- Precision medicine is playing a key role in helping scientists understand COVID-19.
- CRISPR-based diagnostics will help rapidly and accurately diagnose a wide range of diseases, including the novel coronavirus.
- The evolution of gene testing and gene editing will drive the future of healthcare.
One of the most common misconceptions about CRISPR is that it’s only useful for gene editing. In reality, CRISPR can be used for a wide variety of non-gene editing applications, ranging from diagnostics to antiviral applications.
There is also a perception that the gene-editing mechanism of CRISPR is the bottleneck for curing all disease. The reality is that, for many applications, the bottleneck is actually our understanding of the genetic code itself or the limitations of what changing that code can actually accomplish. How factors interplay with our genetic code to produce diseases is a field that is critical for unlocking gene editing’s full potential.
What is CRISPR?
“One of the most perplexing aspects of COVID-19 is its enormous range of symptoms. Three people might contract it and have no overlap in their experience. Precision medicine – an innovative approach to care that takes into account an individual’s genes, environment, and lifestyle – is playing a key role in understanding the genetic and environmental factors that might explain why one person is asymptomatic while another must be put on a ventilator,” says Cameron Fox, Specialist on Precision Medicine at the World Economic Forum, and an expert in COVID-19 diagnostics technology.
“Beyond the current crisis, this innovative work will have lasting, positive effects on many facets of the health ecosystem. One example is CRISPR-based diagnostics. CRISPR’s ability to rapidly and accurately diagnose a wide range of diseases is only now being seriously explored. If this technology can be perfected, it would be a gamechanger in our fight against COVID-19,” Fox continues.
Mammoth Biosciences is a World Economic Forum Global Innovator at the forefront of these developments. Here are five things Mammoth’s Co-Founder and CEO Trevor Martin thinks are important to know about how the field is evolving in the era of COVID-19.
1. CRISPR is the search engine for biology.
The advent of CRISPR-based diagnostics fundamentally means a better understanding of the molecular world around us – for areas ranging from human disease to crop health.
Infectious disease is a key use-case area for the diagnostic applications of CRISPR. It’s become clear that one of its most powerful uses is its ability to provide reliable molecular information quickly and in a variety of formats.
International borders, workplaces, homes and maybe even concerts, conferences or other large events could benefit greatly from having tests for COVID-19 (and other diseases) that give gold-standard results within minutes. During a pandemic, this type of information is critical for fully reopening economies and engaging in robust contact tracing.
“We created a robust test for the novel coronavirus within weeks – particularly important as we contemplate the fact that it is a matter of when, not if, we must combat future pandemics beyond the current one,” says Trevor Martin.
Beyond these more immediate uses, there is exciting potential for testing our environment more broadly, through monitoring samples from sewage or air. These measurements could give us unprecedented insight into our ecosystems and how they influence our health.
2. The future of healthcare lies in decentralized testing.
As CRISPR-based diagnostics pave the way for decentralized testing, the technological disruption will also open the door for accelerated adoption of value-based care models, rather than fee-for-service healthcare as in the United States.
Decentralized testing allows people to have more control over their own health and understand better when and how to interact with the healthcare system. Ideally, robust and prevalent diagnostics could mean fewer physical visits to a doctor (and shorter wait times), but the same or higher quality of care for more people by supercharging a doctor’s ability to care for patients through virtual consultations.
To reach its full potential, decentralized testing needs to go beyond its current model of expensive and complicated boxes with cartridges and embrace fully democratizable formats that can be used by individuals without extensive training. For example, Mammoth is creating CRISPR-based tests for diseases like COVID-19 in a format similar to a pregnancy test. This truly decentralized testing will allow for greater access to care and better information about when to seek it.
The application of “precision medicine” to save and improve lives relies on good-quality, easily-accessible data on everything from our DNA to lifestyle and environmental factors. The opposite to a one-size-fits-all healthcare system, it has vast, untapped potential to transform the treatment and prediction of rare diseases—and disease in general.
But there is no global governance framework for such data and no common data portal. This is a problem that contributes to the premature deaths of hundreds of millions of rare-disease patients worldwide.
The World Economic Forum’s Breaking Barriers to Health Data Governance initiative is focused on creating, testing and growing a framework to support effective and responsible access – across borders – to sensitive health data for the treatment and diagnosis of rare diseases.
The data will be shared via a “federated data system”: a decentralized approach that allows different institutions to access each other’s data without that data ever leaving the organization it originated from. This is done via an application programming interface and strikes a balance between simply pooling data (posing security concerns) and limiting access completely.
The project is a collaboration between entities in the UK (Genomics England), Australia (Australian Genomics Health Alliance), Canada (Genomics4RD), and the US (Intermountain Healthcare).
3. The focus on infectious disease will continue beyond this pandemic.
COVID-19 has opened many people’s eyes to the massive – and surprising – gaps in infectious disease diagnostics.
Diagnostics is, currently, a space where you must choose between a highly accurate result that requires long turn-around times and trained personnel and/or expensive equipment – or a rapid result in an accessible format that sacrifices sensitivity and specificity.
COVID-19 has also made us more conscious of our shared responsibility to combat these unique types of diseases that we silently spread to each other. Hopefully, through focused investment in technology development as well as an elevated societal and government focus on detecting, curing and preventing infectious diseases, we can not only fight this pandemic but come out stronger against emerging infectious diseases.
4. People are thinking about modern healthcare differently.
The adage “an ounce of prevention is worth a pound of cure” will be more relevant than ever – as we’ve seen the devastating effects and herculean efforts required to control and cure an infectious disease once it has evaded containment and prevention techniques.
As part of the focus on prevention, we need to ensure that as many people as possible have access to and entry points into broader healthcare networks. Access in particular should become a key focus as this pandemic has highlighted that we are only as strong as the most vulnerable among us. This challenges the current model of service-based healthcare.
Furthermore, biotechnology will become a top strategic priority for many governments, as an ability to prevent and mitigate a pandemic is an enormous political and economic advantage. It will become ever more important to understand and focus on how to communicate sound science broadly and in a way that all people trust. We’ve seen in this pandemic that the increased use of pre-print servers has accelerated an amazing new model for rapidly disseminating cutting-edge science so people around the world can collaborate and build on it quickly. At the same time, it is harder than ever for individuals to know what is relevant and real. It will be important to find ways to retain the shift in pace, speed and openness of communication while maintaining the reliability and trust that gatekeeping mechanisms like peer-reviewed journals have long tried to provide.
5. Information will play a big role in the public perception of testing and gene editing.
Reliable, accurate and understandable information is key for both. We need consensus sources of information that are trusted by diverse groups and backed by strong science internationally.
People want what is best for their communities, their families and themselves, but it can be hard to separate fact from fiction. It is all the more important to ensure we have robust and frequent communication about science as well as forums that allow for stakeholders of all stripes to participate in a conversation on their benefits and drawbacks.
Ethical use of these technologies should not and cannot be determined only by a single group or individual. It is a shared responsibility across patients, industry, government and civic leaders. Understanding the molecular world and modifying it are increasingly tractable and accessible notions, but the use and misuse of technologies like CRISPR are important topics that have no easy answers.
The bottom line: “It is critical that the public has an opportunity to understand how these technologies work and access to informed and rigorous sources of information for doing so,” concludes Trevor Martin. “Equally important, we must make sure that this information and insight is distributed widely and equally so that all of us participate in shaping and can benefit from these exciting advances.”
Last year, the World Economic Forum launched Strategic Intelligence, its flagship digital product to help individuals and organizations see the big picture on the global issues facing the world. It provides a tremendous resource for exploring the interconnections between over 250 different topics and keeping up to date on everything that could potentially be an opportunity or a risk to you or your organization. Strategic Intelligence enables organizations, like the Global Innovators, to keep abreast of risks, opportunities and trends, enabling them to take more of a data-driven approach to managing their business.