More than 400 patients who signed up to take a pioneering oncology detection test developed by US biotech company Grail received erroneous letters last month suggesting they may have developed cancer.

According to an internal company document seen by the Financial Times, 408 patients were incorrectly told they had a signal in their blood suggesting they could have cancer.

Grail said the letters were sent “in error” by its telemedicine provider PWNHealth and that its staff had moved swiftly to contact affected customers to reassure them their test results were wrong.

The incident has generated concern among some insurers who are trialing Galleri, a multi-cancer early detection test that claims to be able to spot more than 50 cancers from a single draw of blood.

MassMutual, one of the biggest US life assurers, said a “small number” of its policyholders had been affected and that it had “paused” its pilot as a result.

“We are aware that Grail proactively reached out to all our participants to address this issue as quickly as possible,” it said.

Principal, another big US life assurer that has customers affected by the error, said it was reviewing its relationship with Grail following the incident.

The episode underlines the risks for insurers in adopting early-detection technologies, which offer the prospect of reducing the amount paid out in claims by keeping customers healthier.

Grail, which is a subsidiary of the world’s biggest gene sequencing company Illumina, is selling Galleri at about $950 per test and marketing it to insurers and large employers. The test scans so-called cell-free DNA for changes caused by cancer cells.

The test has been hailed as “revolutionary” and “cutting edge” by British and US health chiefs, although many experts have urged caution in introducing them before large-scale clinical trials prove they can save lives.

Grail said the erroneous letters were in no way related to or caused by an incorrect Galleri laboratory test result. The letters were inadvertently triggered by a PWNHealth software configuration issue, which had now been disabled, it said in a statement.

PWNHealth said it had promptly launched an investigation and addressed the underlying problem within an hour of becoming aware of it and that it had implemented processes to ensure it did not happen again.

“In partnership with Grail, we started contacting impacted individuals within 36 hours,” it added.

Grail, which is due to make a presentation on Galleri this weekend at the biggest cancer conference in the US, said more than half of individuals who received the letters had not yet had their blood drawn for the Galleri test.

“No patient health information has been disclosed or breached due to this issue, and no patient harm or adverse events have been reported,” the company said.

In February, US life insurance company John Hancock announced it would expand access to Grail’s “first-of-a-kind” test, saying preventive care and early detection was critical to its commitment to help customers live “longer, healthier, better lives.” It collaborated with Munich Re on the pilot announced in September.

A spokesperson for John Hancock said its partnership with Grail had not changed. Munich Re declined to comment.

PWNHealth, which is a subsidiary of Everlywell, a digital health company, is an independent telemedicine vendor which reviews Galleri test requests, prescribes the test and delivers results to patients.

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In many ways, modern advancements stole the show in the COVID-19 pandemic. With unprecedented speed, researchers decoded and shared the genetic blueprints of SARS-CoV-2. They developed highly effective, safe vaccines and treatments. Near real-time epidemiological data were at people’s fingertips, and global genetic surveillance for viral variants reached unrivaled heights.

But while the marvels of modern medicine and biotechnology wowed, the US struggled with the basics. Health departments were chronically underfunded and understaffed. Behind slick COVID-19 dashboards, health workers shared data in basic spreadsheets via email—and even fax machines. Long-standing weaknesses in primary care deepened health inequities. And useful pandemic prevention tools, like masks, became maligned in the disconnect between communities and local health departments.

At our Ars Frontiers conference this year, I virtually sat down with two leading experts in pandemic preparedness, who talked through these takeaways from the COVID-19 pandemic. I spoke with: Dr. Jennifer Nuzzo, the director of the Pandemic Center and a Professor of Epidemiology at Brown University’s School of Public Health, and Dr. Caitlin Rivers, a senior scholar at the Johns Hopkins Center for Health Security and founding associate director of the Center for Forecasting and Outbreak Analytics at the Centers for Disease Control and Prevention.

More health workers

The conversation started with a big-picture question fielded by Nuzzo on how we generally did with COVID-19. She went through some high points: We all became familiar with pandemic tools, which will be helpful to draw upon in the future; we got real-time data collection going, setting the bar for the next pandemic; and we bulked up health departments with contractors.

But, this last point was also a point of concern because the staff that was hired during the pandemic was brought on with emergency funding—and those positions lapsed when the emergency funding did.

“This is a thing that I’m really, really worried about, probably, perhaps most of all,” Nuzzo said. “If you remember three years ago, when we started this pandemic, we didn’t have anywhere near the kind of public health infrastructure, the public health defenses that we need in terms of people working in health departments to help us make sense of the data and tell us what to do to help us live, you know, healthier, safer lives. … They’re the infrastructure that should be in our communities to help keep us perpetually safe.”

Better data infrastructure

While the state of the people-based infrastructure at the foundation of our response is a big problem, so too is our data infrastructure, Rivers explained. With the public health emergency, the federal government gave the CDC authority to compel states and jurisdictions to share COVID-19-related data, setting the stage for near real-time pandemic tracking at a national level. But, without an emergency declaration, the agency doesn’t have that power. And to get basic disease data from individual states and jurisdictions, the agency has to hammer out individual legal agreements with each state and jurisdiction for each disease, resulting in non-standardized data.

“These are not blanket agreements,” Rivers explained. “They’re disease-specific about when and how and what data will flow. And as you can imagine, it takes weeks, if not months, to organize a single agreement. We’re talking hundreds of agreements altogether, and it’s a very slow process.” The burden of negotiating these “is one of the real challenges that we have with our public health data infrastructure.”

Another is the anachronistic way health departments collect and share data—often in basic spreadsheets, shared via email or archaic fax machines.

“There’s a lot of manual data entry. There’s a lot of faxing. There’s a lot of emailing spreadsheets. And if we could claw back some of that manpower and put it towards public health practice, put it towards actually keeping people healthier, that’s going to be a huge win,” Rivers said.

While she was very optimistic about the new funding Congress has approved for data modernization, she noted that “when you’re starting from fax machines, it’s gonna be a long road back.”

Address inequities and build trust

While our infrastructure needs revamping, we could also be doing more to prepare the public to respond to pandemic threats, Nuzzo said. She noted an example of pandemic drills in Taiwan, where they’ve used mass vaccination of seasonal flu vaccines as practice for emergency vaccinations. The drills help people know what to do and where to go, while officials can test how quickly they can roll out shots and reach high-risk populations like the elderly.

While the US was able to get mass vaccination set up, there were “deep inequities” in who knew where to go and what to do.

“I think one of the biggest lessons of this pandemic is that our underlying social vulnerabilities turned out to be our biggest pandemic vulnerabilities,” Nuzzo said, adding it will take “community-based participation” and policies, like paid sick leave, to address.

Building trust between health experts and communities, particularly vulnerable communities, is critical to responding to the next threat, Nuzzo and Rivers noted.

“One of the things that the pandemic has really exposed is how much of a primary health care crisis we have in this country and that if people can’t regularly access medicine, such that they can build those trusted relationships … I think we’re gonna have a hard time,” Nuzzo said.

Rivers made a similar point, noting that the pandemic responses lacked trusted, known sources for health information. “I’m not sure the public ever had an opportunity to really get to know an epidemiologist or a public health official that could talk to them regularly, day over day, about what is happening and what they should be doing,” she said. The next crisis, she said, needs a “warm face.”

Listing image by Ars Frontiers

The original plans for New York City’s Central Park included a Paleozoic Museum at 63rd Street and Central Park West, which would have displayed life-size concrete models of dinosaurs placed in carefully designed dioramas. Those plans were dashed in 1871, when vandals broke into the workshop of the museum’s designer, Benjamin Waterhouse Hawkins, and smashed the models with sledgehammers, burying the rubble in the southwestern corner of the park.

The traditional take in paleontology circles is that the man behind the destruction was William “Boss” Tweed, who pretty much ruled the city’s Democratic Party political machine at the time with his cronies at Tammany Hall. But a recent paper published in the Proceedings of the Geologists’ Association identifies a different culprit: a lawyer and businessman named Henry Hilton, a member of the Tammany Hall contingent who championed plans for what would become the American Museum of Natural History.

Co-authors Victoria Coules and Michael Benton of the University of Bristol in England also found no evidence of a religious motivation for the destruction, i.e., opposition to the then-nascent field of paleontology and its associated implications for evolutionary theory, which were deemed “blasphemous” by some religious leaders. Rather, it seems to have been one of many “crazy actions” by Hilton. “We find that Hilton exhibited an eccentric and destructive approach to cultural artifacts, and a remarkable ability to destroy everything he touched, including the huge fortune of the department store tycoon Alexander Stewart,” Coules and Benton wrote. “Hilton was not only bad but also mad.”

Benjamin Hawkins was an English sculptor and natural history artist who caused a sensation at the Great Exhibition of 1851 in London with his live-size dinosaur models. Cast in concrete and designed in conjunction with paleontologist Sir Richard Owen, the models were subsequently relocated to what is now Crystal Palace Park. Owen even hosted a memorable dinner party on December 31, 1853, inside the actual mold Hawkins had used to cast the Iguanodon sculptures.

News of the Crystal Palace dinosaurs spread to America and the Board of Commissioners in charge of developing plans for Central Park, led by Andrew Haswell Green. Hawkins was already in the US on a lecture tour, as well as designing and casting a nearly complete Hadrosaurus skeleton for the Academy of Natural Sciences in Philadelphia—the world’s first mounted dinosaur skeleton. So he was a natural choice to create life-size dinosaur sculptures for the planned Paleozoic Museum in Central Park. Green wrote to Hawkins in May of 1868, offering him the commission, and Hawkins accepted. The Board also tapped architects Frederick Law Olmsted and Calvert Vaux to design the park’s layout and features.

The dinosaur models for the Paleozoic Museum would be based on those specimens specifically found in North America, although this was just before the famous American “bone rush” of the 1870s to 1890s yielded large numbers of fossilized dinosaur skeletons and bones. Hawkins was provided a workspace in a large brick building known as the Arsenal (or the Armory) on 64th Street, beginning with small clay models based on the available fossil evidence before moving on to making the life-size molds. Meanwhile, Olmsted and Vaux lodged their architectural plans for the museum building and dug out the foundations.

Alas, the political winds were shifting in New York City by 1870. Boss Tweed disbanded the board led by Green and appointed a new board with all his own people, headed by Peter Sweeny, with Henry Hilton serving as treasurer. By this time, plans were underway for the more ambitious American Museum of Natural History (AMNH), to be located on or adjacent to Central Park. Hawkins had to move out of the Arsenal into a nearby shed to continue his work to make room for the specimens and collections being acquired for the AMNH.

The AMNH wasn’t intended to rival the planned Paleozoic Museum; Green’s board had supported both projects. But Tweed’s newly appointed board felt differently and elected to stop the project in May 1870. The official reason was economic. Their 1871 annual report specifically cited the high cost of completing the Paleozoic Museum (some $300,000, or about $7.5 million today), all coming from public funds, unlike the AMNH, which was supported by philanthropic fundraising. This was deemed “too great a sum to expend on a building devoted wholly to paleontology—a science, which however interesting, is yet so imperfect as not to justify so great a public expense for illustrating it.” There were also plans for a zoo in Central Park, and the board favored supporting living animals over extinct ones.