Strategy, coordinated implementation, and sustainable financing needed for COVID-19 innovations
Authors: Victor J Dzau, Celynne Balatbat
Journal: The Lancet (2020)

Innovative tools and approaches are needed in the response to the COVID-19 pandemic. But innovation alone is insufficient and requires resources and an overarching strategy for implementation in a planned and coordinated way. Furthermore, it is important to evaluate the effectiveness of innovations before they are implemented in clinical care even in an emergency situation. Unfortunately, this strategic approach is not happening in many parts of the world as the numbers of COVID-19 cases and deaths continue to rise. Since so much innovation is bottom-up and entrepreneurial, it can be unclear how best to evaluate, coordinate, or scale up innovations. The problem is not the science, but insufficient infrastructure and strategy to scale up and implement innovations at the population level. There has been no shortage of innovation during this pandemic. With new technology platforms, such as DNA and RNA based vaccines, viral vectors, recombinant proteins, and nanoparticles, scientists have rapidly developed COVID-19 vaccine candidates.1Kim YC Dema B Reyes-Sandoval A COVID-19 vaccines: breaking record times to first-in-human trials.NPJ Vaccines. 2020; 5: 34Crossref PubMed Scopus (86) Google Scholar Effective and safe COVID-19 vaccines might be ready for deployment in less than a year.2Shabad R Fauci "cautiously optimistic" coronavirus vaccine could prove effective by "late fall or early winter".NBC News. July 31, 2020; https://www.nbcnews.com/politics/congress/fauci-top-health-officials-testify-unclear-how-long-pandemic-will-n1235442Date accessed: October 19, 2020Google Scholar Similarly, research has been accelerated for new COVID-19 therapies with antivirals, convalescent plasma, monoclonal antibodies, and immune modulators under investigation in clinical trials,3WHOCOVID 19 landscape of experimental treatments.https://www.who.int/publications/i/item/covid-19-landscape-of-experimental-treatmentsDate: 2020Date accessed: October 22, 2020Google Scholar as well as the repurposing of existing medications such as dexamethasone.4The RECOVERY Collaborative GroupDexamethasone in hospitalized patients with Covid-19—preliminary report.N Engl J Med. 2020; (published online July 17.)https://doi.org/10.1056/NEJMoa2021436Crossref Scopus (6947) Google Scholar In the realm of testing, scientists are pioneering new diagnostic tests based on CRISPR-Cas9 genome editing, next generation sequencing, and microfluidic chips that might increase testing capacity and provide rapid results at the point of care.5Sheridan C COVID-19 spurs wave of innovative diagnostics.Nat Biotechnol. 2020; 38: 769-772Crossref PubMed Scopus (44) Google Scholar A range of innovations in digital technology are also being applied for pandemic planning, surveillance, testing, contact tracing, quarantine, and health care.6Whitelaw S Mamas MA Topol E Van Spall HGC Applications of digital technology in COVID-19 pandemic planning and response.Lancet Digit Health. 2020; 2: e435-e440Summary Full Text Full Text PDF PubMed Scopus (558) Google Scholar Dashboards and web-based platforms, such as the Johns Hopkins COVID-19 Dashboard, have emerged to track COVID-19 cases and deaths globally. BlueDot, a Canadian commercial health surveillance company, gathers disease data from online sources, such as official reports from organisations like the US Centers for Disease Control and Prevention and WHO, as well as non-traditional information, such as airline flight information, to make predictions about locations of infectious disease outbreaks.7Miller E An AI epidemiologist sent the first warnings of the Wuhan virus.Wired. Jan 25, 2020; https://www.wired.com/story/ai-epidemiologist-wuhan-public-health-warnings/Date accessed: October 19, 2020Google Scholar Digital contact tracing smartphone applications can detect when individuals have been in close proximity for an extended period of time to people who have tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).8Congressional Research ServiceDigital contact tracing technology: overview and considerations for implementation.https://fas.org/sgp/crs/misc/IF11559.pdfDate: 2020Date accessed: October 22, 2020Google Scholar Countries such as South Korea, Singapore, Taiwan, and Switzerland were early adopters of the use of this technology.9Ferretti L Wymant C Kendall M et al.Quantifying SARS-CoV-2 transmission suggests epidemic control with digital contact tracing.Science. 2020; 368eabb6936Crossref PubMed Scopus (1649) Google Scholar In addition, mobile applications are being developed to allow patients' health data to be securely shared with scientists and public health professionals to identify new outbreaks, understand how SARS-CoV-2 is spreading, identify at-risk populations, and evaluate the effectiveness of interventions.10Menni C Valdes AM Freidin MB et al.Real-time tracking of self-reported symptoms to predict potential COVID-19.Nat Med. 2020; 26: 1037-1040Crossref PubMed Scopus (915) Google Scholar, 11Grantz KH Meredith HR Cummings DAT et al.The use of mobile phone data to inform analysis of COVID-19 pandemic epidemiology.Nat Commun. 2020; 114961Crossref PubMed Scopus (213) Google Scholar In Germany, public health authorities launched a smartwatch application that gathers vital information to screen for signs of illness; these data are presented online in an interactive map that displays the likelihood of COVID-19 incidence across the nation.12Busvine D Germany launches new smartwatch application to monitor coronavirus spread.Reuters. April 7, 2020; https://www.reuters.com/article/ushealth-coronavirus-germany-tech/germany-launches-smartwatchapp-to-monitor-coronavirus-spread-idUSKBN21P1SSDate accessed: October 19, 2020Google Scholar Innovations leveraging artificial intelligence (AI) are also on the rise. HealthMap, for example, uses AI and data mining to provide real-time information on infectious disease outbreaks and sounded an early alarm on the pandemic.13Cho A Artificial intelligence systems aim to sniff out signs of COVID-19 outbreaks.Science. 2020; 368: 810-811Crossref PubMed Scopus (15) Google Scholar There have also been digital innovations in health-care delivery, such as telemedicine and digital health. In China, clinicians are using AI-assisted CT screening tools to help identify patients with pneumonia due to COVID-19.14Liu J Deployment of IT in China's fight against the Covid-19 pandemic.ITN Online. April 2, 2020; https://www.itnonline.com/article/deployment-health-it-china%E2%80%99s-fight-against-covid-19-pandemicDate accessed: October 19, 2020Google Scholar Some health-care providers are using AI-supported chatbots to screen people with common COVID-19 symptoms and advise them to seek testing.15Vanian J How chatbots are helping in the fight against COVID-19.Fortune. July 15, 2020; https://fortune.com/2020/07/15/covid-coronavirus-artificial-intelligence-triage/Date accessed: October 19, 2020Google Scholar Although such innovations are encouraging, they are insufficient if not deployed in a strategic and scalable way that targets areas of greatest need. A central strategy at the national and global levels and financial resources are required to direct, evaluate, coordinate, prioritise, and integrate the innovations for effective implementation. Furthermore, an overarching national or global command centre would be useful for all COVID-19-related innovations. Existing initiatives for COVID-19 vaccines, therapeutics, and diagnostics—eg, the Accelerating COVID-19 Therapeutic Interventions and Vaccines (ACTIV) partnership and the Rapid Acceleration of Diagnostics (RADx) initiative in the USA and the global Access to COVID-19 Tools (ACT) Accelerator—are promising, but to our knowledge there are no similar approaches for digital health innovations. Additionally, there is a need for a systematic forecasting system at national and international levels for predicting future disease outbreaks and pandemics, analogous to the US National Weather Service and the European Centre for Medium Range Weather Forecasts, which use extensive data from multiple sensors and supercomputing. So far during the COVID-19 pandemic in the USA, there has been inadequate central coordination and command in public health surveillance, response, and innovation. Although ACTIV and RADx have been established, it is unclear how such efforts work together. Furthermore, there are challenges for the coordinated implementation of innovations. A lack of coordination between US state and local public health departments, for example, led to difficulties in delivery of contact tracing programmes.16Landman K Hey America, what happened to contact tracing? Elemental.https://elemental.medium.com/hey-america-what-happened-to-contact-tracing-47a2dbccc020Date: June 29, 2020Date accessed: October 19, 2020Google Scholar Globally, there is inadequate financing to sustain a coordinated strategy for COVID-19 innovations. The ACT-Accelerator, for example, brings together governments, health organisations, scientists, businesses, civil society, and foundations to accelerate development, ensure equitable allocation, and scale up delivery of new COVID-19 tools. But the ACT-Accelerator is principally dependent on funding from donor countries and foundations, which is an insufficient and unsustainable way to finance a global public good. The ACT-Accelerator will require long-term, predictable, and sustained financing based on global solidarity. Innovation to tackle COVID-19 must be centred within strategy, command, coordination, and sustainable financing. VJD served previously as a member of the Board of Medtronic Inc, ending in June, 2014, and received deferred compensation until 2018, unrelated to the topic of this Comment. CB declares no competing interests.