In a recent BBC Richard Dimbleby lecture, Professor Dame Sarah Gilbert detailed how scientists reacted quickly to the Covid-19 pandemic. However, the Oxford professor said they should have moved forward at even greater speed. The overarching question throughout her talk was, “How do you fight a pandemic when you are in a pandemic?” While this question might have been moot in 2019, moving into 2022, there is a clear answer.
Professor Gilbert’s lecture spoke about Covid-19, not a Chemical, Biological, Radiological and Nuclear (CBRN) event in the first responder / military sense, but "B" nonetheless with clear parallels between the two. Both can cause an unrivalled amount of destruction to health and the economy, and both need previous investment, preparation, and training to ensure the best possible response.
We were not prepared for Disease X, but listening to Professor Gilbert’s story about how she developed a vaccine for Disease X should give those involved in CBRN an insight into how we could better prepare for Event X.
Responding to the threat
At the time of writing, Covid-19 has taken 5,340,614 lives, emptied schools, savaged economies, kept us from our loved ones, and closed down entire societies. The virus has killed more people than any infectious disease for over a century.
However, despite the destruction it has left in its wake, the human response has been nothing short of extraordinary. Within less than a year, Professor Gilbert’s team designed, made, manufactured, and distributed a very safe vaccine that is highly effective and available worldwide.
The scientists moved at a speed that would have been impossible pre-2020, facilitated by their level of preparedness before we had even heard of zoonotic disease. Researchers, rather than governments, had been planning for infectious diseases in general—and Disease X specifically. Despite Disease X being a hypothetical, it was seen as inevitable.
Professor Gilbert’s team had surveillance systems in place to track the virus, gathered a vast amount of knowledge from similar previous viruses, and used prior vaccine preparation to create the Covid-19 vaccination. Ironically, pre-Covid we were told the public was tired of listening to experts; however, this sentiment evaporated quicker than the virus was spreading. It was clear for all to see that the experts were the ones who would lead us out of the pandemic.
In the future, new strands will appear, but experts are confident they can beat Covid-19. However, this is dependent on how prepared they are.
Memory: essential in preparing for the next threat
When a virus affects us, our immune system detects intruders and destroys them. Our bodies remember this process so that they can better respond next time.
Our immune systems are very good at doing this, but viruses are quick, which is why they can make us ill. Viruses can hit us before our immune system has had the chance to mobilise its forces—which is why vaccines are so important.
Vaccines provide the immune system with a memory of a virus without the body suffering from the disease. Instead, they present a body with a harmless mimic of a virus. And most modern vaccines show the body only the part of the virus it needs to recognise to produce an immune response.
Using technology to safeguard the future
AstraZeneca, Pfizer, and Moderna all produced vaccines using platform technology, developed due to the inadequate response to ebola. The world first knew about ebola in 1976, but 20 years later, there was still no vaccine. However, everything changed in 2014 with the ebola outbreak in West Africa, when 8% of Liberia’s doctors and nurses were killed by the disease. This shook the world into action, and the WHO began to draw up a list of dangerous diseases against which we should develop vaccinations. The institution was aware of some diseases and unaware of others—the so-called Disease X.
But how do you prepare for a disease about which you know nothing? The answer lies in preparing platform technologies suitable for rapid response. Platform technologies are used as the infrastructure upon which other applications, technologies, or processes can be developed for an end-user. The key to a platform technology architecture is abstraction, which is the quality of dealing with generic forms rather than specific events, details, or applications.
In terms of vaccinations, platform technologies have been developed that could make it possible for multiple vaccines to be more rapidly produced from a single system. Thus, Professor Gilbert used the work she had been carrying out on MERS, which belongs to the coronavirus family, as a springboard from which to start working on Covid-19.
Luckily she secured funding for this research. Unfortunately, many researchers spend their professional lives chasing elusive grants that can take years of work to secure, only to be denied at the final hurdle. This means experts are, for years, trapped in a silent mouse spinner instead of working on scientific discovery.
Rapid, multi-institutional response is everything
When Professor Gilbert received the news that the virus was a coronavirus, she knew the template her team had already created for MERS could be used to develop a vaccine.
When Chinese scientists posted the genetic sequence for the novel coronavirus online, the years of preparation—albeit for a different virus—allowed her and her team to work quickly. Using the code, it took only 48 hours to work out the exact genetic sequence to make the vaccine.
Months of work followed until the Clinical BioManufacturing Facility at Oxford made the vaccine and had it ready for clinical trials. Professor Gilbert described that this moment felt as if “we had created a great sourdough in the kitchen and then you have to supply every supermarket in the world.”
However, her team drew upon existing infrastructure and colleagues in Brazil and South Africa to carry out clinical trials. And this time, they were lucky. Lucky because she was successful when previously they were likely to have failed—not for the robustness of her science but for the lack of funding.
Previous vaccine efforts have moved slowly or halted because they have not been considered a high enough priority. The system of applying for funding is laggard, and vaccines are almost always delayed for this reason rather than for being unsafe. It happened at a time “when we were scrambling to find PPE and clapping for carers—and this kind of limping along would not do,” said Professor Gilbert.
She was able to move quickly because the system allowed her to. Helped by former venture capitalist Kate Bingham, funding cycles were compressed, which allowed her to focus on the research rather than the fundraising. Vaccine development was also helped by The Medicines and Healthcare products Regulatory Agency reviewing the evidence on a rolling basis instead of scientists presenting every piece of evidence at the end of a trial, which is the general practice.
Cooperation and preparedness are the keys to success
The success of the vaccine is not just about its efficacy. It also depends on how many doses can be manufactured, how easy it is to supply, and how many people are willing to receive it.
Manufacturing and producing vaccines was not a problem for Professor Gilbert at Oxford; however, the logistics of distributing them across the globe was. When AstraZeneca, a pharmaceutical manufacturing giant, approached her, this problem became smaller. This type of inter-company, inter-institutional, international cooperation was one of the vaccine’s keys to success. Cooperation on every level is paramount.
However, better preparation and more secure funding would have led to an even faster response. Professor Gilbert admits to not being fully prepared. And as they had never gone through this process before, her team was using never-tried-before techniques, which are always somewhat trial and error.
But the experts learned during the pandemic, and they made the systems more efficient. Time, funding, and practice meant that when the more contagious Delta variant was discovered globally in 2021 they had a much better system in place to analyse how to best address it.
Just like the body’s immune system, Professor Gilbert’s team learnt from past experiences and adapted to overcome challenges. Every time a new variant is detected, work starts to change the vaccinations in response.
Professor Gilbert concluded, “There will be a disease Y. This will not be the last time a disease threatens our lives or our livelihoods. The next one could be worse—more contagious or more lethal.” The only way to beat Covid-19 is through experience facilitated by investment, preparation, and training.
What lessons can we learn from Covid-19 for a CBRN event?
Luckily for us, scientists around the globe like Professor Gilbert were prepared for Disease X. But we were also perturbed that our governments did not seem equally prepared for a pandemic. Surprisingly, according to the 2021 Global Health Security Index, “Despite important steps taken by countries to respond to the Covid-19 pandemic, all countries...remain dangerously unprepared to meet future epidemic and pandemic threats.”
Governments did not believe a pandemic of this magnitude would happen—until it did. For many, this exposes the lack of serious preparation for a possible CBRN event. Accidents and terrorist attacks can cause serious global disruption and are a risk for human health and the economy. To prevent catastrophe tomorrow, we must prepare today.
In the words of Professor Gilbert, “What we discovered is what we can do when we understand our goal and really put our minds to achieving it. By working together, we can have a better response to Disease Y.”
Preparing for a CBRN event with simulation training
Preparing for a CBRN event is a complex process. There are many ways of ensuring an efficient response; however, similarly to Covid-19, successfully addressing CBRN threats involves four core elements:
- Foresight - recognising that one day there will be an Event X
- Investment in the right technologies
- Preparation by studying the best ways to address Event X
- Training using simulation devices so first responders are fully prepared for Event X
CBRN simulation training is a widely used method of preparing investigators in the field to correctly identify chemical and radioactive materials. It involves investment, preparation, and training.
Argon Electronics has over 30 years of experience as a global provider of CBRN detector simulators. The company has developed strong relationships with many of the leading detector manufacturers, which allows it to create realistic simulators that are almost identical to the real devices.
To learn more about simulator training, take a look at our case study about the Tennessee Emergency Management Agency (TEMA). This free download will help you learn how to replicate TEMA's success and prepare for any radiological situation or future 'Event X.' Click the banner below to download it now: