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The lack of routine viral genomic surveillance delayed the initial detection of SARS-CoV-2, allowing the virus to spread unfettered at the outset of the U.S. epidemic. Over subsequent months, poor surveillance enabled variants to emerge unnoticed. Against this backdrop, long-standing social and racial inequities have contributed to a greater burden of cases and deaths among minority groups. To begin to address these problems, we developed a new variant surveillance model geared toward building ‘next generation’ genome sequencing capacity at universities in or near rural areas and engaging the participation of their local communities. The resulting genomic surveillance network has generated more than 1,000 SARS-CoV-2 genomes to date, including the first confirmed case in northeast Louisiana of Omicron, and the first and sixth confirmed cases in Georgia of the emergent BA.2.75 and BQ.1.1 variants, respectively. In agreement with other studies, significantly higher viral gene copy numbers were observed in Delta variant samples compared to those from Omicron BA.1 variant infections, and lower copy numbers were seen in asymptomatic infections relative to symptomatic ones. Collectively, the results and outcomes from our collaborative work demonstrate that establishing genomic surveillance capacity at smaller academic institutions in rural areas and fostering relationships between academic teams and local health clinics represent a robust pathway to improve pandemic readiness. 

The COVAX program aims to provide global equitable access to life-saving vaccines. Despite calls for increased sharing, vaccine protectionism has limited progress towards vaccine sharing goals. For example, as of April 2022 only ~20% of the population in Africa had received at least one COVID-19 vaccine dose. Here we use a two-nation coupled epidemic model to evaluate optimal vaccine-sharing policies given a selfish objective: in which countries with vaccine stockpiles aim to minimize fatalities in their own population. Computational analysis of a suite of simulated epidemics reveal that it is often optimal for a donor country to share a significant fraction of its vaccine stockpile with a recipient country that has no vaccine stockpile. Sharing a vaccine stockpile reduces the intensity of outbreaks in the recipient, in turn reducing travel-associated incidence in the donor. This effect is intensified as vaccination rates in a donor country decrease and epidemic coupling between countries increases. Critically, vaccine sharing by a donor significantly reduces transmission and fatalities in the recipient. Moreover, the same computational framework reveals the potential use of hybrid sharing policies that have a negligible effect on fatalities in the donor compared to the optimal policy while significantly reducing fatalities in the recipient. Altogether, these findings provide a self-interested rationale for countries to consider sharing part of their vaccine stockpiles.