Enemy at the gates

It is 75 years since the last outbreak of smallpox in the USA, and nearly 40 years since the world was declared ‘small pox free’, but in the 21st century with autonomous vehicles looming, virtual voice assistants on hand to help, and mobile technology that’s able to summon everything from a donut to a date with a simple swipe, it is easy to imagine that these basic biological threats are a thing of the past.  

However, although it seems that we have succeeded in winning the battle against smallpox, there are many more diseases which continue to be a threat. Coronavirus and the spreading threat of Covid-19 is of course the most pressing current example.

But there is also growing vaccine hesitancy, listed by the World Health Organisation (WHO) as one of the top ten threats to global health. It means diseases like measles – which may seem like a disease long-conquered – are staging a comeback. Indeed, Europe experienced its highest number of measles cases this century last year - with cases topping 60,000 according to WHO data¹.

Our technology-equipped-lives can also increase our exposure to disease. With more mobile populations and frequent travelling for work and pleasure, we are at risk of becoming carriers, who spread disease within our communities. Something that has become particularly obvious in the current outbreak of coronavirus – in an attempt to control the spread of the disease we have seen widescale concern and over movement of people.

As this transmittance of diseases across the planet becomes more prevalent and diseases make the most of their well-travelled status by mutating into smarter, more sophisticated and harder-to-treat creations, it’s little wonder that health authorities, schools, universities and border controls are growing increasingly concerned about biosecurity. 

Vaccination and immigration
Vaccination has been used to prevent disease since the 17th century, and the science understood and commercially exploited for about 150 years. At an individual level it protects the recipient of the vaccine, whilst at a community level the concept of herd immunity protects others by cutting down the potential for transmission and spread, thus protecting those who may be too young or weak to receive the vaccine themselves. 

Despite the huge benefits of vaccination, there is growing concern that a mixture of complacency, cost and conspiracy theories is reducing the uptake of vaccines. The lack of a standardised approach to vaccination across the globe compounds the issue.

Different vaccination programmes for different countries, coupled with constantly changing recommendations, and the fact that some vaccines require periodic boosters and some may only be required for travel to particular destinations create a confusing and hard-to-monitor scenario that’s fertile ground for diseases looking to spread or mutate. Agencies monitoring vaccination risk are all too often basing their decision on information reported by patients themselves and trusting their memory, or on some form signed by a doctor who is most likely not easily contactable.

In this febrile climate, a huge burden rests on our immigration and registration professionals – who are the gatekeepers protecting vulnerable communities from potential bio-hazard threat. In order to fulfil their role effectively, immigration officials need to accurately answer critical questions every day, such as: should we allow this traveller into the country without knowing their health status? Should we let this person study at our university or work in our hospital without confidence in their vaccination history? 

It is a scenario that is open to manipulation and as more and more institutions start to suggest imposing mandatory vaccination, it’s easy to imagine that fake paperwork might become more commonplace, especially among people who hold strong views against vaccination.  

Although technology has, in many ways, helped to fuel the growing backlash against immunisation, it also holds the key to unlocking the challenge of creating an effective global vaccination strategy.

Digital diagnostic solution

I can readily conceive a vaccination record, backed by some of the technologies that underpin things like Cryptocurrency to provide a verifiable, certifiable record of vaccination, but anyone who has worked in healthcare will know the fragmentation of standards and approaches makes such an idea a huge hurdle even in a single country, never mind trying to achieve global standardisation.

The NHS in the UK has made some steps towards digitising vaccination and health visitor development check for infants, but such approaches only record the “standard” suite of vaccines, and won’t, for example, include details of travel related vaccines even for infants.  

Even if we could agree “one standard” for such records, it would be a huge task to try and back date them using handwritten paper records, likely held in various National Health Service archives.

In such cases, blood tests to confirm immunity (or antibody titres) are a potentially viable solution to prove that a person has been immunised against all the necessary risks in a particular area. However such tests are typically laboratory based and slow, so whilst they might be suitable for deciding if someone can start work, they aren’t appropriate for deciding if you let them into the country. 

Rapid diagnostic tests are increasingly used to quickly screen and identify infectious disease, and in principle the same technology could be readily adapted to determining immunisation status. Combined with some simple to use smartphone technology to read the tests result, capture the person’s identify, and guide the field staff through which tests are needed (perhaps based on where the person has been travelling from) the outcomes could quickly be captured, transmitted to whichever government agencies need it and kept to make future passage easier. 

The underlying technologies to make such processes both more robust and faster already exists, and it is surely only a matter of time before concerns about vaccination reach a point where such proof is required for certain activities.

Author
Dr Neil Polwart, is founder of Novarum DX f and BBI Group Head of Mobile

www.novarumdx.com