In the wake of the COVID pandemic, the US National Institutes of Health (NIH) and Israel’s largest medical center, Sheba Medical Center, are launching a scientific collaboration aimed at identifying emerging disease threats in the region.

One of the first projects planned will be a study examining the impacts on antibody defenses amongst travelers from Israel or Palestine to Mecca to observe the annual Islamic Hajj pilgrimage, one of the world’s largest mass religious gatherings, a representative of the NIH told Health Policy Watch.

The Sheba Pandemic Research Institute (SPRI), a first-of-its kind partnership between Israel and the NIH, was launched late last month at a ceremony in Israel attended by Prof Daniel Douek, Chief of the Human Immunology Section at NIH, who now also serves as the senior scientific advisor of the newly-formed SPRI.

The project is being largely funded by Sheba, the country’s largest private hospital, with support from Israel’s Health Ministry. Douek and the Sheba project organizers, however, stressed that they intend to collaborate with Palestinian hospitals and physicians in research on disease threats that cross political and geographic borders.

SPRI will focus on basic science and clinical research on emerging pathogens and the host response. Through multidisciplinary, multifaceted and collaborative research, the institute hopes to translate basic science research into infectious diseases into clinical products. These biological countermeasures would be rapidly deployable in the event of epidemic and pandemic threats.

In Israel, the centre will be run by Prof Gili Regev-Yochay, head of the Infectious Diseases Unit at Sheba Medical Center, and a scientist who was on the forefront of Israel’s 2020-21 COVID pandemic response and vaccine roll-out, which served as a weathervane for other nations.

Preparedness for next pandemic

Regev-Yochay said that SPRI is being established despite the decline in COVID-19 incidence in most parts of the world, in order to be better prepared for the next pandemic, whenever and whatever that may be. The goal is to be able to have gained enough know-how to take quicker and more effective action next time a deadly pathogen begins circling in the community.

During a speech at the launch ceremony for the new cooperation, Regev-Yochay recalled the first two months of the pandemic, which she said “seemed like two years” and during which she slept no more than two hours a night.

Her scarce rest was “filled with dreadful nightmares,” she said. “I dreamed there was a tsunami and I wanted to stop it. I ran towards it but I understand my body is too small to stop the water from coming in. I felt the first drops and then woke up sweating.

“There was a heavy load of responsibility on my shoulders.”

During the first wave of COVID-19, she said one of her colleagues at the hospital was infected and nearly died of the disease.

Regev-Yochay was also amongst the first people in Israel to take the Pfizer COVID-19 vaccine in Israel’s vaccination campaign, which launched on December 19, 2020 – just days after vaccinations began in the United States.

“I was truly excited,” she recalled. “Vaccines are the only fast way out of pandemic.”

But from those initial shots, many questions arose: How effective will the vaccine be in real life vs. clinical trials? How many times a year will people need to vaccinate?

These questions led Regev-Yochay to recruit hundreds of Sheba healthcare workers to participate in several COVID-19 longitudinal cohort studies over the past two years.

“When I told Prof [Yitshak] Kreiss – [director-general of Sheba] – about the idea of the healthcare workers he said, “recruit everyone you can. We need to report to the world. We have that responsibility.”

Throughout the pandemic, those studies provided valuable insights into disease trends and vaccine responses that were taken up by countries around the world.

Testing antibody responses during mass gatherings

While the collaboration kicks off at a particularly fraught time politically in Israel and the region, Kreiss and other researchers at the launch stressed the importance of fostering scientific cooperation on diseases that transverse geographic and political borders.

The first SPRI study will focus on Muslims from Israel and Palestine who make the pilgrimage to Mecca, Douek explained. The aim would be to create a profile of antibody responses from the worldwide gathering that brought together 2.5 million people in 2019, before the COVID pandemic, and 1 million in 2022, as travel began to rebound from pandemic lock downs.

WHO has frequently stressed the significance of mass gatherings from football matches to religious gatherings as potential hotspots for disease transmission, which can lead to the emergence of new diseases or re-emergence of latent threats.  Good surveillance is key to understanding those patterns.

“We thought it would be very interesting to … just measure what antibodies they have against different viruses before and after the Hajj. This will give us some insight into transmission of viruses from all of the other populations they encounter and what they bring back.”

Over time, depending on funding, the teams hope to examine pilgrim cohorts from other countries, and people in the host country, Saudi Arabia, who are exposed to so many visitors.

The NIH and Israeli teams will be working with Palestinians scientists affiliated with institutions in the Palestinian territories, Douek stressed.

“Scientists, like viruses, don’t know international boundaries,” Douek said. “We work across them very well.”

He said the hope is to launch that project by early 2024, when that year’s Hajj takes place between 14-19 June.

Data sharing

Douek said SPRI arose out of basic desire to “do what we enjoy – work together, learn from each other and make a difference.”

He is the founder of the NIH’s PREMISE (Pandemic Response Repository through Microbial and Immunological Surveillance and Epidemiology) program, which has been setting up a global network of partners, hospitals and labs across the world. The original intent was for Sheba to become of those international partners. But Douek said that “as communication proceeded, it became clear to Gili and her team that they could set up a much bigger pandemic preparedness unit of their own at Sheba.”

The collaboration between SPRI and PREMISE includes the sharing of data, human samples and other materials, as well as formal Zoom meetings ever two weeks. Sheba doctors are also expected to go to the NIH for training and NIH staff will also like go to Sheba to help them set up their labs and learn from them.

“I see this relationship evolving even further – I think it has to,” Douek said. “Pandemic preparedness can be seen as security issue, particularly for a small country like Israel.”

Douek said some research is also expected to be conducted around Israelis who work with birds in the Hula Valley, where this year a lot of cranes died of a highly pathogenic bird flu. There is also some interest in studying West Nile fever.

Translating their work to benefit LMICs

He said a final goal of both PREMISE and SPRI is to see how their work is translatable for use in low- and middle-income countries.

“The intent is to make [the work] available to everyone, especially the countries that need it most,” he said.

Douek added that there are pandemic preparedness initiatives being set up all over the world at the moment.

“A lot are being talked about, some are being set up,” he clarified. “There needs to be recognition globally that the world needs to do this. Every country in the world needs something like SPRI.”

Image Credits: Sheba Medical Center, Clalit Health Fund , Flickr: IMF Photo/James Oatway, Al Jazeera English, National Institute of Health.