Article: Dr. Marc-Antoine de La Vega and colleagues in Dr. Gary Kobinger’s research group at the Galveston National Laboratory (GNL) at UTMB dedicate their efforts to priority high risk pathogens. Their work spans all aspects of research (fundamental, translational, clinical, and field studies) and concerns pathogens such as SARS-CoV-2, monkeypox virus, Zika virus, Crimean-Congo hemorrhagic fever virus, and Ebola virus. All members are full-time academic researchers, but they acknowledge the importance that outbreak response can have on global health. As such, it is not uncommon for them to put their research on pause to assist however possible with containing the spread of an infectious disease. Dr. de La Vega noted that a defining time during his early graduate research journey with Dr. Kobinger was when the 2014 Ebola outbreak hit West Africa. The lab became involved in the outbreak response efforts, with some members (including Dr. de La Vega) setting up rapid response mobile laboratories (RRML) in hot zones; they also aided the clinical development of a candidate vaccine against the Ebola virus itself, now known as ERVEBO®.
The international response to an infectious disease outbreak is intended to act as the surge capacity of a local healthcare system, i.e. support the existing infrastructures while covering the gaps. In terms of laboratory support, this relies on the influx of teams into the outbreak zone to either supplement (reagents, technical expertise, personnel) existing diagnostic labs or staff temporary diagnostic labs in the field. International teams often face the responsibilities of harmonizing with local authorities and institutions, figuring out supply logistics and utilities (e.g. water, electricity) as well as customs and shipping paperwork. For Dr. de La Vega and his team, deployments to hot zones are often achieved alongside organizations like WHO or Doctors without Borders, since the bulk of their focus remains academic research and does not have the capacity to manage logistic complexities of all deployment requests. Meanwhile, during the COVID-19 pandemic, the group set up a nonprofit organization to support 14 individual RRMLs within remote industries in northern Canada to provide diagnostic capacity, free of charge, to local communities. Another grant, awarded by the Government of Canada, enabled them to collaborate with various research institutions in eight African countries. The group tailored research projects around the individual interests of each institution and provided training of personnel in techniques like PCR and serology to build sustainable diagnostic capacity. With this funding model, “the research leads to data and publications, which lead to grants to fund future projects and training programs”, explained Dr. de La Vega.
COVID-19 Mobile Laboratory (Northern Canada, 2020 - Photo provided by de La Vega)
The GNL (Kobinger laboratory plus other GNL/UTMB researchers) is a partner institution of the Global Outbreak Alert and Response Network (GOARN). GOARN is a WHO network of over 250 institutions that mediates the deployment of international resources in response to infectious disease outbreaks and public health emergencies. GOARN works as a communication channel to notify member institutions of new emergencies and recruit teams to deploy based on expertise and resource capacity. Importantly, there was no guidebook for any team or international organization to navigate the key pieces and players of an outbreak response until GOARN created the Rapid Response Mobile Lab Network in 2018-2019. According to Dr. de La Vega, the same 2014 Ebola outbreak that impacted his research journey also irreparably changed the dynamics of global outbreak response. When the outbreak got out of control, the need for RRMLs within hot zones in West Africa exploded and over thirty international teams were deployed to critically affected regions. It was clear that there was no standardized approach between organizations or institutions and “people realized that they were not that ready at putting all the pieces together”, he stated. The RRML Network initiative was thus created to streamline and set expectations for future outbreak response missions.
RRML team during 2018 Ebola outbreak (Mbandaka, DRC - Photo provided by de La Vega)
Example of a basic RRML setup (training exercise, DRC 2019 - Photo provided by de La Vega)
GOARN recently drafted a list of minimum standards to achieve during an outbreak response. These include five overarching pillars corresponding to (i) Operational Support & Logistics, (ii) Knowledge Information Management, (iii), Biosafety & Biosecurity (iv) Quality Management Systems, and (v) Coordination and Interoperability in the Field. To test these minimum standards and indicators, a field simulation exercise in “Global Land’ conducted over the course of several months was organized by the WHO to observe RRML teams working through the outbreak in three phases corresponding to pre-deployment, field operations, and mission conclusion.
Outline of RRML standards and indicators (Diagram source: WHO/GOARN)
GNL team during the RRML Field Exercise: Module II (Turkey, 2023 - Photo provided by de La Vega)
Over the past year, Dr. de La Vega attended all three exercise modules (Phase I – Berlin, Phase II – Turkey, Phase III – Georgia) as a representative of the GNL team. The final module (Phase III) took place during mid-February 2024. At the module’s end, next steps were brainstormed such as the promotion of the network, recruitment of additional collaborators, and development of a governance framework for the network. Another topic was the practicality of incorporating One Health aspects, such as pathogen surveillance using animal populations. All participants agreed that One Health is a necessary goal for future outbreak response efforts. However, it was argued that the current priorities should be the expansion of the RRML network with a focus on optimizing the clinical diagnostic initiative.