Next Frontiers of Disease Surveillance: Global Integration and Scale

Reimagining how global surveillance data are collected, processed and integrated from disparate sources into a unified view infectious disease risk. 

Dr. Kamran Khan, MD, MPH, Bluedot Founder and CEO

Thousands of disconnected disease surveillance systems have been built around the world, including municipal, state or provincial, national, and global systems. In aggregate, these laboratory-based, or indicator-based surveillance (IBS) systems describe the global distribution and activity of hundreds of pathogens that cause human and animal disease. Having been built in isolation, however, the power and perspective of these systems remains under-appreciated.

These systems have also not been built to integrate with event-based surveillance systems (EBS), which collect highly unstructured disease reports from global media and community monitoring, and are often the first to report on emerging disease activity. EBS systems, however, suffer from a lack of consistent reporting on disease activity.

We will address the isolation of these critical global public health resources by connecting and integrating thousands of IBS systems around the world with BlueDot's world leading EBS system. We can draw from the strengths of each system under a unified data infrastructure, designed to capture the rich and evolving spatiotemporal mosaic of population-pathogen interactions. A truly global, living database of disease activity is central to capture a unified, global view of infectious disease and support coordinated responses to mitigate harm in humans and animals around the world.

BlueDot has been working for seven years to support epidemic preparedness and decision-making across government sectors, private sectors, and with academic partners. In government, we have strong, multi-year relationships with municipal, provincial, and national public health, animal health, and security authorities. Within the private sector, we have predominantly been working with travel industry partners. Finally, we work collaboratively with academic partners around the world to publish our work and share data in support others' research (see supporting materials). As part of building this unified system responsibly, we will work directly with our stakeholders to ensure we're building a true solution, rather than another isolated tool.

There are direct and indirect benefits of our proposed solutions. This solution will drastically increase our ability to support the rapid identification of disease threats, assess risks to populations around the world, and enable data-driven decision-making for our partners. Government and academic partners, in particular, will also benefit from our efforts to develop highly structured and truly comprehensive surveillance database. This unified system will drive diverse and important disease modelling projects. In the long term, we see our ability to support and work with research groups around the world as a core measure of success.

As a B-Corporation, public good and impact is central to BlueDot's mission. We see a number of opportunities to participate with and give back to the global community. For over seven years we have been sharing proprietary global mobility data with research groups around the world in the interest of further understanding and publishing on risk of disease spread. We anticipate that these new consolidated surveillance data will open new opportunities to both publish our learnings in peer-reviewed literature, but also for new collaborations with academic partners who have challenging questions to answer. We are also invested in exploring how we can share and externalize our data infrastructure. The case management infrastructure in particular is a high-quality, stable, and scalable system that can be used by other organizations reporting on diseases around the world. Finally, to truly gather data from around the world, we see direct data partnerships with governments around the world as critical to our success. We endeavor to build responsible data sharing agreements with our partners, to provide equitable access to public health insights in exchange for access to data (see potential partner requests).

Target groups are across public, private, and academic sectors. There are direct benefits to each of these groups related to the quality of outputs through our automated early warning and risk assessment system, as well as indirect benefits in data access for research and innovation.

Direct: Our automated early warning and risk assessment system is fed directly from our surveillance system. It ingests surveillance data to assess the likelihood of disease spread locally and globally through ground and air transportation networks. By substantially enhancing the quality of the data feeding this system, the quality of the system increases. This system is currently being used by municipal, provincial, and national governments in 13 countries, and being trialed in several others to provide early warning and assessment of epidemic risk. 

Indirect: Governments and academia in particular will also benefit through direct access to these data through collaboration and partnerships. We have a rich history of academic publication (see Kamran Khan publication record for examples) and have had remarkable collaborations with governments on assessing risk of major disease events.  This unified system will be a foundational step in access to high quality, comprehensive surveillance data to spur public health innovation around the world.

Impact is central to BlueDot's mission, and will scale by: 1) supporting and expediting global innovation; and 2) directly working with governments around the world to mitigate disease impacts.

Year one is heavily focused on developing and iterating on technologies to support integration at scale. Efforts spent in service of this foundation are necessary steps to support the diversity and volume of future projects. We will design the system with our partners, who will receive incremental benefits of our work during development.

Years two and three are when impact will accelerate as the volume of data grows by two to three orders of magnitude. This represents an unprecedented volume and diversity of high-quality global surveillance data. Robust, accessible data are often a limiting factor in important public health research. This system has the potential to become a critical public health innovation resource for government, private, and academic groups around the world. 

Our technologies are already deployed around the world. Alternative partnership models represent important opportunities to support governments with fewer resources to mitigate against impacts of infectious disease. Developing national data partnerships will become increasingly important to both collect further data, and provide equitable access to critical public health infrastructure.

We have developed a number of technical and usage indicators in service of gauging the success of this project. Technical metrics are associated with the quantity of sources, quality of data, and downtime of the system. Each of these are highly measurable and point toward the velocity and quality of the system overall. These will be collected and assessed on an ongoing basis and in real time to identify and improve any systematic issues in our technology. Technical metrics include: the number of sources integrated per month, number of errors introduced through the system, and downtime on script failure. Usage indicators are centred on uptake of these data by our internal team and partners. These will be collected in real time, but assessed on a quarterly basis. These will include the number of data pulls per month, the volume of data pulled, the quality and impact of projects leveraging these data, and number of publications leveraging these data. 

We have identified one internal and one external barrier to scaling this project. Our internal barrier is associated with resources dedicated to this project, while the external barrier is associated with data partnerships. We have a clear understanding of the steps we need to take to scale the integration of global indicator-based surveillance data with our existing systems, but our data engineering and development resources are allocated on other pressing projects. We see this Trinity Challenge funding as a critical opportunity to accelerate work that would otherwise take two to three times longer to accomplish.

The foreseeable external barrier is in developing data partnerships with governments that do not have highly accessible or high quality surveillance data. We have already started establishing data partnerships with some of our government collaborators in South East Asia. These partnerships will help us understand how to structure data sharing agreements with public health authorities. We also see Trinity as a critical resource in supporting our ability to create responsible, equitable data partnerships through experience from other trinity challenge members such as the Bill and Melinda Gates foundation and other organizations (see partnerships section). 

Not applicable. BlueDot is an independently operated B-Corporation. 

We see the trinity challenge as an incredible opportunity to accelerate the integration of disconnected surveillance systems into critical public health infrastructure by one to three years. As a relatively early stage company, we have very ambitious development goals for our work which have to be aggressively prioritized to continue to achieve sustainability. The challenge will enable us to secure required resources earlier than we would otherwise be able to manage. Access to funding enables us to plan ahead  for the ongoing maintenance of the solution. We see the challenge as an initial capital investment in innovation, enabling us to plan for long-term support and success of these systems.

BlueDot is still learning how to create ethical, robust, and open data sharing agreements and data partnerships. We see Trinity partners as a potential wealth of experience in structuring these agreements with governments. If possible, we see Trinity as a central partner for connecting to experienced members who can help ensure we are making informed and responsible decisions about data partnerships.

We are well equipped from a technical perspective, but could benefit from legal and contractual support in developing robust and responsible data sharing or data partnership agreements. There are a number of Trinity members that could help in this domain, including: Bill and Melinda Gates Foundation, McKinsey and Company, Microsoft, and Legal and General. We feel that these organizations likely have deep and valuable experience in working directly with governments around the world to partner on important and responsible data projects. We believe that mutually beneficial partnerships are important to our ability to answer complex public health challenges. Having collaborators with experience in structuring these types of data partnerships would help further accelerate our ability to integrate these important data sources, while giving back to our data partners and the global public health community.