Opening remarks: CITF legacy: Opportunities for serosurveillance in Canada

Speaker: Tim Evans

The COVID-19 Immunity Task Force was funded in April 2020 to mobilize knowledge on SARS-CoV-2 infection and immunity and to inform the public health response to the COVID-19 pandemic. Dr. Tim Evans, Executive Director of the CITF, provides reflections on the past four years of the Task Force’s activities and highlights the successes of a pan-Canadian network in collating and synthesizing SARS-CoV-2 research activities in a format useable by public health officials. As the Task Force reaches the end of its mandate, Dr. Evans demonstrates the need for an ongoing serosurveillance network (Hema-Net) to ensure that the collaborations and partnerships built using residual (otherwise discarded) samples are appropriately leveraged for health emergencies and pandemics of the future. The objectives of the Hema-Net serosurveillance network meeting will be discussed, setting the stage for the next three days of this meeting.

Core foundations of serosurveillance:
Lessons from SeroSummit 2023

Speakers: Bill Moss, Andrea Carcelen.

Moderated by Prativa Baral

In March 2023, the Serosurveillance Summit was organized by Dr. Bill Moss and Dr. Andrea Carcelen at the International Vaccine Access Center of the Johns Hopkins Bloomberg School of Public Health to identify the challenges and potential solutions for building serosurveillance programs worldwide. Dr. Moss and Dr. Carcelen presented some of the core foundations of serosurveillance, based on lessons learned from last year’s Summit. Specifically, they discussed the feasibility and utility of multiplex serosurveillance systems to identify immunity gaps for vaccine-preventable diseases in low- and middle-income countries (LMICs). Additionally, they discussed opportunities and challenges in implementing serosurveillance across several use cases, including in-depth discussions on supply chain issues, laboratory assays, data analysis and operations.

Scientific Strategy – use cases for serosurveillance

Speakers: Shelly Bolotin, Agatha Jassem, Steve Drews, Inna Sekinov, Sheila O’Brien, Iris Ganser.

Moderated by Steve Drews & Agatha Jassem

The Scientific Strategy discussion was focused on exploring a few of the use cases for serosurveillance in Canada. The panelists discussed a use case, identifying gaps and opportunities in the current public health surveillance strategy, while demonstrating ways in which serosurveillance can be utilized for implementing better policy decisions. Dr. Sekirov discussed the need for ongoing SARS-CoV-2 serosurveillance to inform booster policy as well as for informing appropriate responses to other respiratory pathogens and/or future pandemics. Dr. Bolotin provided an overview of measles in Canada, highlighting the role that serosurveillance can play in evaluating vaccination programs and anticipating outbreaks. Dr. O’Brien and Iris Ganser discussed the incredible potential of longitudinal serosurveillance in understanding antibody-waning dynamics after infection and/or vaccination. Finally, Dr. Drews provided a potential use case of serosurveillance in monitoring the impact of climate change on emerging diseases. Resoundingly, the panel demonstrated that serosurveillance can be used to understand the impact of a variety of communicable and non-communicable diseases affecting Canadians.

Data strategy: Data governance, platforms & linkages

Speakers: Harriet Ware, David Buckeridge, Sheila O’Brien, Lori Beach.
Moderated by Cate Hankins

Adequate data linkage is essential for realizing the full potential of serosurveillance initiatives. This session focused on highlighting the value of linking serosurveillance data with health records and discussed the real-life challenges regarding data linkage during the COVID-19 pandemic. The panel also touched on the challenges in sharing data across our country and deliberated on the need to establish standardized data management processes to ensure preparedness for endemic and emerging health emergencies.

Privacy & ethical consent management for residual bloods

Speakers: Deborah Money, Caroline Quach, Mélanie Dieudé, Ray Saginur.
Moderated by Cate Hankins

While residual blood samples represent an enormous value proposition for serosurveillance initiatives, it is important to consider the ethical considerations of their intended use while respecting Canadians’ privacy. Dr. Money provided an overview of her experiences navigating privacy-related complexities in antenatal surveillance projects. Some of the panelists, namely Dr. Quach, Dr. Dieudé, and Dr. Saginur, also discussed ways in which ethical documents and frameworks can be created to ensure that study participants are well-informed while also using the full potential of their valuable biospecimens in advancing public health priorities.

Value-for-money assessments of a serosurveillance network

Speakers: Jonathon Campbell, Cate Hankins, Sherrie Kelly, Caroline Wagner.
Moderated by Jonathon Campbell

The Public Health Agency of Canada has multiple routine surveillance platforms which have been employed to understand the impact of a variety of acute and chronic health conditions on the Canadian population. Dr. Campbell presented a value-for-money assessment of a unified serosurveillance network such as Hema-Net, compared to other largely vertical surveillance efforts. A combination of various surveillance strategies (incl. serosurveillance and wastewater surveillance) can be used in unison to address appropriate gaps in public health priorities. The presentation also demonstrated the value of Hema-Net beyond the public health space to the economy, as well as to capacity-building and biomedical preparedness, for future public health emergencies.

Keynote presentation: Past, present & future of serosurveillance

Speaker: Maria Van Kerkhove

Dr. Maria Van Kerkhove’s keynote presentation provided an overview of the past, present, and future directions of serosurveillance. The presentation focused on the World Health Organization’s (WHO) sero-epidemiology efforts. Dr. Van Kerkhove described the development of the CONSISE guidelines in the context of the H5N1 Influenza epidemic, which standardized best practices in conducting and reporting studies. These have since been adapted to create guidelines for other pathogens of concern, most recently during the COVID-19 pandemic. Dr. Van Kerkhove highlighted the key role of LMICs-led studies during the COVID-19 pandemic, the success of the SeroTracker dashboard, and the importance of collaboration and maintenance of pandemic preparedness.

Serosurveillance as a core public health science capacity

Speakers: Maria Van Kerkhove, David Buckeridge, Alicen Spaulding.
Moderated by Sarah Viehbeck

Following Dr. Van Kerkhove’s keynote, a panel discussion highlighted the role of serosurveillance in the current public health landscape, the existing challenges and barriers, as well as the future needs and opportunities to strengthen it as a core public health capacity. The panelists discussed gaps in timeliness of data synthesis and in data infrastructure. They also discussed the reliability of complex models of disease surveillance, the importance of collaboration and resource-provision driven by local priority, ways in which serosurveillance could compliment the broader surveillance landscape, and the importance of capacity building and retention.

National serosurveillance efforts across the globe

Speakers: Olav Hungnes, Hans Zaaijer, Helen Ward.
Moderated by Tim Evans

To better understand the global serosurveillance landscape, this panel focused on existing national serosurveillance efforts around the world, identifying best practices, lessons learned, and opportunities to collaborate and standardize approaches globally. The presentations highlighted use cases for serosurveillance using residual sera and/or blood donor samples in three different countries, namely, Norway, the Netherlands, and the United Kingdom. Specifically, the presentations discussed: 1) the use of residual bloods collected annually and analyzed by the Norwegian Institute of Public Health to study influenza transmission, immunity, and vaccine effectiveness; 2) use cases for serosurveillance by Sanquin, the national blood bank of the Netherlands; and 3) the use case of serosurveillance for assessing community transmission in the UK using self-test antibody kits.

Cross-country opportunities for serosurveillance analyses

Speakers: Thomas Jaenisch, Isabel Bergeri, Mairead Whelan, Harriet Ware.
Moderated by Tim Evans

To better understand how serosurveillance efforts can be synthesized across different countries, this panel explored benefits and challenges of international collaboration, including data sharing and analyses, as well as strategies for harmonizing efforts across different jurisdictions. Specifically, this session highlighted examples of serosurveillance conducted at a multinational or global scale. These included examples of large-scale seroprevalence studies, use cases that combine seroprevalence data with environmental suitability data, efforts to standardize research methodology and reporting, and efforts to synthesize and harmonize serosurveillance data.

Scientific frontiers of serosurveillance (precision immunology and serolomics for public health)

Speakers: Monika Strengert, Alex Dulovic, Emilia Liana Falcone.
Moderated by Jennifer Gommerman

The scientific frontiers panel delved into new scientific approaches and technologies supported by serosurveillance, discussing the current and future applications and implications of serosurveillance efforts. Specifically, Dr. Strengert outlined the use of multiplex assays for throughput analyses of humoral immunity, which are used to assess cross and partial immunity to pathogens of interest and create advanced vaccination response profiles. Dr. Dulovic presented use cases of multiplex immunity assays to identify re-infections with RSV, and study Lyme disease in a single test step. And finally, Dr. Falcone shared insights on clinical research on infectious disease sequelae caused by microbiota dysregulation, and the possibility of harnessing seroprevalence to monitor the prevalence of chronic conditions.

Presentation series:

Presentation 1: Global Immunological Observatory: A weather map for viruses (Michael Mina)

Presentation 2: PREMISE: Opportunities for diagnostics & therapeutics (Alicen Spaulding)

Speakers: Michael Mina, Alicen Spaulding.
Moderated by Ligia Pinto

This session presented the possibilities and potential for innovation in serosurveillance, with the introduction of a Global Immunological Observatory (GIO) by Dr. Michael Mina and the Pandemic Response Repository through Microbial and Immune Surveillance and Epidemiology (PREMISE) by Dr. Alicen Spaulding. Specifically, Dr. Mina’s presentation described the use of phage display immunoprecipitation technology to map the immunity and infection history of individuals. He also highlighted challenges in scaling these efforts and considerations for ethics. Dr. Spaulding then presented the PREMISE program, which aims to create a repository of immune assays and immunobiological countermeasures to accelerate pandemic response. The session also discussed challenges given decreasing interest in pandemic preparedness more broadly.

Modeling capabilities with serosurveillance data

Speakers: Daniel Park, Caroline Wagner, Jane Heffernan.
Moderated by David Buckeridge

This session outlined use cases of modeling capabilities using serosurveillance data, their applications in public health, and the challenges and best practices when integrating modeling with serosurveillance data. More specifically, Daniel Park discussed a case study of an SIR model of Enterovirus D68 transmission and the use of seroprevalence data to fill knowledge gaps on population susceptibility. Dr. Wagner discussed use cases of modeling SARS-CoV-2 infections and vaccinations. Dr. Heffernan outlined methods in immuno-epidemiology and the use of models to project longevity of immunity for humoral and cell-mediated responses while characterizing them within the population. Panel discussions covered the possibility of multi-pathogen models, challenges in data reliability and data sharing more broadly, as well as the unique value add of serosurveillance data in modeling efforts.

Federal and provincial needs for serosurveillance

Speakers: Nadine Sicard, Shelly Bolotin, Carmen Charlton, Lori Beach, Derek Stein, Inna Sekirov.
Moderated by Sarah Viehbeck

Navigating the complexities of serosurveillance in Canada demands tailored strategies that address the unique needs of each province within a cohesive national framework. Identifying and overcoming regional challenges are pivotal in enhancing public health monitoring and response. This involves a collaborative effort to innovate and adapt serosurveillance practices, ensuring they are comprehensive and flexible enough to meet the diverse health landscapes across the country. The panelists highlighted some of these challenges and discussed the impact of resource limitations, while also emphasizing the need for alignment with federal priorities as the national pandemic preparedness plans are refreshed.

Research dimensions of serosurveillance in the context of pandemic preparedness

Speakers: Ligia Pinto, Melissa Coughlin, Alicen Spaulding.

Moderated by Jennifer Gommerman

This panel included international panelists to discuss the utility of serosurveillance beyond disease monitoring. Research in serosurveillance plays a pivotal role in enhancing our preparedness for pandemics, offering insights into immune responses, disease spread, and the development of vaccines and therapeutic strategies. Dr.Pinto provided an in-depth look at the latest developments in serological research within the SeroNet framework, emphasizing the role of serology in understanding immune responses, tracking the spread of diseases, and guiding the development of vaccines and therapeutics. Next, Dr. Coughlin’s presentation detailed the CDC’s surveillance efforts on SARS-CoV-2 in the U.S., focusing on seroprevalence studies to capture a comprehensive picture of infections, including those not reported in case-based surveillance. Altogether, the panel discussed the challenges of using early antibody assays in COVID-19, the importance of clear public communication, the distinction between vaccine-induced and infection-induced immunity, and the integration of cell-mediated immunity into surveillance. Discussions emphasized the need for sustainable surveillance infrastructure, coordination among stakeholders, and leveraging learnings for future pandemic preparedness.

Assessing population representativeness of serosurveillance data

Speakers: Deborah Money, Dawn Bowdish, Scott McLeish. Moderated by Alton Russell

Assessing the representativeness of serosurveillance data is crucial to understanding the true dynamics of disease spread within the Canadian population. Dr. Russell presented strategies that can be used to identify gaps in population representativeness when using residual blood samples. Subsequently, Dr. Bowdish and Dr. Money presented data showing how adequate measures and targeted population-specific surveys can be developed to address these issues and ensure a more comprehensive understanding of disease prevalence and immunity across various demographic groups. Efforts to address these gaps include comprehensive demographic data collection, timely data integration, and innovative sampling methods such as leveraging residual antenatal blood samples. Strategies outlined by Statistics Canada aimed to enhance representativeness through broader coverage and faster turnaround of results, ultimately bolstering pandemic preparedness efforts.

Building a network of laboratories for serosurveillance across Canada

Speakers: Inna Sekirov, Lori Beach, Amanda Lang, Derek Stein, Carmen Charlto.
Moderated by Marc-André Langlois

The panel brought together a core element of Hema-Net: a coordinated network of laboratories that can handle a variety of blood-based biospecimens to address the endemic and emerging health threats against Canadians. This laboratory panel discussed the need for labs across Canada to collaborate with each other and the Canadian Public Health Lab Network/NML to ensure that assays are cross-comparable and uniform standards can be maintained across the different equipment, assays and reagents. The panel members also discussed the many resource challenges they faced during the COVID-19 pandemic, including maintaining highly talented staff, difficulties in equipment acquisition, sample transport and supply chain issues. Solutions for these may include leveraging national networks and establishing processes to streamline material transfer agreements, shipment of samples to regional specialized laboratories and data sharing.

Building capacity & infrastructure across the network

Speakers: Angela Crawley, Mairead Whelan, Lori, Beach, Sheila O’Brien.
Moderated by David Buckeridge

A library of selected residual specimens utilized for serosurveillance initiatives is an incredibly valuable tool to ensure biomedical countermeasure development and emergency preparedness. The lack of an established national/regional biobank was a hindrance to assay development and standardization during the COVID-19 pandemic. Dr. Crawley from CoVaRR-Net introduced their network’s efforts in establishing the Canadian Biobank and Data Alliance to facilitate the establishment of standards and sharing of resources across Canada. Dr. O’Brien and Dr. Beach shared insights about some of the challenges faced by smaller jurisdictions, and suggested the need for robust adaptive serosurveillance systems that foster collaboration across the nation. Finally, Mairead Wheland emphasized the need for a minimum viable product approach to ensure Hema-Net can be built on a strong foundation.

Closing remarks: Hema-Net serosurveillance meeting

Speaker: Tim Evans

Dr. Tim Evans provides closing remarks summarizing key takeaways from the past three days of the Hema-Net serosurveillance network meeting. These takeaways are presented along with suggestions on next steps to further develop Hema-Net. The rest of this session is an open discussion in which meeting participants provide their suggestions regarding the minimum viable product essential for the first iteration of Hema-Net, its most compelling use cases, the necessary national and international partnerships for success, and the short- and long-term vision to reach the network’s full potential.