Serological tools for COVID-19 control and vaccine roll-out in Southeast Asia

The ongoing COVID-19 pandemic, caused by the SARS-CoV-2 virus, has caused immeasurable burden on economies and public health globally, including in Asia. New diagnostics for detecting the present and past exposure to the virus have been developed, and vaccines are emerging for clinical evaluation and roll-out. As the number of cases plateau, the exit strategy of Governments will involve the use of surveillance and contact tracing to limit the damage of future sporadic outbreaks in the short to medium term, while vaccination will ideally lead to elimination. However, many of the tests and vaccines under evaluation are based on the same biological targets, and infection control activities will need to distinguish immune responses to vaccines and those elicited by SARS-CoV-2 infection, which cannot yet be achieved with current front-line rapid testing kits. With this in mind, we propose to investigate alternative immunological targets arising from LSHTM modelling, informatic tools and laboratory work. These targets will be assessed within ongoing collaborations with government research institutes and hospitals in Thailand and The Philippines, who are at the forefront of clinical management and infection control in the COVID-19 response. These sites have pre-existing biological samples and data collected for diagnosis and treatment that will be used in the proposed project. We will evaluate new biological targets and establish assays that can be implemented by these countries to assist a surveillance system to monitor the progress of vaccination and SARS-CoV-2 elimination in the community. This will provide vital data for the direction of vaccine rollout and containment strategy. Most importantly, the tools developed can be easily implemented across other LMIC countries with a minimal laboratory set-up. With this, our goal, is to make a lasting contribution to Southeast Asian COVID-19 surveillance infrastructure, thereby improving the health and economy of the nations.

The unprecedented spread of SARS-CoV-2 has led to the rapid development of diagnostics of active disease, serological assays for infection exposure, and the evaluation of potential vaccines in clinical trials. Governments have begun to consider and evaluate possible exit strategies underpinned by surveillance and vaccination. Surveillance, utilising mass testing and contact tracing, will limit the damage of future sporadic outbreaks in the short term, while vaccination will ideally lead to elimination. To date, many rapid serological tests and vaccines under evaluation are based on the same SARS-CoV-2 targets (e.g. spike protein), but surveillance activities will need to distinguish vaccine from natural infection. Research supporting the deployment of these measures will prove vital to their timely implementation and long-term efficacy.

Our project builds on an existing collaboration of LSHTM with its genomic-immunology tools for the active surveillance of SARS-CoV-2, and the Thailand Ministry of Public Health (MOPH) and Philippines Department of Health (DOH), who are at the forefront of clinical management of COVID-19 and involved in their countries infection control taskforces. We will evaluate new serological targets and establish assays that can be implemented to assist a surveillance system to monitor the progress of vaccination and SARS-CoV-2 elimination in the community. To achieve this, we will apply tools that can differentiate immune responses to vaccines and those elicited by SARS-CoV-2 infection; something that cannot yet be achieved with current front-line rapid testing kits. This will provide vital data for the direction of vaccine rollout and containment strategy, develop deployable tools, and make a lasting contribution to Thailand and Philippines COVID-19 surveillance infrastructure.