And welcome, everyone. Wherever you are to today's conversation, which is titled 21st Century Technologies for Tackling 21st Century Pandemics.
Thanks for joining us. This event is part of a series of talks organised by the Oxford Martin School called
Building Back Better Lessons and Opportunities from the Cave at 19 Pandemic.
My name is Oliver Pipers. I'm Professor of Evolution and Infectious Diseases at the Department of Zoology at Oxford University,
and I'm also a co-director of the Oxford Martin School Programme on Pandemic Genomics.
I am absolutely delighted to be joined in conversation today by Professor Christophe Fraser.
Cristoff is professor of infectious disease dynamics at the Nuffield Department of Medicine,
and he's a senior group leader in Pathogen Dynamics at Oxford University's Big Data Institute.
Christophe is a world leading expert in infectious disease epidemiology in the mathematical modelling of epidemics and in pathogen genomics.
He originally trained in physics before turning to mathematical biology after his PHC.
And before joining the Big Data Institute at Oxford in 2016, he was a professor of epidemiology at Imperial College London.
Now, Christopher's applied his expertise to numerous epidemics,
including the H1N1 pandemic influenza in 2009 and the West Africa Ebola virus epidemic in 2014, 2016 and more recent years.
His team is particularly focussed on HIV in Africa and Europe.
This year, Cristoff and his team published the first paper that suggested an important role
for contact tracing smartphone apps and controlling the Kofod 19 pandemic.
And he has provided scientific advice to the NHS and Google to support their development of smart phone contact tracing apps.
So before I begin our conversation proper. I have two administrative announcements to make.
For all watchers and listeners. Firstly, there'll be a question and answer session after our conversation.
And if you'd like to ask a question, you need to be watching via crowd cast.
If you click on the ask a question button and that's towards the bottom right hand side of your screen.
You'll be able to add a question there. If you're watching on YouTube, I don't believe there's any way that you're able to feed in a question,
but I hope you enjoy the conversation nonetheless.
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OK, with the introductions out of the way. Let's begin that conversation.
And, of course, that the pandemic needs no introduction. It's become a defining event of the 20th 21st century.
We've been in a race with a marathon, now with the virus.
So we're trying to trace and prevent transmission faster than they occur.
Some countries and regions have managed to get ahead of the virus, whilst others have struggled to keep up.
And today we'll be discussing whether new modern technologies can provide alternate ways to
understand virus transmission and to get ahead of the virus and control the epidemic spread.
So what are the opportunities and challenges in applying new technologies such as smartphone apps or pandemic at a pathogen genome sequencing?
And can we deploy these tools fast enough to make a real difference to public health?
So to set the scene to begin with, I think it be good to talk about the history of the study of transmission as a scientific pursuit.
So before the current pandemic,
how did we go about understanding where transmission occurred and how it occurred and using that information to control spread?
And there's a number of linked terms here that I think might be useful to introduce,
such as the difference between contact tracing and outbreak investigation.
So what do you think that defining events were in the history of the study of transmission, Christof?
Well, sir,
the most famous outbreak investigation that everybody studies in and introductions to to do epidemiology is is is John Snow in London and Soho,
who is investigating a cholera epidemic, know arranging cholera epidemic.
And he collects data himself around to find out the source where people were were were getting sick from.
And what he found by mapping them out and sort of produced this very beautiful map of of time and space
is showing the cases of the cases where we're very clustered around a single drinking water pump,
the Broad Street pump. And he also found that there was a few unlinked cases.
But when he went to interview people, he found, you know, that the that that the cases that were far away,
people were coming to Broad Street pump because because that's where they they liked the water from.
So so that was a classic outbreak investigation. Well, you you ask a number of people who are suffering from heart disease, you know,
a questionnaire and you look for a common denominator and that common denominator points to it being a source.
So so that's kind of an outbreak investigation, which identifies a common source, which is, you know,
a closed space and time where people have been exposed to infection and acquired infection and went out.
And first, there's sort of one of the later founders of of the study of epidemiology and
who was the head of the U.S. Public Health Service in the 1918 pandemic of,
you know, the famous Spanish flu pandemic. He had systematised John Snow's approach.
So so he would travel around the U.S. sort of investigating what water borne diseases
and he would produce these maps and he would invariably find find their source.
Now, contact tracing is is a little bit different. It's sort of, you know, in the early days of this, what it was done a lot for, for tuberculosis.
And it was done, you know, for for for for cholera in households.
And that was done at actually went home come first, did it in the 1918 flu.
You know, you go around and you look at the cases, you typically see clustering of cases in and households.
And basically the point of that is that if it's people who are in close contact for a period of time,
you might not be able to attribute it to a particular place.
And it may only be a small number of cases.
A contact tracing is about mapping out the contact events that link ball and to break the transmission chains,
typically by by quarantining, quarantining people at home.
But they're kind of linked together because if you imagine, you know, and we saw this a lot in Ebola,
we saw this in this large epidemic, if you imagine a superstar Supersport.
And let's get this president is kind of where contact tracing meets outbreak analysis.
That's a single person, not a single place. You know, it can be in a food market.
It can be in a church. It can be in a concert somewhere where people aggregate and where where essentially.
And a lot of people came into contact with a single person causing causing an outbreak.
So in all cases,
it's about finding the source case and using that to to contain the infection while disrupting as few people as possible in the process.
So in the case of the famous cholera outbreak that John Snow investigated,
there was a fairly direct public health intervention that came from his his identifying the outbreak, which.
Yeah. He removed the Broad Street pump so that people can drink water and people still look at the time series.
And, you know, just as just as we see now, people argue whether it was actually already going down before before he asked the pump.
Yeah. You you hit. That was an ongoing exposure in a place.
And you you you close the Broad Street pump.
And that direct analogue of that was if you look back at the start of this year, the exposure in the food market,
seafood market, and we're hattan, which was the first time that we heard about it.
And it's not where we think Kevin starts. And we think probably.
I mean, you know, you can comment more on on on on the origins from your from your own work.
But we think it started a few weeks before. But in the seafood market, it was a very similar situation to John Broad.
Broadstreet pump is, you know, people were coming to the market.
It had these had these strange symptoms that were showing up in hospital.
And similarly, people went through the question as and what did they have in common?
They all went shopping. And this at the supermarket and the first intervention with closing the seafood market.
And then, of course, now, you know,
we have lots of molecular tools which we're able to say this was a this was a new virus and people were being exposed by contaminated surfaces.
And that's safe at markets. So theoretically, it's exactly the same approach that John Snow took.
So it sounds from what you're saying, there's this sort of continuum and it's contact tracing, an outbreak investigation layer on this continuum.
And for some pathogens, are they better controlled with outbreak investigation or other pathogens better controlled through contact
tracing and other characteristics of pathogens that make them better controlled by either of those two options?
Yes. So I think there are two two really important characteristics which determine, you know, whether you want to focus the contact tracing.
You're really looking at the person and the outbreak investigation. You're looking at the source, which might be a person at that point in time.
But it really depends on the route of transmission and the extent to which you have super spreading.
So if you imagine if you look at it to some extent, all pathogens have surface spreading, but some more so than others.
So. So if you look at flu transmission, the some people, in fact, are more likely to infect others.
Some people are more infectious than others, but it's it's not massively heterogeneous.
I mean, we characterise this in an earlier works, even going back to us on that date of 1999.
We see a very consistent message that it's sort of it's it's close proximity contacts
predominantly through through droplets and aerosols and predominantly three,
three, three children at schools and then children when they come home.
But the that you don't see these really large outbreaks now, you see at the other end of the spectrum, Sovs is somewhere in between.
If you if you look back to 2000, 2003, it kind of causes really big outbreaks.
There was a big outbreak in a hotel in Hong Kong.
Know a couple of hospitals had outbreaks involving 200 people that were, you know, at a single point in time.
There was a block of flats. So it contaminated.
And so that's that's sort of, you know, where you want to be doing both contact tracing and outbreak investigation.
And then you look at sort of the environmental sources of cholera.
So, for example, there was a really big outbreak of cholera in Haiti recently after the earthquake.
And there it was really linking it back to a contamination to get to a source of contamination.
So. You know, something like flu or maybe HIV, you're not going to look for four for places and sources,
you're going to focus on the people cowritten source somewhere in the middle.
And and and Connor probably is it's really focussed on environmental sources safe.
I think both of these are what we might call traditional shoe leather epidemiological methods or shoe leather and clipboard approaches.
But as as I alluded to at the beginning, this idea of a race between between tracking transmission and the virus,
creating new infections that approach a contact tracing doesn't scale particularly
well once we get to tens or hundreds of thousands of new infections every week.
Which brings us to our main theme, which is that can technology help us in this race?
And the two technologies I think we're going to mainly talk about today are using smart
phones to help notify people of that of the risk of infection and using genomics to
look at the genomes of viruses and pathogens to understand how they have been spreading
in the past and say let's let's first have a talk about these two new technologies.
They might not be familiar to everyone listening and explain briefly how they work.
They should start with with a smartphone apps. Okay, so where there is nowadays, we have we have smartphone apps for or for everything,
but these smartphone contact tracing apps where they rely on is is the technology low energy Bluetooth to measure the proximity between phones.
So if you if you have two people who are carrying smartphones, spend a certain amount of time together,
there's an there's an exchange of Bluetooth signals, which is basically just a handshake.
And this is this is a technology that's been there for a while. It's for example, you know,
when you use a find my phone function and that's that's how your that's how
your phone is is funnelled through this sort of very energy efficient states.
And so what happens is, is, you know, if if we were meeting in person rather than virtually our phones,
would we'd exchange these handshakes and based on the signal strength and so on and some other characteristics, we can work out that distance.
You can work out actually first signals being scrambled, you know, like in a bus, for example.
So you can get a pretty good idea of of whether the risks the event is something that could give rise to transmission.
And then the nice thing is that if or the useful thing is that if two days later one of us test positive for Turbit,
then the other one gets a notification.
And that can be an entirely anonymous notification that you've spent a set amount of time in an in close proximity with somebody.
Now turns out. So this is sort of a window in the past. Now turns out to be infected and you get instant notification.
And in that gain, speed is is absolutely critical because the issue which we saw we've covered really early on,
which is which is still really problematic, is, is that a lot of transmission occurs in people before they get characteristic Turbit symptoms.
So by the time you're looking for contacts to break chains of transmission, you know,
the you're really in a race against time where on average you've got about two days between,
you know, developing symptoms and the contact being notified. And then, you know, that's an average of quite white distribution.
So, yeah. So the key benefits over shoe leather epidemiology,
one speed of notification and to the fact that this system will continue to work perfectly well depending on where there's 10 infections or 10000,
and it takes just as long, I seem to notify a thousand people that they might be at risk as it does to just notify one person.
Absolutely. Yeah. So it's it's it's instantaneous. I mean, there's there's it's not quite instantaneous.
So, for example, there are some filters that are built in to make sure that the system stays to cure, you know, that that it can't be gamed.
En masse and so on, which is really important, I think, with with digital technologies, but basic needs is it's very scalable.
And if you start to imagine that coupled with these rapid point of care test, which can now be manufactured antigen tests and in the future,
you know, we can mount Manufaktura antigen test, vote for Enea and your antigens for future pathogens.
You could imagine getting tested, you know, getting a result within half an hour and then notifying contacts, being notified later.
But at this point in time, it sort of speeds the contact tracing process.
It's also it's also the other benefit is that it helps when, you know, you don't necessarily you don't necessarily take down the name of everybody.
You know, if you spend some time at the or the from the person who was sitting behind you closely in the in the adjacent table.
Now, you know, we've seen through it through the pandemic that restaurants are supposed to take people's names.
And in fact, you know, they then sell out some of them so that they could make money.
And so. So this is a much more privacy preserving. And, you know, it doesn't care whether you know, the person you have contact with or not.
Is there a key threshold in terms of the number of people that need to be using it for it to be effective?
Or is there still benefit from it, irrespective of the take take-up?
So there's benefit from it. You know, as soon as you have one group of friends or a group of colleagues or a group,
a big group of co-workers who meet, there's there's a protective effect for for that sort of bubble of people.
There's two ways of thinking about it.
You can either think about it, you know, from the perspective of the the the chief scientific adviser or the minister of health,
you think, what do I need to to protect, you know, the whole population?
And there is a protective effect that probably once you get past about 15 percent of the population who are users in the UK,
we're sort of over 30 percent, something like 40 percent of adults, and we're well above that threshold.
But if you think about it as an individual user, the threshold is, you know, other people you come into contact with also using that.
So it really only depends on what's happening in your in your neighbourhood in terms of that direct sort of benefit.
Okay. Let's let's briefly introduce listeners to Pathogen Genomics.
And here, of course, we're talking about virus genomics. And this is a topic that both you and I have spent a lot of time researching.
So some but not all of our listeners might know that infectious microorganisms such as bacteria and viruses, undergo quite high rates of evolution.
And that means that the genome or the instruction set for that virus or bacteria is often slightly different in each infected individual.
And if you use genomic technologies to read that genome, you can observe these differences.
And the interesting thing is that they their differences accumulate during the chain of transmission so that the pattern is shared.
Differences amongst different infections reveals the history of transmission events.
Is that pathogen that's been spreading? Now, that's seems a little bit remote, I guess, from the process of transmission.
But but does it contain information about transmission that the other sources of information that we've been talking about, don't you?
Absolutely. So certainly imagine, you know, maybe some person who's infected, who you've sampled, being able to work out.
So if you're investigating a cluster, for example,
you've got a cluster of cases in a hospital or a cluster of cases around a school or a cluster of cases as appeared,
you know, around a car, then being able to being able to say, oh, these infections actually linked.
You know, is there a surface spread even as happened here?
Is there something for me to understand or authorise you being able to reject transmission dredges?
Well, you know, yes, there are a few cases here, but they don't seem related to each other.
They just happened to be in the same place at the same time. You know, it is critical to your understanding.
And if you're going to if you're going to do something like close a school or close a workplace,
you know, and you want to do it quite early on the basis.
The because as you're saying, because this is always about speed.
So, you know, the metaphorical Broadstreet pump, you want to save prevent infections by removing it as quickly as possible.
So so the quicker you get information about whether you're really seeing your outbreak can be, the more effective your action is going to be.
I mean, likewise, I don't know if you want to get this letter as a study looking instead of school level or country level,
you know, the number of introductions and into the into the UK.
You know how that worked out. Tell us about.
Yeah, I think you're right that one of the key benefits of this data is the ability to determine
the number of different chains of transmission that are in a particular location.
And this year, during the covered pandemic in the UK, genome sequencing has been widely used across lots of settings and in hospitals.
Very important if there is an outbreak occurring to determine where this is just one outbreak or multiple.
And in fact, it might be affecting different wards of different parts of the hospital into the need one outbreak response team or two.
And typically going all the way back to John Snow in the Broad Street pump,
you were saying about how people had come in from outside and being been infected.
So in in traditional epidemiology,
there will be the idea that cases that are near each other in space and time are likely to be linked through transmission.
And that's usually, but not always the case. And if there has been movement of individuals, whether within a country or internationally,
that can produce infections close to each other in space and time,
but they're not actually linked to each other in terms of a close chain of transmission and pathogen genomes have very.
Powerful information about Rissole think that and our work was looking at the
number of times that size Cavey two has been introduced into the UK from abroad,
particularly during the first wave in early summer.
And there was some very interesting dynamics, both a number of introductions, which was at least 13.
Fifteen hundred, and almost certainly many more. But also the rate of of change of introductions changed over a matter of just a few weeks.
And also, the source countries have where introductions were coming from was very dynamic as well.
And that was all information that I think pretty much any pathogen genome sequence data could could resolve.
So I guess we were already starting to sort of explore that the new types of information that these new technologies can give us.
I mean, we're mostly talking about smartphone apps and and pathogen genome sequencing.
I think that's some more that is perhaps even more experimental that that hasn't been fully utilised in this pandemic.
But that could be really important in the future. And those are wastewater surveillance.
This is a genomic technology, but it is slightly different, actually,
being able to detect and quantify the number of cases either in the region or a building
or a district through looking at the presence of the virus in wastewater and sewage.
And secondly, it's very interesting, recent work on on using smart watches and fitness trackers as potential measures of people's physiology.
And in fact, if you can, those detect whether somebody is infected or not, do you think these are potential tools of the future?
Absolutely. Because, I mean, again, you know, in the name of the game is is speed.
And just to sort of comment on your on a really interesting finding about the number of introductions early on in the U.K.,
I think we're now in a difficult situation, obviously economic then epidemiologically,
where we're just now obviously want to prevent infections without, you know.
But the economy in its turn to keep on going. But I think well,
what's really clear is that there was an opportunity early on to to take sort of take
the economic shock for a short period of time in terms of of movement restrictions.
Right.
To this start not letting all of these chains of transmissions sort of sort of get pounded around the country and really use more limited capacity.
Was told to contain the first few outbreaks and then to build up that capacity.
I mean, there's been a lot of talk about control measures just delaying the epidemic, but that's kind of the whole point.
If by delaying their pandemic, you know, you have that you have the ability to increase capacity and then actually open up things later on.
I think economically and epidemiologically, you know, that the early action is is Rubini.
And, you know,
it's not a theoretical argument because very clear that that's one of the signatures of the countries that have come out of this relatively well.
And again, the early notification.
I mean, at the moment, you see the pandemic starting with a cluster of cases, essentially by the time you see the first surface bird event.
But you can imagine you could imagine that with sequencing, sequencing as is sort of as very specific and it's it's very agnostic.
So you could see very quickly, you know, people come and Mora's Børge infections.
If this if this looks unfamiliar, sequencing is now getting sort of cheap enough that it can be and it is being worked and
sort of standard diagnostic practises and because it's rich in information is quantitative.
It tells it how much of a pathogen there is.
It gives you something, some indication about what the best way to treat these particular cases and so on.
So I think there's lots of future there. And and Westwater surveillance as well.
You know, again, it's anonymous and that allows it to count how many how many pathogens are circulating.
The wearables, you know, again and gives you that speed.
So you could imagine you can imagine at an indication we probably don't all want to be testing for everything or time.
But you can imagine an indication that would tell you, yes, you should get tested.
You know, and anything that allows allows you at the right time to get tested and then to take appropriate action at a personal level in terms of,
you know, managing your risks, not transmitting to your family members,
not transmitting that to people who are vulnerable and allows contact tracing to happen to people.
You know, contact tracing is all about disseminating information so that people can take appropriate, appropriate action on an infection spread.
So so digital technologies, tremendous way of disseminating that information and organising that information.
And the genetic technologies really allow you to to differentiate between the different pathogens that go on together.
And I mean, it comes back to our analogy of a race that no matter what the infrastructure for tests traced and an isolate is,
it's always going to have a finite capacity. And we've been able to build the capacity of that infrastructure through time.
It was initially too small in the U.K. and it was potentially great in other countries before the pandemic occurred,
which is why they were able to deal with things better. And.
All of these technologies are helping us increase our speed in this race and to try and keep up with the virus.
And do they work synergistically? I mean, I'm looking towards a super optimistic future where actually some of these technologies start to link
in with each other and that that combination would be vastly more efficient than each on its own.
Yes, I think so. I mean, as I think pathogen genomics, you know, will get linked into into emerging diagnostics because I mean,
it probably is just to do the the the pricing.
If you look you know, if you look at the cost of running a standard microbiology or infectious disease laboratory in a hospital,
you know that the progress in sequencing just just makes it competitive on price.
And you just you just start stacking up all of the data that you can get from from this.
This this one sample. To me, it kind of seems inevitable that that things will will go in in that direction.
So that's just what smart phones are all the way as a patient, you know.
That way, you get information in a really usable manner.
So if I if I get information on anonymous information, you know that you should test for X or Y.
That's very useful. Of course, you know, not everybody has a smartphone.
It's still we're in the age of apps, but there's still sort of a quarter of the population who don't have a smartphone.
And so, you know, this is the direction of travel.
But we need we need multiple solutions. So if you look in the case of pivot, you know,
smartphone technologies would not have would not have helped with the cab switch account for a or a very significant fraction of the mortality.
So it's said, you know, and. We we still need we still need care and infrastructure and so on.
But an infectious disease control, to some extent, you never lose.
Right. Because if you're if you're staying, if you if you're preventing infections amongst, you know,
people who are happy to use smartphones and apps, you're also preventing infections spreading out into the hospitals and then into the care.
So because. Because we're so connected.
Great. I was thinking of exploring a bit further distinction between the message, you know, Mick,
virus discovery for for new pathogens that we haven't seen before vs. the kind of testing that we have now,
which is very specific testing for a known disease that we're trying to track the spread of.
I'm going to hold that and maybe come back to it later if we if we have a bit more time,
because we've talked about the the best case scenario is that the synergistic effects of these different
technologies really enabling us both for this pandemic in future pandemics to get ahead of transmission.
Now that the use of these technologies isn't without its own challenges,
and many of those challenges do relate to people's concerns over the use of some of the data that they're generating.
So, I mean, can you explain, a have done to a certain extent,
but in a bit more detail how the privacy is maintained during these these these smartphone apps?
How would you make somebody confident who is a little bit worried about using the app that it's that it's it's a private privacy secure thing to do?
Yeah. So the contact tracing apps that have been rolled up through the Google Apple operating system converged on a privacy first design.
And that meant that the you know, the exchange when you have close proximity and then so.
So the two of us sit next to each other and have a chat.
We exchanged anonymous keys and those keys rotating.
So they can never be traced back and they stay on your phone.
And, you know, if I later get diagnosed at the set of keys, you know, get circulated.
But essentially, there's no central server.
So essentially, they get your phone and cheques up on the list of people who've who've been diagnosed and the anonymous keys and says,
oh, you know, I was in contact with this key and it notifies you of that notification and doesn't doesn't go any further.
Similarly, the NHS up has it does both contact tracing and outbreak investigation.
So so does outbreak investigation. But encouraging people to just Carnamah QR code where they go to a location where an outbreak might take place.
So that's sort of a tool to prevent or to respond to a super spreading event associated with particular locations.
But those QR code scans again and not uploaded anywhere, they stay on your phone and, you know, at the moment to preserve privacy.
And you can delete those. But the contact tracing of manual contact trace call when I called her up.
Can I ask you to read off the locations of your QR code and you're in control of that information in future?
That can be simplified. But I think the person it was was meant to turn to do that.
And I think, you know, I mean, the the the there is quite a complex issue because I think we do want to.
We do want to and we can live in a world where we're not being surveyed all of the time for for everything.
And you can easily imagine them. And there are already abuses of data at the moment.
You know, there are there are apps, non-governmental apps or private companies, you know, who who install.
You know who. I'm sorry, pulling data from from from marketing apps and collect that data and collect a lot of that information.
But with you may not be aware about so. So privacy is a really important issue.
And, you know, the in terms of governments, we don't want, you know, a massive manhunt for everything,
but we want good information to be collected selectively for in situations like emergencies, you know.
So it's a smartphone. Mobility apps mobility data has been very useful when there are disasters, earthquakes, that kind of thing.
And you can see you'd be quite happy if somebody was looking at your smartphone trace.
If you're trapped in a building after an earthquake and you know, and similarly,
you could argue that in pandemics or certain types of data, which would be which would be useful, but it was felt that this is.
You know, the precedent here is to have gone for privacy first design, and I think I think, you know,
that that the system that's been developed is very effective in terms of being able to make sure
that that personalised information meant to turn to contacts and outbreak situations gets to you.
But it does mean that so they're being able to find out what type of contacts or
give rise to infection is not really within within the purview of this stuff.
So, know, we've had to the shoe leather epidemiology that this has focussed much on function.
But I think, you know, it's clearly a compromise, right?
Between what? That the technology could potentially do a lot of that potential isn't being met by the current apps.
But that's a necessary compromise in order to ensure that people feel confident
to use it and that we can still get the benefits of a recently high take-up.
That's right. So. Yeah. And I think, you know, that's the way it was designed.
And I think it's a really good design at this point in time.
So it will be interesting to see in the future whether in a into a pandemic period,
whether people's socially as a society and individually people seise on on the value of this data and and the risks to their data change.
I mean, it's true enough to say that that considerably more personal data is used to to put an advert selling you a car
on a Web site than it is then it's being used to give you notifications through the smartphone tracing apps.
Definitely. There isn't a great deal to touch on in terms of pathogen genomics, I think in terms of patient privacy,
because those genomes are generally shared in entirely anonymous way.
And just just to clarify, these are not genomes of the person who has been infected.
It's the genome of just the infectious agent itself, which tends to be quite, quite small and short.
I mean, there have been instances where that kind of pathogen genomic information is used to.
Try to answer whether a particular person has transmitted an infectious disease to another person.
And here I'm thinking about the U.S., its passage in genomic data, say in a criminal trial where somebody has been accused of deliberate infection,
often of HIV, but sometimes other pathogens that's infecting somebody deliberately, which can be a criminal act.
So it's worth noting, and I think there's a lot of work to be done,
both scientifically and ethically to to enable the best use of pathogen genome
data whilst maintaining the same kind of privacy that we've been talking about.
I agree. And I think I mean, that is also true in healthcare acquired infections.
I mean, you can imagine, you know, this is clearly useful.
So you brought up the example of when you have two outbreaks in different parts of the hospital.
You know, it's really important for the hospital infection control team to know whether the same outbreak and there's some
there's some way in which the pathogen is going backwards and forwards between these two locations in the hospital.
Or if that, too. If there are two separate outbreaks, because then again,
you want to investigate and you just want to make sure it doesn't happen again or doesn't spread to a third location.
But in an era of litigation, that's that's you know, that can be that can be quite a fraud investigation.
And but I think the I mean,
the underlying issue is we need to essentially we need to enable if we need to enable the positive uses which are that prevention,
which are getting the information mixed.
On the other hand, you know, the kind of question as an epidemiologist and I'm sure I'm sure you feel the same, people always ask me,
you know, this virus transmitted here is a virus transmitted that, you know, how safe is it to go to the supermarket?
How safe is it to go to the park in our house? And I should disclose. I should disclose.
We closed. You know, what about somebody jogging past Mayo?
You know that there are all kinds of information. And as the saying, you know what, I'm working on HIV.
People always want to know about, you know, is the virus transmitted in this way or that way?
And the way we we answer those questions is by collecting data on transmissions that have happened and limiting for the common pattern.
And we tried to do that. You know, obviously you can well design studies, but those well-designed studies involve,
you know, people undergoing that that that that they life, as it were.
And you have to collect the data so that you don't keep on reproducing the behaviours or the patterns,
you know, and it can be very enabling because it was collecting data about schools,
which allowed us to say that by and large and schools in the case of covered were not going to be the major drivers of the pandemic.
Despite that, you do have cases in schools and it can be distressing.
But you don't get these explosive epidemics, so you might get another sort of simit similar settings.
We've seen much more difficult Tehran University halls and involving older children and about and in workplaces where people are very close together.
So do factory work, especially if if it's sort of within that confined situation.
Yeah, it's interesting. Our transmission is a social, even an intimate act.
It involves people usually being close to each other.
And and scientifically, it's really important to people researching a very cognisant of that.
And I think I think scientists working in infectious disease have a lot to learn from people working in law and sociology and ethics to
understand how we can get the right balance between getting the real utility information about transmission that you've just mentioned,
but also balancing that with with people's real, real and genuine concerns about this.
But as we mentioned, information, people really want wrong information.
And people, you know, if it is information, people always ask you again and again.
And they're surprised that that information, as you know, isn't as precise as they want about the roots of transmission.
Unknown isn't as plentiful as they were.
People want to know very early on, you know, how protective masks to infecting other people and how much the masks and protective.
And again, you have to study pogoing in everyday life.
So there's sort of three ways of thinking. One is. You can have up to an opt out.
So some people opt in to sharing these data to a certain approaching people.
Then you can think like with the contact tracing out, there was a lot of progress made in terms of privacy,
preserving algorithms to wherever it's possible to do what you want.
And to use algorithms. So so, for example, you know, your computation, the the epidemiological question, where is transmission happened?
It might be that I write or somebody else writes a piece of code, but that piece of code gets run on your phone.
So the answer the important answer, you know, never leaves your phone.
The data never leaves your phone. But the computation is a bit that travels around and that gradually builds up a statistical answer.
And then the third aspect is,
is simply that there are some people who are health researchers who are governed by a code of conduct and who don't misuse your data because,
you know, they're not open nature.
This sensitive data, just like clinical records. You know.
I think I mean, it's been an absolutely fascinating conversation, it's been wonderful talking with you, Cristoff.
Oh, we could we could go on. I was going to ask you sort of what three things do we need to do to prevent the next pandemic?
Perhaps we'll leave that for one of the audience to pose as a question.
So thank you so much for that for that fabulous conversation. And let's take a look at some of the questions that have come in.
So I am just starting to negotiate the.
The question window on this broadcasting system.
OK. So we have a question here with four upvotes from none other than Charles Godfrey, director of the Oxford Martin School.
And that question is which technology will help cope with?
Each of these challenges has been accelerated the most by Caven 19.
And I guess I could add to that which which needs the most acceleration for the next pandemic.
Yeah, well, I guess we can both give an answer to that.
I mean, clearly, one of the things I take away from from looking at the way things are progress is preparing in advance,
you know, is really useful, and that the speed of the of the vaccine development didn't come from nowhere.
The vaccines that were developed were developed. So that was the most impressive story so far.
For sure. But it was built on on 20 years of planning.
You know, the Coalition for Epidemic Preparedness was well, you know, and go and so on.
International organisations that looked and and committed governments to donate large amounts of money.
With great foresight into into generic platforms.
And that the vaccines, the orks of vaccines, the Moderna, the MRN vaccines,
the usual vaccines which had been explicitly designed for for for a pandemic situation.
And they've worked a certain tremendous.
But still, you know, if we could if we could know, experience what we've experienced this past year while waiting for the vaccine, that would be good.
I think digital technology in all its forms, including contact tracing, really has come forward.
And I'm pretty sure that, you know, we're now in a situation where where something could be deployed.
There was really good could be deployed right to the start of an outbreak with
we're very applicable sort of tools that really would make a difference.
And I think rapid point of care testing, you know, involving sequencing.
So, so, so on the technologies side and in my group and and together with with colleagues
with we're sort of working on getting those rapid point of care tests.
So we've been working on this in the context of HIV. But the platforms are very general.
So when you do that rapid test from coma as a saliva sample or a blood sample and a very small,
very small sample, and you get a result of preliminary result there and then you go and confirm it.
But but doing sequencing, so, so rapid point of care testing, immediate dissemination of the information across the risk network,
you know, through it, through outbreak analysis, through outbreak information and contact tracing.
And I imagine that could be done much more quickly in the future.
Yeah, my my pick for my pick for the future would be, I think, the wastewater surveillance.
I mean, it's starting to be used now, but in a in a.
Still a fairly experimental way.
But if we could get the infrastructure and the analytical capability to pretty much be screening wastewater and other types of environmental samples,
perhaps air filtered virus or bacteria from from large venues,
then we have the potential not only to quantify an outbreak better when it's when it's been detected,
but also to detect a new pathogen that emerges in humans right at the very beginning of an outbreak when there perhaps are any 10,
20 or 100 people infected. And as we know, speed of response is everything.
And to nip to nip an epidemic in the bud. Yeah, and I agree.
I mean, that sounds that sounds phenomenal. Huge, huge technical challenges both both in terms of basic science and in terms of operational research.
I mean, everything from the amount of rainfall, the the water flow in the sewers,
Fatburger and everything comes into whether the numbers you get out of reliable or not.
I mean, I guess the other question where we're going to, you know. Figure out over the next four years that sort of predicting out of, you know,
the multitudes of viruses and bacteria, most of which are entirely harmless.
You know what other things to have a pandemic potential?
Because, I mean, I think as far as like Corona virus, didn't, you know, it was reasonably plausible.
A high risk pathogen. I mean, the most corona virus is not that distantly related.
And that's been sort of regarded as possibly the number one threat, you know, globally.
So we can probably make why do you think we can make quite a good job in terms of knowing what we're looking for as well?
And we're looking so so this is really interesting academic debate happening right now
in terms of whether it is valuable to invest large sums of money in attempting to
identify and discover all of the viruses that are out there in other species and environment
and to get some information about them before they potentially jump into humans.
I mean, the other thing I like about your wastewater proposal, I mean, I've done Tchula.
There's always going to be a role for shoe leather epidemiology on target.
I mean, the sort of human investigator, you know, coming relatively agnostic, me wearing that shirt,
wearing out their shoes because they're walking everywhere and writing on their notepad.
But the more information they have coming in and the more they know where to look and the more they get to look early on,
the better job they can do so. So there's kind of tremendous synergies.
I mean, if you imagine, you know, your you've got a new virus and you've got your West, you look at your wastewater nationally and, you know,
you've you've you've been looking at an outbreak in Southampton and suddenly you see the same the same virus in the west, wastewater very.
And then north of the country. You're not in a specific location. Your letter opener mythologist.
Well, we'll be looking in the right place. Now, we have this vision of of Acento with, you know, big, big computer screens on it, flashing up,
sort of warning new virus reported in Enceladus, say, and then but of course, that's just in Hollywood movies.
But you know that that would be the kind of thing that it would be nice to have before the next pandemic.
Let's let's take a look at some these other questions.
This one from Donna Simmo, which read, you mentioned contamination of surfaces in Chinese food market.
Do you think that was the main media transmission or airborne transmission?
So I guess this is related to some some recent discussion of whether the virus can be transmitted to a region like China,
which is effectively eradicated. It can initiate any chain of transmission, not three infected travellers,
but three but three products, particularly those that that have been frozen or in the cold chain.
So my understanding is that in this particular outbreak, it was environmental services and the virus was recovered,
environmental services in different locations in the market.
But in the epidemic more generally and sort of airborne and direct droplet transmission has been the most prominent form of transmission.
I mean, it's worth noting that we've closed down a lot of the opportunities for those super spreaders.
So there's sort of at the moment that there's a degree of transmission we see.
So it reflects a little bit that the measures in place are in most parts of the world, big gathering's and are not allowed.
And I know APNIC. And and so on.
But at this point in time that the main foremast transmission, this is airborne and direct and again, the importance of social distancing and masks.
And again, I don't see these things as contradictory. I think a lot of well-designed digital data and passenger data would be very
helpful in the context of studies to better understand the effectiveness of masks.
Again, if you're looking at effective muscle mass, being able to ask whether two cases are linked or not,
women study using pathogen genomes would be an essential tool.
We've seen you know, we've seen that in the case of HIV to prove the effectiveness of condoms, to improve the effectiveness of antiretroviral therapy,
pathogen sequencing said these true people definitely didn't know one thing, but transmission makes those studies much more powerful.
That's great. I'm just scrolling through the questions.
You see the questions, are there any that today is one that has got lots of votes about surveillance and privacy?
OK. I haven't had that one you to read it out. How do you navigate people's concerns of surveillance?
Certain countries that have been successful with contact tracing have more explicit surveillance of its peoples.
But in the US and probably much of Europe, individuals are very forthright about privacy.
How should people feel about these technologies and privacy? We kind of discussed that a little bit.
But I think I think there are ways of. That is a challenge for the scientific community to to find ways of of doing and prevention we
want and getting the generalisable in for information we want without invading people's privacies,
because people are also very forthright that they want the data, they want the information.
They want to know is the scale risk, is my skull risky? You know, people say, you know, it's quite interesting.
I find wonder people. On the one hand, one person doesn't need privacy.
And I you know, I'm a great kind of George Orwell. I don't want to live in a in a surveillance, authoritarian society.
That's very important if you're thinking about future to me.
But on the other hand, you know, if there's an outbreak in in a local school, people really want to know the information.
Was my child playing with that, you know, and and so on and so forth.
So and that there's a balance in between those two things.
But one of the really interesting things I think, going forward, as I've seen, is,
is algorithmically search to one way is to sort of explicitly regulate that balance the same way we regulate whenever,
you know, whenever any human rights you have, you know, you always have trade-offs.
So you can explicitly negotiate that trade off. But also, there are great ways of actually and sort of getting your cake and eating it.
Again, I say I'm getting the information. It's worth noting that the acts in different countries are very different.
Yeah. That that some of those apps that have been used, particularly in East Asia,
are storing and retaining very different kinds of data to the ones that are being Eastern Europe.
And it's been any discussion of of sort of data sunsetting.
So the idea that data that is kept or isn't used for the purposes of gaining information during an outbreak would have
algorithmically at the software level some kind of fixed lifespan and would disappear after it's effectively not useful.
And so there is very active discussion about sunsetting.
And I think to some extent, the new resolution with this particular contact tracing apps has been to go towards privacy.
So not collecting the information in the first place. Know as has been even better than sunsetting in terms of privacy.
But I think, again, that's not straightforward because you have to there's some information that, you know,
you want to keep because your you're helping the next group of people that maybe probably will be us or,
you know, involve many of the many of us, because the next pandemic won't be that long into the future, I think.
I don't know what your opinion is, so. That discussion requires requires quite careful thought,
and I think I think the key thing is that people want to know that the process is relatively transparent and,
you know, and properly overseen by by, you know, members of the public, bioethicists and so on.
And I think if we can have a sort of mature discussion around the value of these data and whether they're sensitive
and who they're valuable for and what how they can be misused and what we can do to stop that from happening,
then, you know, a consensus can be reached.
Yeah. I wholeheartedly agree.
And we'll take that as an opportunity to wrap up the proceedings of our conversation.
Let me just thank you again, Cristoff, for an enlightening and fascinating talk.
I'd like to thank all of the audience for for watching and listening.
Thank you for joining us. And special thanks to those of you that provided some questions at the end.
I'm sorry we weren't able to get through all of them today.
I hope you can find some answers to some of those questions in the near future.
And I have one final announcement before we disappear.
And that is to announce the final talk in this series of conversations, which is with Professor Julian Saville Eskew and Dr. Sam Vandersloot.
And they'll be in conversation on Thursday, the 3rd of December at 5:00 pm.
And they will be talking about mandatory 19 vaccination, the arguments for and against.
And if you want to register for that event, please press the green button at the bottom of the screen that says next event in the series.
So, again, all that's left is for me to thank Cristoff.
Thanks, everyone, for listening. And I hope you all have a great evening.
Goodbye from.