It is high time to re-evaluate health surveillance protocol and laboratory biosafety measures

There is a growing consensus among World Health Organization member states regarding the need to update and renew focus on World Health Assembly resolution WHA58.29 (adopted in 2005 in response to the epidemic caused by SARS-CoV-1), which urges member states to strengthen the biosafety of laboratories known to process dangerous pathogens and toxins in the interest of global health security.

“The containment of microbiological agents and toxins is critical to preventing outbreaks of emerging and re-emerging diseases such as acute respiratory syndrome (SARS),” reads the resolution, noting that “some Member States may not have adequate biosafety controls in place” while urging individual countries to review and strengthen the state of their laboratory safety protocols and to divert human and financial resources toward the accomplishment of this aim.

The unprecedented scope of and circumstances surrounding the outbreak of the first SARS crisis moved the global health community to action and planning. However, nearly two decades after the last known case of SARS-CoV-1 was identified, we now find ourselves contending with the aftermath of a pandemic orders of magnitude more devastating (the official death toll for the SARS-CoV-1 crisis stands at 811, versus nearly seven million confirmed deaths resulting from SARS-CoV-2, in addition to a years-long disruption of human activity the world over).

The advancements in science, technology and interconnectedness of today would be difficult to imagine in 2005, and it is high time to re-evaluate health surveillance protocol and laboratory biosafety measures.

To address topics closely related to these matters, public health policy, laboratory and clinical field experts have been called together for the forthcoming 6th Biennial Annual Conference of the African Society for Laboratory Medicine (12-15 December), centred on the theme of shaping laboratory systems and diagnostics services for the 21st century.

Key discussions will include the enumeration of known pathogens and toxins which pose significant risks to African biosecurity; strengthening pandemic preparedness and response through the development of a pandemic treaty; structuring a guidance framework for use in the event of accidental or deliberate threats; and examination of the Grand Challenge for Sustainable Laboratories.

To understand how to respond to emerging epidemics, one must consider the typical cycle of a disease outbreak: a new infectious agent is introduced to a population — via zoonotic spillover, international travel, environmental changes or accidental or deliberate release. Growing urban populations, often living in close proximity, create favourable conditions for the transmission of disease.

The overuse of antibiotics may contribute to the development of drug-resistant strains of bacteria; and climate change, deforestation, overpopulation and other ecosystem disruptions can influence the emergence and spread of infectious disease, further exacerbated by inadequate healthcare infrastructure.

In the case of infectious disease, the best offence is a good defence; a synergistic African health security ecosystem, bolstered by sophisticated biosafety systems, must be prioritised if we hope to prevent future disease outbreaks on both the local and global scale.

With the expanded scope of biosecurity involving human, animal and plant-based pathogens, there is a need for increased collaboration across sectors — human health, veterinary and agricultural authorities must work together to address potential biosecurity threats comprehensively.

Interdisciplinary approach

The integration of novel technologies in various biological research and development activities likewise necessitates an interdisciplinary approach to biosecurity, involving not only technological safeguards but also ethical considerations, regulatory frameworks, and international cooperation to address evolving challenges.

The relatively recent introduction of artificial intelligence (AI) and technology for the development of genetically modified organisms (GMOs) in laboratory settings significantly expands the scope of biosecurity, posing new and complex questions.

AI, used in the analysis of vast datasets related to genomics and epidemiology, enables rapid identification of patterns that may indicate the emergence or spread of infectious diseases, but may also be used to determine the most advantageous pathways of disease spread in cases of biowarfare.

While GMOs are typically developed for beneficial purposes, such as specialised crops, there are concerns that the technology may be used to enhance the pathogenicity of organisms, posing serious risk if containment measures fail or in instances of deliberate misuse.

Misuse of biological weaponry poses significant threats to global biosecurity during times of war. These agents, which may include viruses or bacteria, can be engineered for specific characteristics, such as increased virulence or resistance to treatment.

With the ongoing conflicts in Ukraine and the Middle East, the use of bioweaponry is a significant concern not only for the nations directly involved, but for countries around the globe; infectious agents have the unique potential to spread far beyond the targeted area, leading to regional or even global health crises.

Scientific research conducted for civilian purposes may be overtly or covertly repurposed for military use. Facilities involved with AI and GMO development, among other emerging technologies, need to implement robust containment and safety measures to prevent accidental release or intentional misuse of artificially modified biological materials.

Responsible research practices and adherence to international guidelines, such as the Biological Weapons Convention, are essential to preventing unintended consequences of scientific development.

Our response to biological threats must involve a combination of public health, security and diplomatic measures. Public-private partnerships and international cooperation will be crucial in effectively preventing and addressing future health crises.

To safeguard the citizens of our member states, we must:

• Strengthen disease surveillance systems to detect and respond to novel infectious agents;


• Invest in healthcare infrastructure, including hospitals, clinics and laboratories;


• Develop and regularly update comprehensive emergency response plans;


• Enforce stringent regulations regarding the handling, transport and research involving dangerous pathogens;


• Have legal frameworks in place to address individuals or entities engaged in illegal activities related to biological weapons;


• Establish clear communication channels to disseminate information between sectors and to the public during a crisis;


• Invest in research and development of vaccines and treatments for biological threats;


• Ensure an efficient distribution system for vaccines and medical supplies in times of crisis;


• Collaborate with other nations and international organisations to share information, resources and expertise; and


• Continue to be involved in the international effort to ensure a harmonious global health security landscape. DM

Dr Wilmot James is professor of practice at the Brown University School of Public Health and a senior adviser to the Pandemic Centre. He is also the director of Health Biosecurity, a division of the Wits Health Consortium at the University of the Witwatersrand.