A global economic perspective on whole-genome sequencing strategies for pathogens: continuous surveillance versus outbreak-triggered investigations

Whole-genome sequencing has emerged as a crucial tool for infectious diseases control. Health systems globally are faced with the decision of whether to implement comprehensive genomic surveillance (sequencing all or relevant selected isolates) or outbreak sequencing (when an outbreak is suspected). In this Personal View, we provide a detailed literature review of economic analysis of these strategies. A scenario-based sensitivity analysis and cost comparison illustrate that although comprehensive genomic surveillance requires higher upfront and steady investment, its potential to avert large-scale outbreaks might yield substantial long-term savings. For selective surveillance, establishing the selection criteria remains essential for pathogen sequencing. In contrast, outbreak sequencing minimises routine expenditure but risks incurring substantial costs when an outbreak is not caught early. In this Personal View, we argue that, in many settings, the invest now, save later preventive approach of comprehensive surveillance might rapidly become an economically sound strategy.