The Nonlinear Library EA - Three Reasons Early Detection Interventions Are Not Obviously Cost-Effective by Conrad K.
Apr 24, 2024
33:46
Welcome to The Nonlinear Library, where we use Text-to-Speech software to convert the best writing from the Rationalist and EA communities into audio. This is: Three Reasons Early Detection Interventions Are Not Obviously Cost-Effective, published by Conrad K. on April 24, 2024 on The Effective Altruism Forum.
Summary
For pandemics that aren't 'stealth' pandemics (particularly globally catastrophic pandemics):
Reason 1: Not All 'Detections' Are Made Equal: there can be significant variation in the level of information and certainty provided by different detection modalities (e.g. wastewater surveillance vs. syndromic surveillance), and the efficacy of early detection is heavily dependent on the ability to quickly trigger an epidemiological response. Thus, the nature of the detection signal is probably an important factor affecting the time required to confirm an outbreak and take action.
There should probably be a greater prioritisation of plans for public health response to different types and levels of detection signals.
Reason 2: 'Early' Might Not Be 'Early' (or Cheap) Enough: for highly transmissible pathogens, early detection systems may only provide a lead time on the order of days to weeks compared to "naive detection" from symptomatic spread, and the costs to achieve high confidence of detection can be prohibitively expensive (on the order of billions). Improving cost-effectiveness likely requires carefully targeting surveillance to high-risk populations and locations.
Methodological uncertainties make it difficult to have high levels of confidence about how valuable early detection interventions are for a range of pathogen characteristics, particularly for GCBR-level threats.
Reason 3: Response Strategies Matter, A Lot: the cost-effectiveness of early detection is highly dependent on the feasibility and efficacy of post-detection containment measures. Factors like public compliance, strength of the detection signal, degree of pathogen spread, and contingencies around misinformation can significantly impact the success of interventions. The response strategy must be robust to uncertainty around the pathogen characteristics in the early stages of a pandemic.
More work is needed to ensure readiness plans can effectively leverage early detections.
Background
I want to start this post by making two points. Firstly, I think it is worth flagging a few wins and progress in pathogen-agnostic early detection since I began thinking about this topic roughly nine months ago:
The publication of 'Threat Net: A Metagenomic Surveillance Network for Biothreat Detection and Early Warning' by Sharma et al., 2024.
The publication of 'Towards ubiquitous metagenomic sequencing: a technology roadmap' by Whiteford et al., 2024.
The publication of 'A New Paradigm for Threat Agnostic Biodetection: Biological Intelligence (BIOINT)' by Knight and Sureka, 2024.
The publication of the preprint, 'Quantitatively assessing early detection strategies for mitigating COVID-19 and future pandemics' by Liu et al., 2023.
The Nucleic Acid Observatory continued its work, publishing several notebooks, resources, white papers, reports, and preprints and even creating a tool for simulating approaches to early detection using metagenomics.
The UK government published its biological security strategy in June 2023, which included goals such as the establishment of a National Biosurveillance Network and the expansion of wastewater surveillance.
The U.S. Department of Health and Human Services (HHS) announced actions the department will take following National Security Memorandum 15, signed by President Biden, including accelerating advanced detection technologies.
The Armed Forces Health Surveillance Division's Global Emerging Infections Surveillance branch hosted its first Next-Generation Sequencing Summit.
Various funding opportunities for improving diagnostic technology were announced, including:
The National Institute of Biomedical Imaging and Bioengineering'...
Summary
For pandemics that aren't 'stealth' pandemics (particularly globally catastrophic pandemics):
Reason 1: Not All 'Detections' Are Made Equal: there can be significant variation in the level of information and certainty provided by different detection modalities (e.g. wastewater surveillance vs. syndromic surveillance), and the efficacy of early detection is heavily dependent on the ability to quickly trigger an epidemiological response. Thus, the nature of the detection signal is probably an important factor affecting the time required to confirm an outbreak and take action.
There should probably be a greater prioritisation of plans for public health response to different types and levels of detection signals.
Reason 2: 'Early' Might Not Be 'Early' (or Cheap) Enough: for highly transmissible pathogens, early detection systems may only provide a lead time on the order of days to weeks compared to "naive detection" from symptomatic spread, and the costs to achieve high confidence of detection can be prohibitively expensive (on the order of billions). Improving cost-effectiveness likely requires carefully targeting surveillance to high-risk populations and locations.
Methodological uncertainties make it difficult to have high levels of confidence about how valuable early detection interventions are for a range of pathogen characteristics, particularly for GCBR-level threats.
Reason 3: Response Strategies Matter, A Lot: the cost-effectiveness of early detection is highly dependent on the feasibility and efficacy of post-detection containment measures. Factors like public compliance, strength of the detection signal, degree of pathogen spread, and contingencies around misinformation can significantly impact the success of interventions. The response strategy must be robust to uncertainty around the pathogen characteristics in the early stages of a pandemic.
More work is needed to ensure readiness plans can effectively leverage early detections.
Background
I want to start this post by making two points. Firstly, I think it is worth flagging a few wins and progress in pathogen-agnostic early detection since I began thinking about this topic roughly nine months ago:
The publication of 'Threat Net: A Metagenomic Surveillance Network for Biothreat Detection and Early Warning' by Sharma et al., 2024.
The publication of 'Towards ubiquitous metagenomic sequencing: a technology roadmap' by Whiteford et al., 2024.
The publication of 'A New Paradigm for Threat Agnostic Biodetection: Biological Intelligence (BIOINT)' by Knight and Sureka, 2024.
The publication of the preprint, 'Quantitatively assessing early detection strategies for mitigating COVID-19 and future pandemics' by Liu et al., 2023.
The Nucleic Acid Observatory continued its work, publishing several notebooks, resources, white papers, reports, and preprints and even creating a tool for simulating approaches to early detection using metagenomics.
The UK government published its biological security strategy in June 2023, which included goals such as the establishment of a National Biosurveillance Network and the expansion of wastewater surveillance.
The U.S. Department of Health and Human Services (HHS) announced actions the department will take following National Security Memorandum 15, signed by President Biden, including accelerating advanced detection technologies.
The Armed Forces Health Surveillance Division's Global Emerging Infections Surveillance branch hosted its first Next-Generation Sequencing Summit.
Various funding opportunities for improving diagnostic technology were announced, including:
The National Institute of Biomedical Imaging and Bioengineering'...