Saudi Arabia, home to Islam’s holiest cities, faces an exceptional problem. The hajj and umrah bring millions of religious pilgrims to the kingdom every year, creating a hotbed for infectious diseases to mix and spread. As part of a broad effort to improve the nation’s ability to respond to diseases, King Abdulaziz City for Science and Technology (KACST) is developing an Advanced Technology Platform for Infectious Disease Surveillance to detect, monitor and predict infectious disease threats. “We want to be sure we are prepared to face any outbreak that appears in the kingdom,” says project lead, Majed Nassar.
To accomplish this, the platform will combine several components: a surveillance network consisting of well-established core labs inside KACST, other labs around the country, and two mobile labs; a data repository and biobank; bioinformatics and health geographic information system (HGIS) tools to support epidemiological research; and small-scale biomanufacturing facilities to produce pilot lots of vaccines. Because KACST isn’t authorized to collect samples from patients and farm animals, the surveillance network will include regional labs belonging to the Ministry of Health (MOH) and the Ministry of Environment, Water, and Agriculture (MEWA), as well as labs at research institutes such as King Saud University, and the King Faisal Specialist Hospital and Research Centre.
Researchers in the kingdom and elsewhere will be able to use data from the platform to study the origin of infectious diseases in the country and model how they spread. In addition to improving the awareness and prediction of diseases, the platform aims to build Saudi infectious disease research capacity. The small-scale manufacturing facilities included in the project will support vaccine research by enabling scientists to produce vaccines on a pilot scale for evaluation and clinical testing.
KACST, which already has significant bioinformatics and HGIS expertise and hosts high-throughput sequencing platforms, will serve as a hub coordinating research efforts and the surveillance and monitoring network. “We will not lead,” explains Nassar. “We don’t want to dominate the work. We are just trying to complete the ring. KACST usually supports research and development at other institutes, and that’s what we’re doing here.”
With these tools, researchers and officials will have access to up-to-date, accurate information about endemic and zoonotic diseases in the kingdom, as well as the ability to monitor travel-related outbreaks. However, the pieces aren’t all in place yet. “We started in January 2017, and we’re still in meetings with MOH and MEWA to establish the infrastructure,” says Nassar, who currently spends much of his time liaising between KACST and the ministries. While the platform is being established, the team is also working to integrate data from separate databases existing at the two ministries in order to identify patterns related to infectious diseases.
Despite some similarities, the platform isn’t designed to mimic the US Centers for Disease Control and Prevention. That role will be filled by Saudi Arabia’s newly established National Center for Disease Prevention and Control (NCDPC) and National Health Laboratory (NHL). Nassar describes the KACST platform as a tool that will provide data to support decision-making by the NCDPC and the Saudi government. “Our main goal is to have a trusted source of accurate information that can help the government, the public and the media –national and international – be aware of any incident inside the kingdom,” he says.
“There’s a huge amount of data that no-one understands. We’re analysing it, simplifying it, and making it useful for everyone,” says Nassar. While the primary goal is to provide this information to Saudi authorities and experts, the project also aims to inform the public directly through the media. In the long-run, Nassar envisages a publicly accessible portal that anyone could use to get up-to-date, accurate information about disease outbreaks in the country.
A potential issue for the project will be the question of transparency. In 2012, Saudi Arabia was at the centre of an outbreak of the MERS coronavirus, which involved more than 2,000 confirmed cases and 730 deaths, most of them within the kingdom. Two years later, international experts criticized the country for a lack of open communication and collaboration, which hindered containment of the disease. Preparedness for similar outbreaks was part of the motivation for establishing the NCDPC, NHL and the infectious disease surveillance platform.
Though an exact figure has not been disclosed, Nassar reports that the project is well funded. Bureaucratic hurdles at the ministries have slowed the project, but Nassar is confident that the support of KACST's president and the concerted efforts of ministry officials will overcome the delays and the project’s main goals will be accomplished by 2020.
Saudi Arabia also faces healthcare challenges from inherited or non-communicable diseases such as diabetes, but preparing to handle infectious disease outbreaks is important for the country’s future. “We’re afraid that one day a mutation [in the MERS virus] will make us face a disaster that will threaten Saudis and visitors similar to the SARS outbreak in China, which led to 8,000 infections and 774 deaths,” says Nassar, who is also concerned by the lack of an accurate source of data to control future outbreaks of emerging diseases in the kingdom. “We don’t have an accurate, unified source of data to ensure we can be prepared for and control these diseases. It’s getting more dangerous by the year, so we want to make sure we are well prepared to face these problems.”