Equity and efficiency in global respiratory virus genomic surveillance

Public health decision-making for respiratory virus outbreaks relies heavily on genomic sequencing to detect new (variant) viruses. However, respiratory virus sequencing infrastructure is highly unequally distributed globally, potentially limiting the efficiency and effectiveness of surveillance efforts and raising concerns about preparedness for future threats. Using mathematical models, we demonstrate that relative to global sequencing efforts during the COVID-19 pandemic, increased global solidarity in respiratory virus genomic surveillance would vastly improve the capacity to rapidly detect novel threats, even with a substantially reduced number of viruses sequenced globally, leading to improved effectiveness and efficiency. As a result, the time between a (variant) virus first global detection and first local case would increase in all countries, allowing for more time to design and implement global and local public health measures to mitigate the threats potential public health impacts. Our results show that operationalizing global health solidarity is key to guiding investment in preparedness for future pandemic threats.