Digital therapeutics for distributed response to global pandemics

Abstract

Despite advances in the development of drugs and vaccines, the spread of infectious diseases remains an imminent threat to our global health, in extreme cases potentially having detrimental consequences. At present our response to this threat is based on physically distributing therapeutic material, which utilizes the same transportation networks that support the spread of the infectious agent itself. Such competition is at risk of failure in the face of a rapidly spreading pathogen, especially given the inevitable delay from the initial outbreak to the development and execution of our response. Moreover, based on our existing transportation networks, we show that such physical distribution is intrinsically inefficient, leading to an uneven concentration of the therapeutic within a small fraction of destinations, while leaving the majority of the population deprived. This suggests that outrunning a virulent epidemic can only be achieved if we develop a mitigation strategy that bypasses the existing distribution networks of biological and chemical material. Here we propose such a response, utilizing digitizable therapeutics, which can be distributed as digital sequence files and synthesized on location, exposing an extremely efficient mitigation scheme that systematically outperforms physical distribution. Our proposed strategy, based for example on nucleic acid therapeutics, is plausibly the only viable mitigation plan, based on current technology, that can face a violently spreading pathogen. Complementing the current paradigm, which ranks drugs based on efficacy, our analysis demonstrates the importance of balancing efficacy with distributability, finding that in some cases the latter plays the dominant role in the overall mitigation efficiency.When studied from the angle of its worst-case scenario, surviving a highly infectious pandemic depends on a competition between the infectious pathogen and the therapeutic technology, each racing to reach the majority of the population first. This competition confronts us with several challenges: (i) the inevitable response time R required for us to instigate a mitigation plan places the pathogen at a potentially significant spreading advantage; (ii) while the pathogen reproduces as it spreads 1-3 , a therapy must be manufactured and shipped from one or few sources, whose production and distribution capacity may be limited 4-12 ; (iii) the dissemination of antibiotics or vaccines can be hindered by various external factors, such as geopolitical and socio-economical constraints [13][14][15][16] , which have little effect on the propagation of bacteria and viruses. But even if such factors are eliminated, e.g., assuming that an effective cure already exists, stockpiled in sufficient quantities and benefits from worldwide cooperation in its distribution, it would still have to outrun the pathogen, competing along the same routes of dissemination as the epidemic, i.e. the international transportation networks 17-23 . For a rapidly progressing epidemic, such competition may f...

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