Anonymous experts on the best ways to fight pandemics

By 80000_Hours @ 2024-09-30T08:47 (+19)

This is a linkpost to https://80000hours.org/articles/anonymous-advice-what-are-the-best-ways-to-fight-the-next-pandemic/

By Anemone Franz and Tessa Alexanian

This is Part Two of our four-part series of biosecurity anonymous answers. You can also read Part One: Misconceptions.

Preventing catastrophic pandemics is one of our top priorities.

But the landscape of pandemic preparedness is complex and multifaceted, and experts don’t always agree about what the most effective interventions are or how resources should be allocated.

So we decided to talk to more than a dozen biosecurity experts to better understand their views. This is the second instalment of our biosecurity anonymous answers series.

Below, we present 12 responses from these experts addressing their views on neglected interventions in pandemic preparedness and advice for capable young people entering the field, particularly as it relates to global catastrophic risks.

To make them feel comfortable speaking candidly, we offered the experts anonymity. Sometimes disagreements in this space can get contentious, and certainly many of the experts we spoke to disagree with one another. We don’t endorse every position they’ve articulated below.

We think, though, that it’s helpful to lay out the range of expert opinions from people who we think are trustworthy and established in the field. We hope this will inform our readers about ongoing debates and issues that are important to understand — and perhaps highlight areas of disagreement that need more attention.

The group of experts includes policymakers serving in national governments, grantmakers for foundations, and researchers in both academia and the private sector. Some of them identify as being part of the effective altruism community, while others do not. All the experts are mid-career or more senior. Experts chose to provide their answers either in calls or in written form. As we conducted the interviews almost one year ago, some experts may have updated their views in the meantime.

Note: the numbering of the experts is not consistent across the different parts of the series.

Summary

Some key topics and areas of disagreement that emerged include:

Here’s what the experts had to say.

Expert 1: Improving PPE and detection technologies

For me, the biggest one is probably superior PPE [personal protective equipment]. I think our current PPE [makes it] difficult to get a good tight seal. They’re much less effective if you don’t have a good fit. And if we really have a pandemic as transmissible as Omicron but more deadly, then we’re going to really struggle to keep essential services open in the absence of well-fitting PPE. But we also need to figure out the business case and the policy case of actually getting people to shift towards new and improved, like reusable PPE, etc.

There’s actually a lot more people now working on improved pathogen-agnostic and multiplex pathogen detection through wastewater sequencing and clinical detection of illness of unknown aetiology. So it’s really a growing field and that’s great. But there’s more that can be done there. I think platform countermeasures, like mRNA vaccines are also important, and host-directed therapeutics. There’s a lot of people working on those. So those are a little bit less neglected, but I think they’re still very promising.

And then I also think just the law enforcement and national security element of trying to prevent a non-state actor from misusing biology is also a really important area.

Expert 2: Enhancing security measures against malicious actors

If you think, as I do, that a lot of biorisk comes from bad people doing bad things, then working in fields that try to stop the bad people — rather than trying to fix the dangerous technology — might be promising. So I think of law enforcement, intelligence work, national defence, etc. And I’ll be keen to see more of it. Making it very costly to have a clandestine weapons program or hunting down bad people trying to do bad stuff in civil society, for example, seem pretty promising to me.

One problem is that if you don’t work in this area, you get no real sense of the efficacy: security services often don’t announce their successes. This came up in 9/11 of people saying, well, how many terrorists have you actually stopped, and how much more do you expect to stop on margin with this impediment of civil liberties? But my guess is I would like more people to work in this area even if they end up being, for fairly obvious reasons, pretty siloed from the effective altruism community.

Expert 3: Implementing biosecurity safeguards and behavioural science

Some promising interventions:

  1. Safeguards on synthetic biology

    a. Integrating DNA screening, like the kind used by the DNA synthesis industry, in a broader range of platforms, such as DNA procurement by industry and universities, computationally-assisted genomic design tools, cloud labs, and biofoundries.

    A tractable problem for a young person: partner with a synbio tool developer and help them implement biosecurity safeguards. Document the technical challenges, the response from the synbio community, and any barriers, resource costs, or inconveniences introduced by adding the safeguards.

    b. A digital credentialing system for life science customers that verifies that a person has undergone Know Your Customer screening. These credentials could be used across life science product and service providers, ensuring that customer screening is conducted to a high and consistent standard and alleviating the burden on companies to do this themselves.

  2. Work on early warning

    a. Economic evaluations of genomic pathogen surveillance in different forms, such as clinical metagenomic vs whole genome sequencing, community wastewater surveillance, and biosensors targeted to priority pathogens. This work should factor in how the cost/benefit ratio changes across countries and communities.

    A tractable problem for a young person: partner on an existing surveillance project and document the costs and benefits, try to estimate how these might change under different settings.

    b. Work to integrate genomic surveillance programs run by different organisations for different purposes that use (or could use) the same infrastructure and skills.
    Sequence airplane wastewater or samples from returning travellers who present to hospital with an illness to better understand which infectious diseases are imported from which countries and how often.

  3. Countermeasure development

    a. Rapid response vaccine design — both in terms of the platforms to do it and the international capacity to make it work in practice. I’m seeing some really promising platforms in development at the moment, so I don’t think this is particularly neglected, but I think figuring out how this would be rolled out internationally in a crisis is neglected.

  4. Behavioural science and communication

    a. A big part of the shortfall between what we thought our preparedness was for a pandemic and how we actually responded was a failure to accurately anticipate how people would behave. I’ve heard people say we need to do a better job of ‘controlling the narrative’ around how governments are responding to a pandemic next time, but I think the public sensed that governments were trying to do this, and this was partly responsible for their lack of trust. We need to do a better job of proving to the public that governments and scientists deserve their trust.

    b. We also need to do a better job of understanding why people make the choices they do. There was some really nice research that came out of the pandemic on vaccine-hesitant people, and their reasons for hesitancy were quite understandable. When deciding how we should communicate with the public to get them on-side for an intervention, we should actually listen to them and shape our strategies around their values and uncertainties rather than trying to impose our values and expertise on them.

    A tractable problem for a young person: do some public engagement projects to communicate about key issues in biosecurity and treat them as a two-way exchange — collect their points of view, objections, and lingering questions. Document how you would update your communication strategy based on the public’s input.

Expert 4: Protecting field researchers and advancing vaccine platforms

An area that’s been very neglected is protecting researchers who are out in the field collecting samples from wild animals, whether environmental samples or biomedical samples. Most countries don’t have any kind of national field biosafety regulations or oversight. And that area is important since it focuses on looking for new potential pandemic pathogens in different countries, and there’s going to be an increasing number of people in the field doing this kind of research. We need to make sure that they have a higher level of protection than we currently do, because that is one of the pathways to bring a novel virus into an urban area.

Dual-use research is obviously a major concern, but there’s a lot of attention being paid to it now, so it’s a little hard to say that it’s neglected. One area that deserves continued attention is vaccine platforms technologies, because these are rightly viewed as a key component for pandemic preparedness. And for example, mRNA vaccines that were created to deal with COVID-19 were incredibly successful. They’ll most likely come out with new versions for other diseases.

But there’s a class of platform technologies based on viral vectors that involves research on immune invasion that could potentially be problematic and also contribute to the development of a cadre of researchers who have the knowledge and skills to do viral engineering. And when that involves viruses from families that are infectious and dangerous for humans, that increases the chance that there are these transferable skills being developed that you don’t have the same level of oversight of. Because the assumption is, well, this is vaccine work, so it’s totally safe and there are no kinds of security concerns here.

But in fact, there are some technologies that pose higher risks for misuse than others. I think prioritising that and understanding that space is important.

The last thing is, there is a lack of appreciation and resources devoted to building up biorisk management capacity in labs globally. Only a handful of countries really score well on biorisk management across the board. But you see more and more countries and labs in different countries developing either BSL [Biosafety level] 3 enhanced or BSL 4 labs that don’t necessarily have the same level of national governance on biosafety, biosecurity duties, and research oversight. Building that awareness, building that capacity in a variety of countries to make sure they’re operating at the highest international standards is really important. That’s largely a public policy intervention that needs a lot of effort to figure out how to get a diverse group of countries to adopt these higher standards.

Expert 5: Focusing on containment and early detection

Overall, I think there is an unfortunate lack of focus on interventions that will be most valuable in a pandemic scenario with a highly transmissible, high-mortality pathogen. Especially interventions that will allow for an effective containment response. These are scenarios where a successful 100-day medical countermeasure mission would not be nearly fast enough to prevent widespread suffering and incalculable loss.

Further, these are scenarios where a successful response will depend on the ability of society to function despite the uncontrollable spread of a pathogen. This type of biological incident must rely on earliest detection and robust protection. Earliest detection means creating a system […] that is constantly surveilling sentinel high risk populations through multiplexed and pathogen-agnostic approaches like genetic sequencing.

Robust protection means next generation PPE with the best fit, comfort, reusability, and affordability to be stockpiled judiciously across all sectors of society, ready to be deployed at a moment’s notice as a form of truly pathogen-agnostic countermeasures on Day 0. Further, protection of shared spaces through community-level protection (e.g. ventilation, filtration, germicidal UV light) will be most important in high-risk scenarios for both civilian and military populations.

These approaches benefit not only by being an insurance policy against future biological incidents but potentially as deterrence against someone from developing or using biological weapons in the first place.

All of these approaches rely on novel technology, but ultimately novel regulatory and incentive structures, to build a robust ecosystem that rewards preparedness over response. Most importantly, the only way for these interventions to move from neglected to prioritised status is for there to be strong leadership demanding action. For that reason, one of the most robust things someone can work [on] is building expertise, reputation, and clout within the public health and biosecurity field.

In the short term, building regulatory expertise especially in the areas of diagnostics could be helpful for the early warning mission to assist with a path forward for multiplexed and pathogen-agnostic devices.

Expert 6: Balancing policy and technical interventions

Over the last year, partly due to the FTX collapse reducing the amount of immediate funding available, there’s been a bit of a shift back away from technical interventions and towards policy. As someone working on the technical side of biosecurity, this is a bit frustrating.

Biosecurity in effective altruism started as a very policy-focused area. Back in 2018, it was all policy, and people didn’t really know what to do with technical folks. Then there was a phase between 2020 and 2022 where the technical stuff was getting a lot of attention. Now it’s shifted back to policy again. On the one hand, this means that if you’re a capable young person, your ability to get mentorship and nice career trajectories are probably better in policy than in technical paths. But I personally don’t have that much confidence in the government to solve the problems without dedicated technical work.

The most obvious technical intervention that is just absurdly neglected is PPE. Everyone has been acknowledging PPE as a top priority technological intervention for biosecurity for several years now. And yet the actual amount of work that’s going into producing pandemic-proof PPE is very small and I don’t think there’s much funding for it from Open Philanthropy. I think we’re just collectively dropping the ball on this pretty badly. Part of the reason for that is people are pessimistic about tractability. I think the counter to that is something like, well, if we don’t have better PPE, then we’re doomed. So we have to try.

I think far-UVC is actually not that neglected. There are bits of it that are neglected, but it’s not that neglected relative to its importance. There is quite a bit of buzz for far-UVC at the moment.

I agree with the general arguments for deprioritising medical countermeasures, and I think that while it would be nice to have more people working in that area, it’s not a top priority from a GCBR [global catastrophic biological risks] perspective. Basically, it just seems very unlikely that these will actually make a difference on the kind of timescale that would be needed. Like, let’s go from the emergence of a novel pathogen to a validated vaccine in 100 days: this is both extremely ambitious and extremely inadequate. And that’s not a good place to be.

One example of a technology that I think is anti-neglected is DNA synthesis screening. We’re actually getting to the point where there’s somewhat acrimonious competition between providers there in a way that doesn’t seem great.

Biosurveillance is another area that’s gotten a lot of buzz. But actually, very few people are working on it from a GCBR perspective, and there’s still a lot of research that needs to be done on different approaches. There are also lots of jurisdictions to implement it in and no one is going to be able to work with more than a few of these. So having multiple different biosurveillance groups focused on different jurisdictions or sampling approaches would be quite useful.

Expert 7: Understanding the bioeconomy

I would like to learn more about how the bioeconomy is growing and what investments the US is focusing on. Who are the people that are thinking about safety there, and what are their concerns? I think that this is very neglected.

I think that people think a lot about public health, and we all want vaccines for all the diseases. But which kinds of vaccines we should prioritise really matters. And then even within people who care about making vaccines for all viral families, making sure that you have platform-based technologies is relatively neglected there.

We also need to make sure things are pathogen-agnostic or can be modified quickly. I think it’s just not how the FDA is set up or how companies or investors typically operate. I think that’s a problem. But even beyond that, the idea of “Are medical countermeasures actually what you want? How important is it to have PPE versus vaccines?”

If you really do think bad actors are the problem, and you think it’s really likely that bad actors will act, then increasing intelligence-gathering is probably really important. However, that is hard to prove or operationalise without a bunch of insider information. And because there’s that information barrier, it’s unclear to me how progress on that is going or what needs to be done.

My understanding is that it’s neglected by the intelligence community relative to how important it should be. But I also don’t even know how tractable things are with current technologies. And then, given all that, it’s a little hard to tell what can be done about it because in the United States, it’s hard to get the government to intervene unless it’s clear someone’s going to be doing something very bad. And so if you could tell someone is making an organism but not what their intent is, then the laws are not structured such that you could intervene. But, the government is good at figuring out what people are trying to do, and that’s generally how they catch people.

Expert 8: Prioritising biosurveillance and risk modelling

I still think biosurveillance is incredibly important and useful in terms of monitoring the creation and evolution of viruses that we don’t really understand very well. Just thinking back to all the things we knew about coronaviruses because we had studied them for 30 years when SARS-COV 2 popped up. I would hate for […] some pathogen that we don’t think about as having pandemic potential to pop up and we haven’t been studying it for a long time.

And it’s not just about data collection but also modelling and assessment of evolving risk. We need to be able to create models that can assess different risks — specifically pathogen transmissibility. And that opens up lots of dual-use and information hazard questions, which I get, but I also don’t see the alternative as appealing at all. The only alternative I can think of is we don’t look, we don’t bother modelling this, and we just wait, which seems like a terrible idea to me.

I would much rather lean forward, have models that predict this kind of risk, monitor that situation globally, and then accept the fact that you maybe have to have some kind of control over access to those models or smaller populations of people who are trusted that have access to those models. I think those are maybe the two things that I would prioritise in terms of young people working in this field: models to predict risk and then global biorisk monitoring.

Expert 9: Increasing biodefense efforts

Certainly, for American and UK citizens and a few other countries like Germany or Sweden, I think working on biodefense is really critical. The defence community hasn’t done enough in this area and I think they’re increasingly recognizing the need. The US Defense Department released its first-ever biodefense posture review, and it elevates the importance of preventing, deterring, and preparing for deliberate threats. Unlike health ministries, defence and national security agencies can accomplish a great deal in this area by working together, obviously also with their partners in the civilian biodefense world.

I have a bias towards public service, government service, because I think that’s an area where we can have tremendous impact. For example, the Pentagon spends less than one-fifth of 1% of its budget on chemical and biological defence. We need to change that. We need to make that a 1% annual investment. It’s going to take people, though, to implement these programs and advocate for these programs.

Expert 10: Integrating pathogen-agnostic sequencing

Integration of pathogen-agnostic (metagenomic) sequencing into disease surveillance and diagnostic systems remains my top choice. I think there is also important work to be done in exploring how production capacity can be scaled. How do container-based vaccine production platforms (such as those developed by Bio-N-Tech) enable this? Should we be pre-positioning such platforms, and what are the proliferation implications of doing this?

It’s also important to further adoption and development of gene synthesis screening technologies globally and integrating these practices into laws and regulations. We should also invest in the development of tools and technologies that enable automated triage of dual-use hazard assessment to avoid needing to train 10,000s people on what we are most concerned about and enabling widespread screening that currently isn’t done.

Expert 11: Bolstering intelligence and early detection

Although there is a growing public health emphasis on addressing pandemics around the world, this focus is unequally distributed. In particular, there is a large gap in pandemic preparedness interventions for natural biological risks compared with deliberate threats, with the latter receiving considerably less attention on a global scale. There is a significant opportunity for capable young people to contribute in this sphere. However, it’s important to caution that, for many of the promising interventions, individuals should not operate in isolation; the complexity of the issues at hand and the potential to cause harm mean that support mechanisms and professional networks are vital.

In terms of specific interventions that I consider to be priorities, prevention is better than cure when it comes to pandemics. One way to prevent deliberate biological risks is through stopping malicious actors from being able to physically create pathogens. As advances in AI progress this decade, the “build” step in the design-build-test-learn cycle will increasingly become an important chokepoint. The most promising method to tackle this is through robust DNA synthesis screening. While various groups have discussed solutions in this space over the years, no government has yet mandated screening and there are still unresolved issues. This presents ample opportunity for a capable young person to help address outstanding problems in this area and turn technical and policy solutions into concrete regulatory actions.

Other areas that are important yet neglected are bolstering the capabilities of intelligence services within governments. There is a need for national security professionals to be better equipped to monitor current and future capabilities of malicious actors. Deterrence by denial is a promising strategy that requires further implementation within various circles. Most of the interventions here cannot be enacted from the outside, but a career addressing biological risks from within the intelligence community would be highly impactful.

When it comes to early detection, biosurveillance is critical, particularly for novel pathogens. However, it’s not just about introducing new technological capabilities like metagenomics. The importance of system design thinking is often overlooked; the technology is only as effective as the system that integrates it. Implementation considerations and system design is crucial, and I believe remains relatively neglected in biosecurity circles. An integrated data system that pools information from diverse sources can enhance our ability to detect and respond to threats early on, preventing outbreaks from becoming pandemics.

Expert 12: Promoting biosafety research

I think if biosafety could have one hundredth or even just one thousandth of the investment that we’ve spent on biodefense, it would be really transformative. We really have no idea how accidents occur and what interventions are effective at mitigating them.

That being said, entering the biosafety workforce isn’t necessarily the right way to address that problem because we have biosafety officers. It’s a reasonable career to go into, but I think folks who are looking to 80,000 Hours probably aren’t going to be super attracted to what those careers involve. It’s a lot of paper pushing and regulation, and there really aren’t careers yet in biosafety research. I’m trying to change that, but so far, that’s not a career path that’s accessible to new people. So that’s probably the real downside there.

There are two ways people become biosafety officers. There are people who come at it from a health and safety background, who were trained on preventing everyday safety hazards like fire and electrical. And then they also took on biosafety as part of that role.

And there are other people who start as bench scientists and decide that they want to leave the bench and go into safety. Generally, the most successful and forward-thinking biosafety professionals are the latter. The ones that finished a PhD or a master’s in biology and then went into safety and then learned how to not have people fall off ladders after that.

So for those applicants in a biology career who think, “How can I make more of a difference than sitting on the bench?” I think biosafety careers are reasonable as long as they can tolerate the bureaucracy that the jobs entail.

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