Independent Task Force report outlines a One Health approach to address risk factors for future pandemics

The Independent Task Force on COVID-19 and other Pandemics (www.independentcovidtaskforce.org) announced that their report "Pandemic Origins and a One Health Approach to Preparedness and Prevention: Solutions Based on SARS-CoV-2 and Other RNA Viruses" has been published in the Proceedings of the National Academy of Sciences (https://doi.org/10.1073/pnas.2202871119).

Independent Task Force chair, Dr. Gerald T. Keusch of the National Emerging Infectious Diseases Laboratory and Center for Emerging Infectious Diseases Policy and Research at Boston University said that "The world has largely failed to meet the challenge to be better prepared to prevent or respond adequately enough to the next pandemic, whatever the etiology. Our Task Force believes that the best way to address risk factors for future pandemics is a One Health approach that balances and optimizes the health of people, animals, and ecosystems."

The Independent Task Force focused on scientific findings before and during the pandemic, and a historical review of multiple previous RNA virus outbreaks to identify critical intervention points to interrupt zoonotic transmission and translates this knowledge into recommendations based on a One Health approach to prevent or mitigate an outbreak, and if necessary, to respond rapidly to prevent epidemic or pandemic spread.

Background of the Task Force

The emergence of animal-origin (zoonotic) RNA viruses like SARS-CoV-2, whether from wildlife, livestock, or domestic animals, is an urgent and growing threat to public health. Understanding how SARS-CoV-2 and other RNA virus outbreaks originate can guide how we can more effectively prevent, mitigate, or respond to future emerging infectious diseases (EIDs). Increasing outbreaks in recent decades have been driven by many factors, including human and livestock population growth coupled with expanding human-animal-environment interfaces, changing patterns of land use, climate change, globalized travel, and trade. These outbreaks have common characteristics, including zoonotic spillover from an animal reservoir host to humans, with or without involvement of another animal transmission host. These events highlight the importance of a One Health approach to design relevant, feasible, and implementable solutions to prevent, mitigate, and respond rapidly to future outbreaks.

The Independent Task Force is a group of internationally renowned scientists with diverse disciplinary expertise in human, animal, and public health, virology, epidemiology, wildlife biology, ecology, and EIDs. Twelve members were convened in June 2020 as a Task Force within the Lancet COVID-19 Commission. In November 2021 with the addition of 2 new expert members, they formed the Independent Task Force to assess available evidence on what drove the origins and early spread of COVID-19 and provide evidence-based recommendations to reduce the impact of and improve responses to outbreaks. A critical review of the literature, interviews with other scientists, and extensive discussions culminated in the present PNAS report.

Key findings

The Independent Task Force Report shows that:

• Animal RNA viruses, including coronaviruses, have a long history of crossing species barriers to humans. The report provides a historic timeline of estimated origin dates for major coronavirus outbreaks affecting people or livestock and highlights coronaviruses that represent a growing risk to both human and animal health.
• The risk of pandemics emerging increases when people and animals interact closely in new settings driven by land use and climate change, environmental degradation, the wildlife trade, population growth, and economic pressure. Evidence indicates that most new zoonotic outbreaks have wildlife or livestock origins. The report provides recommendations that target high-risk animal-human interfaces to prevent or mitigate the risk of future spillovers. An important strategy is 'Smart Surveillance' and sampling programs which have proven helpful for disease outbreak forecasting and to guide strategies to reduce risks at the source.
• Substantial newly published scientific evidence reviewed in the PNAS Perspective report strongly indicates that COVID-19 originated via a pathway similar to SARS-CoV, involving spillover from bats to intermediate animal hosts, then to people within the wildlife trade, leading to the first known cluster of COVID-19 in the Huanan Seafood Market in Wuhan, China, in December 2019. The Task Force finds no verifiable or credible evidence to support the possibility that SARS-CoV-2 was created in or released from a laboratory (See Table S.6. in Supporting Information: https://www.pnas.org/)
• Efforts to control and respond to the COVID-19 pandemic were hindered in many countries by politics, misinformation and disinformation, and a growing anti-science/anti-vaccine movement.
• The importance of critically evaluating the potential of a zoonotic link to wildlife is that it leads to implementable One Health-oriented changes in policy and practice that can reduce the likelihood of similar occurrences in the future. Importantly, this presents no conflict with continuous efforts to improve laboratory and field biosafety and biosecurity.

Recommendations

The Independent Task Force Report makes the following recommendations:

(1) "Smart Surveillance" to identify high-threat potential pathogens. Targeting surveillance to people, wildlife, and domestic animals within emerging disease hot spots; improving methodologies for safe surveillance; and innovating a risk assessment framework to provide early warning of pathogens most likely to emerge. The benefits of Smart Surveillance conducted by trained personnel using rigorous protocols to maximize safety and security far outweigh risks and provide critical data for research and development of vaccines, therapeutics, diagnostics and better early warning systems, and inform One Health strategies for prevention and response..

(2) Preparedness and translational research. Investing in R&D for innovative and broad spectrum diagnostics, antiviral and vaccine strategies for priority pathogens based on data from 'Smart Surveillance'; streamlining approaches to build capacity for clinical trials, licensure, and manufacture of medical countermeasures; and understanding the pathogenesis of potential high-threat pathogens to guide new therapeutic strategies.

(3) Reduce the drivers for spillover risk and spread. Working with communities and countries on the frontline of disease emergence to understand epidemiological, value chain, and behavioral drivers of EID emergence; implementing risk reduction strategies; developing incentives to minimize human-wildlife contact at interfaces in rural areas and commercial markets; and strengthening awareness of the emerging disease-linked health impacts and costs of land use and climate change to provide incentives for sustainable development.

(4) Counter misinformation and disinformation about the prevention and control of emerging diseases. Interdisciplinary research on what drives the emergence, spread and public acceptance of misinformation and disinformation in order to develop robust counter-mechanisms; develop strategies to counter distrust of science and expert advice, including creating organizations to support scientists under threat arising from disinformation and politically-motivated attacks; designing and promoting programs to improve public understanding of the scientific method and where to find trusted evidence-based scientific information.

(5) Strengthen One Health governance and science. Creating an inclusive, multi-stakeholder One Health-based governance framework at local, regional, national and international levels for pandemic preparedness and response; increasing funding for cross-disciplinary, collaborative One Health research; learning from indigenous knowledge; participation of civil society and engagement of public and private sector expertise; and efforts to educate new generations concerning the scientific method and reliable sources of information.

Comments from other members of the Independent Task Force:

"Applying data from predictive programs must be coupled with government engagement and widespread education campaigns. By building a united front against misinformation and disinformation, we can equip people around the world with the tools needed effectively to protect themselves and others."

• Dr. Malik Peiris, School of Public Health, University of Hong Kong, Hong Kong

"Humans share the planet with animals and viruses, which evolve in an ever-shifting evolutionary landscape of risks. To stay ahead of the challenges posed by emerging infectious diseases like COVID-19 and to protect the human family from the next global pandemic, we need to find new frameworks for international scientific collaboration that transcend the tensions of geopolitics. Cooperation on smart surveillance is our best bet to stay one step ahead of the next virus."

• Dr. Peter Daszak, EcoHealth Alliance, New York, USA

"As climate change, land use patterns, and the growing wildlife trade in certain regions continue to create opportunities for zoonotic spillover of EIDs, the solutions in this report have crucial implications for the global community for years to come. We must learn from past pandemics to prepare for success in anticipating, mitigating, and responding effectively to future pandemics. "

• Dr. Marion Koopmans, Erasmus Medical Center, Rotterdam, The Netherlands

"The COVID-19 pandemic introduced or highlighted scientific disciplines, such as virology and epidemiology, to the broader community. Although the 'lessons learned' are certainly not new to scientists, it is our responsibility to ensure that these lessons and our recommendations are better understood and are more readily embraced and acted upon to protect communities, animals and ecosystems now and in the future"

• Dr Danielle Anderson, Victorian Infectious Diseases Reference Laboratory, The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia.

"COVID-19 has decisively challenged our perception and our capacity to handle threats that on top of causing the loss of human lives, represent a risk to other animal species, global economies, food security and systems, or the trust of people in science, just to name a few. We need stronger international regulatory and financial systems that, embodying a one health approach, can truly help transform the way we live and use our planet's resources, so that we can prevent and be better prepared for threats such as SARS-CoV-2."

- Dr Carlos G. das Neves, Norwegian Veterinary Institute, Ås, Norway

"Despite advancements in biomedical science and technology over the past century, we have largely turned a blind eye to the inextricable interconnections among humans, other animals, and the shared environment. COVID-19 has taught us that failing to recognize the relevance, complexity and dynamism of the socioecological systems of planet earth not only puts the world at risk of pandemics, but limits our ability to effectively counter them. One Health approaches are therefore urgently needed in all sectors at all levels!"

- Dr. John Amuasi, Kwame Nkrumah University of Science and Technology, Ghana

"This pandemic has pointed out, once again, that spread of viruses from animals in formerly isolated locales to human populations is increasingly likely as humans impinge on these environments. This report provides a One Health framework for thinking about, and responding to, these cross-over events, recognizing that people at all levels, ranging from local to international, must be involved to prevent future pandemics."

- Dr. Stanley Perlman, University of Iowa, Iowa City, USA

"SARS-CoV-2 taught us that viruses do not respect borders, walls, demographics or politics; nor do they respect species barriers. Emerging/re-emerging RNA viruses (including coronaviruses) are a major cause of zoonoses leading to epidemics/pandemics that impact human, animal and ecosystem health. They spillover from animals to humans and spill back into animals to establish new host reservoirs of viral persistence and evolution. Our Perspective highlights One Health (animal-human-environment interconnections) strategies based on integrated cross-disciplinary, interagency, regional, national and global collaborations to survey, detect, research, respond to and stem zoonotic disease outbreaks, leading to measures to predict, prevent, mitigate and control future pandemics."

• Dr. Linda J Saif, The Ohio State University, Wooster, USA

"SARS-CoV-2 is not the first virus that found its way from animals to humans, and will not be the last. A lot could have been learnt from SARS-CoV-1 already decades ago, a vírus that even belongs to the same species as SARS-CoV-2, or from MERS-CoV, yet, the world was not prepared for a coronavirus pandemic. The devastating impact on human health and on our societies due the COVID-19 pandemic should be the ultimate lesson that we need to invest more in preparedness, but also prevention of novel viral spillovers."

- Dr. Isabella Eckerle, Geneva Centre for Emerging Viral Diseases, Switzerland

"Acceptance of the underlying epidemiological drivers of disease emergence, 'smart' surveillance, universal diagnostic and vaccine platforms, and a genuine One Health/One World approach are fundamental to mitigating and managing future global pandemics."

• Dr. Hume Field, University of Queensland, Australia

List of Independent Task Force members (www.independentcovidtaskforce.org)

Dr. Gerald Keusch MD (Chair November 2021 - present) is Associate Director of the National Emerging Infectious Diseases Laboratories and a core faculty member of the Center for Emerging Infectious Disease Policy and Research at Boston University, Boston Massachusetts, U.S. His research has focused on pathogenesis and control of emerging bacterial, protozoal and viral diseases through collaborative basic laboratory, field and clinical research. He is the former Director of the Fogarty International Center of the U.S. National Institutes of Health and is a member of the U.S. National Academy of Medicine. Contact: Rachel Lapal [email protected]

Dr. John Amuasi MBChB Ph.D. is the head of Global Health at the School of Public Health, Kwame Nkrumah University of Science and Technology, and is Group Leader of the Global Health and Infectious Diseases Research Group at the Kumasi Centre for Collaborative Research in Tropical Medicine, Accra Ghana and the Bernhard Nocht Institute of Tropical Medicine, Hamburg, Germany. He has extensive experience in One Health approaches to emerging zoonotic diseases.

Dr. Danielle Anderson Ph.D. is a Research Scientist at the Victorian Infectious Diseases Reference Laboratory at The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia. She is a virologist investigating pathogenesis of high consequence emerging viruses. Contact: Aline Riche. Phone: +61 3 8344 1911; email: [email protected]

Dr. Peter Daszak Ph.D. (Chair July 2020 – November 2021) is the President of EcoHealth Alliance, New York, N.Y., in the U.S. He is a member of the U.S. National Academy of Medicine, and chairs its Forum on Microbial Threats. He is an expert in ecology, surveillance, and field research of emerging zoonotic viruses such as SARS-CoV, MERS-CoV, and SARS-CoV-2. Contact: [email protected]

Dr. Isabella Eckerle MD is Associate professor, physician-scientist at the Centre for Emerging Viral Diseases at the University Hospitals of Geneva. She has led extensive clinical, epidemiological, and pathogenesis research on endemic coronaviruses, MERS-CoV, and SARS-CoV-2. Contact: [email protected] & [email protected]

Dr. Hume Field DVM Ph.D is Adjunct Professor in the School of Veterinary Science at the University of Queensland, Australia and a science and policy advisor to Ecohealth Alliance. He has made expertise in field studies and surveillancey of bat-origin emerging viruses such as Hendra, Nipah, SARS-CoV and SARS-CoV-2. Contact: [email protected]

Dr. Marion Koopmans DVM Ph.D. is Head of the Dept. of Viroscience, Erasmus Medical Center and Pandemic and Disaster Preparedness Center, Rotterdam, Netherlands. Her research focus is to understand the modes of transmission of viruses among animals and between animals and humans, explore the potential of next generation sequencing techniques and other types of data on drivers for emergence for outbreak prediction, detection and tracking. She is a member of the WHO-WOAH-FAO-UNEP One Health High Level Expert Panel, and a member of the Royal Dutch Academy of Sciences. Contact: [email protected]

Dr. Dato' Sai Kit (Ken) Lam Ph.D. is Professor Emeritus at the University of Malaya, and Senior Fellow of the Malaysian Academy of Sciences. He is an expert in vector borne viral diseases such as dengue and a co-discoverer of Nipah virus in Malaysia, for which he has received the 2001 Prince Mahidol Award for Public Health in 2001 and the Merdeka Award for Outstanding Scholastic Achievement in 2013.

Dr. Carlos das Neves DVM Ph.D. Dipl.ECZM is the Director for Research and Internationalization at the Norwegian Veterinary Institute, Past President of the International Wildlife Disease Association, member of the IUCN SSC–Wildlife Health Specialist Group and Chair of the Wildlife Population Health Specialty at the European College of Zoological Medicine. He is an expert in zoonotic wildlife viral infections and One Health approaches to contain and control spillovers. We works also on the science to policy interface both in Norway and internationally. Contact: [email protected]

Dr. Malik Peiris Ph.D. FRS is the Professor of Virology at the School of Public Health, at the University of Hong Kong. His research focuses on the pathogenesis, innate immune responses, transmission, ecology and epidemiology of human and animal (poultry, swine, wild birds) influenza viruses, and emerging coronaviruses. Dr. Peiris was the first person to isolate SARS-CoV and is conducting active research on COVID-19.

Dr. Stanley Perlman MD Ph.D. is Professor of Microbiology and Immunology, Professor of Pediatrics, and University of Iowa Distinguished Chair, Iowa City Iowa in the U.S. He is a physician-scientist involved in studies of the pathogenesis of respiratory coronaviruses including SARS-CoV, MERS-CoV, and SARS-CoV-2.

Dr. Supaporn Wacharapluesadee Ph.D. is the Senior Research Scientist at the Emerging Infectious Diseases Clinical Center, King Chulalongkorn Memorial Hospital, Thai Red Cross Society and Chula School of Global Health, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. Dr. Wachaeapluesadee's team was the team leader for detecting the first MERS-CoV case in Thailand in 2015 and the first to positively identify a human COVID-19 infection outside of China.

Su Yadana, MPH. is a Research Scientist and Project Coordinator at EcoHealth Alliance in New York NY in the U.S., and a team member of the EcoHealth Alliance collaborative research network in Southeast Asia to study the spillover of viral pathogens from wildlife to humans. Her research interests focus on identifying risk factors for spillover of animal viruses to humans and development of evidence-based strategies to reduce these risks and improve population health. Contact: [email protected]

Dr. Linda J. Saif Ph.D. is Distinguished University Professor, Center for Food Animal Health, Departments of Animal Sciences (CFAES, OARDC) and Veterinary Preventive Medicine (CVM), Wooster Ohio, and Co-Director of the Viruses and Emerging Pathogens Program of the Infectious Diseases Institute, The Ohio State University, Columbus, Ohio, U.S.A. Her expertise is in virology, pathogenesis, immunology and epidemiology of animal coronaviruses resulting in consequential animal diseases and spillovers and spillbacks between animals and humans. She is a member of the U.S. National Academy of Sciences. Contact: Emily Caldwell, [email protected]