries.

COVID-19 revealed gaping holes in the global pandemic response. Many countries, including  the USA, were not adequately prepared, as evidenced by:

• Shortages in PPE, testing capacity, and medical equipment.
• Low coordination with international preparedness resulting in a lack of information and resource sharing, as well low consistency in measures taken across different countries.
• Dependence on a single source for key goods. The global supply chain relied heavily on a few key countries for the production of PPE and pharmaceuticals, leading to widespread panic and corruption as countries scrambled to secure goods. Most LMICs had no access to PPE as wealthier nations hoarded supplies.
• Supply chain fragility led to delays and bottlenecks in vaccine distribution. Cold chain requirements for mRNA vaccines were not amenable to countries with limited access to cold storage equipment.

Given the interconnectedness of international supply chains, it is critical to develop companies and technologies that  operate globally. Doing so will not only improve international inequity in pandemic-responses, but also improve national security. However, in order to advance in this aspect, there are major technological gaps to be filled in LMICs.  These gaps include:

• Building vaccine manufacturing capacity: Given unpredictable supply chain integrity during a pandemic, there need to be local vaccine manufacturing capacity in LMICs. Manufacturing facilities should be equipped with trained research and development teams that are rapidly deployable in case of emergency. Fancy factories aren’t required. BioNTech set up manufacturing processes for their mRNA COVID-19 vaccine inside standard metal shipping containers which can be rapidly built in areas that lack vaccine-manufacturing capabilities. They are sending the first vaccine factory kit to Kigali, Rwanda in the first quarter of 2023. This modular, ready-build kit approach is amenable to regions that don’t yet have manufacturing capacity and need to build it quickly, efficiently, and affordably.
• Ambient temperature stable vaccines: It is unlikely LMICs will accelerate infrastructure to the level required for cold-chain distribution before the next pandemic. We must instead develop vaccines that do not require cold chain maintenance and are favorable to the environmental constraints in LMICs. These vaccines should also require the least materials for administration (do away with syringes, waste buckets, and anything that presents opportunity for bottlenecks in rapid distribution). For example, a pill format or capsule that can be rapidly developed, distributed, and administered.
• Passive surveillance: In an ideal world, there would be global surveillance infrastructure that enables continuous monitoring of waste for harmful pathogens in every major city. Data would be uploaded and consolidated in a centralized database. This is especially important in highly populated cities in LMICs. Fluid Robotics is using AI and robotics to map wastewater pathogens in Mumbai, India, but there are major gaps in other dense LMIC cities.

Alvea and Microbiota are two two tech-forward companies solving for some of the issues described above. Alvea is building a platform for responding to novel pathogens using DNA vaccines, with a focus on LMICs. Alvea is developing DNA vaccines since they are stable at room temperature (no cold storage requirements as mRNA vaccines require) and won’t face the same challenges of cold-chain storage which limit mRNA vaccine distribution in LMICs. They are working with partners to address the logistical, regulatory, and commercial challenges that have slowed vaccine distribution in LMICs.

Metabiota has a mission of making the world more resilient to epidemics through partnering with local stakeholders in LMICs to prevent, detect, and respond to outbreaks. Their data and analytics technology was acquired by Ginkgo Bioworks, in August 2022, due to its extensive breadth of infectious disease outbreak data that is suited for epidemiological tracking and forecasting. They operate on 3 pillars:

• Disease surveillance: plan, support and execute surveillance activities of humans and animals together with local authorities to manage known, and identify new emerging infectious diseases.
• Capacity building: drive the development of strong disease surveillance and response capabilities by strengthening infrastructure and workforce to excel at biosafety and biosecurity, diagnostics, response, treatment, and more.
• Science: conduct and support local research to understand local disease and epidemic risks.