Turn the millions of US blood donations per year into a national pandemic early-warning system.

## **Stakes**
Detection speed is the first rate-limiting step in a pandemic response. Timing is critical — costs compound exponentially with the spread of the pathogen. Every day that passes before countermeasure deployment could mean tens of thousands of lives lost.

Earlier detection buys time for every other defense layer. The current detection system is highly reactive: a novel pathogen has to make enough people extremely sick to read as an unusual signal in hospitals, or infect enough people to rise above the noise in wastewater. In practice, we generally detect a new pandemic by some threshold of patients seeking care or clinicians noticing out-of-the-ordinary patterns, meaning one or more transmission generations have likely already elapsed.

A pathogen that initially causes very few symptoms or lethal cases, also known as a “stealth” pathogen, may not be detected by our current systems until it is too late to effectively prevent spread or distribute vaccines.

This has happened already. HIV spread for years before it was recognized in 1983, infecting an estimated 12,000 people through the US blood supply. This mission is about instead using US blood supply samples to detect pathogens early.

Blood donors are people who believe they are healthy, making them the perfect cohort for detecting the spread of a stealth pathogen. Sequencing their samples could catch a stealth pathogen long before the current system would, saving countless lives.

## **Context**
There were 11.5 million blood donations in 2021. Every US blood supply donation is already tested for a fixed panel of known viruses, including HIV and hepatitis, usually within 24 hours. This mission would add a metagenomic sequencing (MGS) step, meaning that we would analyze the nucleic acid sequences (DNA & RNA) in samples and flag pathogens that are not on that fixed panel. The leftover blood from testing would be enough to do this, so this would have no effect on the amount of blood donations received.

There are few organizations that do the screening, e.g. [Creative Testing Solutions](https://mycts.org/About/WhatWeStandFor) tests ~70% of the US blood supply. This means that national coverage could be reachable through just a handful of partnerships. There is also significant precedent for using leftover samples. During COVID, the CDC and blood organizations analyzed over 1.4 million donor specimens across every state. This was done under standard donor consent, suggesting donor consent would not be a barrier to instituting a system like this.

We also may not need national coverage. This mission was primarily sourced through a [February 2026 paper](https://www.medrxiv.org/content/10.64898/2026.02.06.26345722) from researchers at MIT, the Broad Institute, SecureBio and Harvard. The paper estimates that sequencing samples from just 10,000 donors a week would detect a novel HIV-like pathogen before it infected 0.01% of the US population, and that such a system could be run for ~$5.8M a year. The technical pipeline for analysis is also already built, courtesy of [SecureBio Detection](https://securebio.org/detection/), and more significant functional analysis capabilities are being developed by companies like [Valthos](https://valthos.com/).

Blood works best for pathogens that circulate in the bloodstream, unlike respiratory viruses, so this system complements other types of surveillance as opposed to acting as a replacement.

## **Target End-State**
Within ~12-24 months of a founder starting, there is a standing, validated MGS pipeline for the US blood supply that is ready to scale. The paper models a longer-term goal of ~10,000 donors per week. A possible one year milestone is ~1,000 donors a week at a single location. This pipeline should also have written plans in place for coordinating action in case a novel pathogen is detected.

## **Owner Profile**
This can be led by a driven generalist with the ability to hire out expertise.
The ideal owner profile:
- Operations background, ideally running a lab or some type of technical service.
- Genomics expertise, or the ability to hire it.
- Strong networking skills or existing relationships within the blood donation network.

## **Initial Scoping**
**First 3 Months**
- Read [Justen et al. (2026)](https://www.medrxiv.org/content/10.64898/2026.02.06.26345722).
- Talk to Lennart Justen and the SecureBio Detection team.
- Talk to Creative Testing Solutions or other blood centers about potential challenges with sample access.
- Reach out to Illumina, Oxford Nanopore, and PacBio to discuss the best way to set up the pipeline.
- Develop a plan for coordinating response in advance of a positive result.

**Key Questions**
- Is it better to test on individual samples or test samples pooled? (Pooling is cheaper and offers a privacy advantage, but individual samples allow for easier donor follow-up.)
- Would this operate better as a standalone organization, a program inside an existing center, or an MGS provider?
- What is the relevant regulatory landscape?

## **Funders and Partners**
**How much money is behind this?**
A [wave of philanthropic capital](https://nanransohoff.substack.com/p/the-third-wave-of-american-philanthropy) is soon to be available for founders looking to work on important problems like biosecurity. The OpenAI Foundation, for instance, is part of an estimated $37–100B/year in new AI-lab-driven giving. Existing philanthropic capital is also significant. Coefficient Giving alone deploys over $100M per year to biosecurity.

**Potential Funders**
[Coefficient Giving](http://coefficientgiving.org)
[BlueDot Impact](http://bluedot.org)

**Potential Partners and Stakeholders**
[Creative Testing Solutions](https://mycts.org)
[SecureBio](https://securebio.org)

## Learn More
[Leveraging the U.S. blood supply to detect emerging viral threats — Justen et al., 2026](https://www.medrxiv.org/content/10.64898/2026.02.06.26345722)
[Exploring Blood-Based Biosurveillance, Part 1: Blood as a Sample Type — NAO](https://forum.effectivealtruism.org/posts/7hFEPDjiysHtzrmXS/exploring-blood-based-biosurveillance-part-1-blood-as-a)
[Comparing Sampling Strategies for Early Detection of Stealth Biothreats — NAO](https://naobservatory.org/reports/comparing-sampling-strategies-for-early-detection-of-stealth-biothreats/)

## Interested in building this?
Contact: Olivia Scharfman, [olivia@bluedot.org](mailto:olivia@bluedot.org).


Bloodbank MGS Surveillance