Mapping global emergence of pathogens with epidemic and pandemic potential to inform and accelerate pandemic prevention, preparedness, readiness and response

IntroductionIncreasing occurrence of epidemics and pandemics and concurrent emergence of different pathogens calls for multi-sectoral, multi-pathogen preparedness actions. Data on various factors that drive emergence of diverse pathogens can inform evidence-based preparedness by identifying geographies at-risk. When leveraging evidence within a One Health approach, multiple pathogens can be addressed simultaneously, thereby strengthening countries pandemic preparedness efforts. MethodsFor seventeen priority pathogens (avian influenza viruses, zoonotic coronaviruses including COVID-19, hemorrhagic fever viruses including Ebola, Henipaviruses, and arboviruses including yellow fever and Zika), we identified global evidence on animal reservoirs, vectors, environmental suitability, and reported human cases. We discriminated geospatially recorded pathogen detections from a background sample and constructed maps using these datasets to generate an evidence-based assessment of emergence risk globally. ResultsSeventeen pathogen-specific assessments were combined into a global composite map. Sub-Saharan Africa and South Asia have evidence supporting emergence risk for the greatest number of pathogens (included areas at-risk of all pathogens) and scored highest when strength-of-evidence weightings were factored. The Americas had the lowest tally of considered pathogens. Environmental suitability analyses received the highest weights, reservoir ranges the lowest. DiscussionPreparedness and readiness must consider the range of global biological threats. Our methodology is capable of incorporating changing evidence on emergence potential for multiple pathogens to identify geographies at higher risk with different pathogen combinations. Our maps can contribute to existing decision-support structures, guiding shared interventions and strategic allocation of resources for spillover prevention and pandemic preparedness, thereby enhancing local response capacities applying a multidisciplinary approach. Research in ContextO_ST_ABSEvidence before this studyC_ST_ABSUsing PubMed, we searched for "[PATHOGEN] Preparedness Map" for each of seventeen priority pathogens to explore what resources might exist to be used to guide contemporary preparedness actions. The seventeen pathogens were: avian influenza viruses (AIV,all subtypes), chikungunya virus (CHIKV), Crimean-Congo hemorrhagic fever virus (CCHF), dengue virus (DENV), Ebola virus (EBV), Hendra virus, non-specific Henipaviruses, Lassa virus (LASV), Marburg virus (MARV), Middle East respiratory syndrome coronavirus (MERS-CoV), monkeypox virus (MPXV, all clades), Nipah virus, Yersinia pestis, Rift Valley fever virus (RVF), severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), yellow fever virus (YFV), and Zika virus (ZIKV). We also searched for "Emergence Preparedness Map" to try and identify a singular resource that housed all these pathogens. Searching for specific pathogens identified resources that had deployed specific approaches or types of data in answering this question, but often did not collate multiple varied evidence streams. Similarly, the more detailed resources tended to be more geographically restricted in scope. When searching for emergence resources more broadly, we identified some clusters of epidemiologically related pathogens being synthesized (for instance thinking about integrated management of vector-borne diseases), but none that spanned the full repertoire of pathogens listed. Others attempted to characterize the phenomena of emergence more broadly, but as a result lost the ability to further capitalize on pathogen-specific activities since pathogens were not a building block within a broader methodology. Added value of this studyIn evaluating the emergence potential for seventeen priority pathogens, we have collated the widest range of pathogens into a common map for synthesis. In doing so, we provide a support mechanism for actionable next steps for epidemic and pandemic preparedness at scale that leverage current knowledge. Contrasting to prior assessments, we leverage different types of data and provide a mechanism to differentially weight their inclusion. We outline a mechanism by which even for pathogens where comprehensive or detailed data is not present, the information currently available can be acknowledged and integrated, to provide immediate support for decision-making, while future enhancements are integrated when available and iterated upon. We also demonstrate how this modular methodology allows customized aggregations of pathogens where scopes of work necessitate - for instance, collating all pathogens with similar vectors where vector control actions can be undertaken. We show with examples of Marburg virus disease in Equatorial Guinea, how the maps demonstrated the prior evidence-base related to emergence of this disease in that geography and use that example to outline how these maps can indicate geographies of concern. Implications of all the available evidenceEpidemic and pandemic preparedness is multi-faceted and multi-sectoral; some actions require pathogen specific insights, while other actions will work to counter a group of pathogens simultaneously. With this methodology, we demonstrate that it is possible to integrate data from diverse formats across different transmission routes and pathogens ecological dynamics globally to produce a set of resources to support local, regional, and global evidence-based decision making. Different groupings can be called upon to support different actions - pathogen specific maps where pathogen-specific vaccination schedules need to be undertaken; tracking the full pathogen-set that any given reservoir is implicated in; determining the differential diagnosis needs for a specific health facility and corresponding population it serves as a function of the implicated local pathogens or their potential future emergence; and supporting local health facilities in developing protocols, training, and necessary equipment to effectively detect and respond to possible local cases. Finally, these maps are designed to evolve alongside advancing infectious disease intelligence, allowing for continuous enhancement and resolution of data limitations across diverse surveillance systems and national contexts.