Pathogen surveillance at APSI-India: From Innovative Technologies to Policy Advocacy

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Highlight: The APSI-India consortium came together in July 2021 as an emergency response team to supplement the ongoing #SARS-CoV-2 sampling and surveillance network across India. While the team has been continuing to keep an eye on emergent variants of SARS-Cov-2, for the past 18 months, we have taken up environmental surveillance of several WHO- and ICMR-listed priority pathogens as well as antimicrobial resistance (AMR) surveillance. The main focus is to develop innovative protocols and surveillance kits to use environmental surveillance as an early warning system and predictive disease modeling for better disease preparedness in India.

Generously supported and funded by The Rockefeller Foundation , the Alliance for Pathogen Surveillance Innovations, APSI-India , facilitated by the Office of the Principal Scientific Adviser to the Government of India came into being in July 2021. The #APSI-India is a multicity consortium, comprising several research institutes in 4 nodal cities (Bengaluru, Hyderabad, Pune, and Delhi-NCR). The consortium began to take shape when India was massively crippled with COVID-19, during the second wave of the pandemic. It came up as an emergency collaboration, supplementing the ongoing SARS-Cov-2 genomic surveillance. We carried out clinical sampling, COVID-19 vaccine response, wastewater surveillance for viral presence, pathogen load and variants. These data were shared on a regular basis with the local municipal governments and health organizations.

Our current mandate extends to environmental and molecular surveillance for many disease-causing pathogens beyond #SARS-CoV-2 (such as influenza and dengue viruses, as well as bacteria which contribute to AMR). Detection of pathogenic organisms in wastewater can serve as an early warning system to predict disease outbreaks. Over the last 2 years we have developed protocols for the reliable detection of SARS-CoV-2 from wastewater and shown it to be a good predictor for clinical caseloads of COVID-19 across the consortium cities. The surveillance data are deposited to INSACOG, a pan-India network to monitor genomic variations in #SARS-CoV-2 and #GISAID, a global resource network for secure sharing of genomic data of infectious disease pathogens. Post-sample processing and nucleic acid extraction, the team carries out metagenomic next-generation genomic sequencing to detect circulating variants as well as optimize detection of other pathogens.

Our approach involves collecting samples samples for #Wastewatersurveillance, #VectorSurveillance for mosquito-borne diseases (#Dengue, #Chikungunia), #AirSurveillance and #AntiMicrobialResistanceSurveillance to develop standardized procedures that can detect disease burden. In addition, APSI-team also conducts #Clinical Surveillance to design high-efficacy, low cost molecular diagnostic kits for some of the priority disease-causing pathogens and pathogens contributing to AMR. The data are further used for disease-modeling and prediction. We also employ our research to develop indigenous low-priced and efficient pathogen surveillance kits for infectious diseases of local concern as well as for AMR. The technology for the innovative surveillance kits is passed on to manufacturing bodies for scaling and furthering the efficacy and cost-effectiveness with the help of our industry partner, InDx (Indigenous Diagnostics) at the Centre for Cellular and Molecular Platforms (C-CAMP). Environmental surveillance can be employed as a robust method of early warning system for these pathogens percolating in the environment, as a readout of human infections.

Each city cluster’s data is periodically updated to the local municipal organization and public health departments with the goal to deliver the resulting protocols and innovative low-cost indigenous surveillance kits for societal impact and public health consumption. Driven by this goal, we continuously aim towards disseminating the resulting protocols, data, surveillance kits and in parallel conduct educational training to better the public health system and to work with civic bodies and the Government for policy advocacy, implementation decisions and action plans for disease preparedness, management and prevention.

Partnering with Govt of India and Health Sector, #APSI-India’s work is a huge contribution for public health preparedness, and it is currently gearing up towards this goal to lead the way in India! As the program progresses, the surveillance has to go hand-in-hand and thereafter be taken up by the Govt. of India and State Govt. Health depts. for disease-response decisions as actionable and long-term sustainable policy plans. This will happen by timely utilization of APSI-India’s research data and its innovative surveillance kits by the Govt- Health sector.

Currently, as the pathogen and AMR surveillance works at APSI’s city clusters is catching speed, APSI-India simultaneously has increased its outreach activities, ranging from workshops for antimicrobial resistance awareness, ongoing #AMRsurveillance being carried out at APSI, the importance of #AMRsurveillance in raising awareness and advocacy for reduced antimicrobial drug prescription. The #AMRFrontline workshops are spearheaded by #APSI-India’s outreach partner, Superheroes against Superbugs(SaS) for healthcare professionals in various cities. Through the workshops, we educate and raise awareness about #AMR which is a global public health threat, India being one of the largest countries with widespread AMR prevalence. Due to over-prescription of antimicrobials, AMR causes infectious pathogens to develop resistance to antimicrobials. The APSI-team works with wastewater and clinical samples to detect AMR burden, AMR gene abundance and correlations of AMR in wastewater with clinical samples. At the AMR workshops, we share our AMR surveillance data, city-wise AMR burden and insights with the hospital professionals and medical fraternity, to train them early-on about the importance of reduced antimicrobial prescriptions to patients for infection control and help reduce AMR burden. We need hospitals, medical colleges, and healthcare professionals to come together and partner with us and become the ambassadors for #AMR awareness to tackle this potent threat.

To further strengthen India’s Public Health surveillance system, APSI-India is working towards increased advocacy for routine employment of the APSI-India’s developed environmental surveillance protocols and indigenized low-cost kits, with the local government and ultimately, with the state govt and at the national level. We have partnered with Chase India for advocating to the state and national government to appeal to the decision makers, for timely implementation and inclusion of the innovative surveillance systems as actionable public health policies.

To increase the visibility and outreach of these efforts, APSI-India actively employs digital and onsite tools and science communication through social media posts, website blogs, media coverage, publications on our website and social handles. Our aim is to represent APSI-India’s work and put it in the correct perspective for Public Health utility/uptake and sustainable and profound societal impact. As we proceed to transfer the innovative surveillance protocols and kits to our industry partners at #CCAMP-InDx for indigenization, we hope, with the support of our teams and partners, that our developed methods and kits are taken up by the government and public health departments to make India better prepared for pathogen-caused diseases and AMR and implement routine surveillance policies.

Visit #APSI-India’s website: https://lnkd.in/gGMpr-MR and our social media handles to learn more about the APSI.

How can you help? Spread #APSI-India’s message| Health and hospital folks: Partner with #APSI-India and help deposit #clinicalsamples | For more details and to participate in our efforts, reach out to us @apsi@ccmb.res.in & contact Dr. Aruna Panda, Program Director, APSI-India.

We look forward to more of the exciting work lined up in the new year. Stay tuned for more Outreach and APSI-India Advocacy!

#EnvironmentalSurveillance #WastewaterSurveillance #STPs #WBE #WWSspeaksOfcityHealth #VectorSurveillance #PublicHealthSurveillance #DiseaseCausingPathogens #WHOprioritypathogens #AMRsurveillance #AMRFrontlineWorkshops #PublicHealthEducationTraining #SurveillanceKitsIndigenization  #RoutineImplementation #EarlyWarningSystem #DiseasePrediction #IndiaDiseasePreparedness #PandemicPreparedness #APSIOutreach #APSIGearingUp for #APSIdeliverables #PublicHealthAdvocacy #PublicHealthPolicy #PublicHealthAction #LocalMunicipal #GovtOfIndiaHealth

LS SHASHIDHARA, Rakesh Mishra, Vinay Nandicoori, Taslimarif Saiyed, PhD, Anurag Agrawal, Aruna Panda, Surabhi Srivastava, National Centre for Biological Sciences (NCBS), Centre for Cellular and Molecular Biology, Tata Institute for Genetics and Society, India, Centre for Cellular and Molecular Platforms (C-CAMP), CSIR- National Chemical Laboratory, Pune Knowledge Cluster, Indian Institute of Science Education and Research (IISER), Pune, Ashoka University, CSIR-IGIB, Superheroes Against Superbugs, Ministry of Health and Family Welfare, Government of India, Chase India

LinkedIn article: https://www.linkedin.com/pulse/pathogen-surveillance-apsi-india-from-innovative-technologies-j1vme