June 2026—This conversation is part of a series of one-on-one virtual roundtables in which CAP TODAY publisher Bob McGonnagle speaks with one vendor and one laboratory expert to spotlight a company and a customer for their laboratory solutions and work. He spoke on March 12 with Jessica Van Allen, PhD, technical support lead for ZeptoMetrix, and Jesse M. Young, PhD, medical director for TriCore Research Institute’s research and clinical trials department and director of point-of-care testing. Dr. Young is also clinical assistant professor at the University of New Mexico.
Dr. Young, tell us about TriCore and the laboratories you oversee.
Dr. Young (TriCore): TriCore Reference Laboratory is a full-service diagnostic laboratory. The core laboratory offers about 2,900 test codes and has a modality similar to that of Labcorp and Quest, but we’re focused on New Mexican populations. We serve most of the hospitals in the area and have statewide collection sites whereby we’re trying to expand health care and provide coverage for our communities so everyone in the state has access to health care near their home instead of having to drive six hours to the nearest collection site, drive home, and then be called back for a critical value.
I am not the CLIA license holder of those point-of-care facilities. I am a consulting medical director under the TriCore head. I support the compliance and quality aspects of the TriCore network, which includes the University of New Mexico and the Presbyterian and Lovelace hospitals in the state. I am able to see systems and the challenges they face. Through the centralization of testing at TriCore, we try to get as close as we can to providing quality health care for all patients across the state.
There are areas and hospitals that elect not to use TriCore services, but we are trying to expand our coverage to as many people as we can. Our product is strong and our diagnostic capabilities are fitting for our community.
Dr. Van Allen, how are emerging threats defined today and how has the definition evolved since the COVID-19 pandemic? Tell us also about variant evolution and its relationship and impact to assay performance.
Dr. Van Allen (ZeptoMetrix): Emerging infections are new diseases that have appeared more recently in a population, or known diseases that have spread to new areas or new populations or have had an uptick in spread. Reemerging infections are known diseases that have returned after being mostly controlled.
An example of an emerging infection is COVID-19, a new infection we hadn’t seen at that severity. Reemerging today is the measles. With the pandemic, we started to see a focus on variant evolution. Many pressures were placed on that virus and it evolved much more quickly than what we were used to seeing, so we ended up with many variants. That had an impact on assay performance. The mutations the virus picks up can lead to primer and probe template mismatches, reducing sensitivity or even causing molecular assays to give false-negative results. Many specific gene target failures popped up in assays.
Studies of variant-specific failures became a focus during the pandemic, and now the focus is on surveillance and monitoring. The continued surveillance will drive molecular diagnostics forward.
Dr. Young, are public health laboratories and others better equipped today to detect variants?
Dr. Young (TriCore): The quick answer is yes. COVID taught us a lot about the resources we need, at least in the phases we experienced with COVID. That doesn’t mean we are prepared for everything we could face, but we’ve developed and continue to develop pathways. It isn’t that we’ve rewritten the book on our surveillance but that we’re redoubling our effort and saying this is critical.
New Mexico participates in the CDC’s Emerging Infections Program, a network of 12 states. TriCore is closely linked to the New Mexico Department of Health, thanks to the wonderful work of Drs. Karissa Culbreath, John Fissel, and Gabriela Uribe in TriCore’s infectious disease department. We report and provide surveillance metrics, as we did before, but now with a redoubled frame to say not only what’s going on but also what trends we see.
Many of us think of emerging pathogens as the new dengue, Oropouche, or other East African hemorrhagic fevers, or those that are local to New Mexico, where we’re seeing blips of West Nile. Many are also subemerging threats for which there is an increase and change in multidrug-resistance organisms.
We’re better prepared as a result of changes implemented after the pandemic. We need to continue to define preparedness plans along with the thresholds for what’s emerging and give attention to what is changing. Even a single cluster of cases or a sentinel case can be a trigger for enhanced surveillance and the beginning of a preparedness phase that we weren’t used to before 2019–2020.
What is the role of vaccination rates? Many have been falling. Measles is an excellent example.
Dr. Young (TriCore): We are seeing a decrease in vaccinations. A public perspective is that a vaccine is a purely preventive measure, but vaccinations are also proactive in preventing reservoirs of infection. The dampening of infection in communities allows for the reservoir effect to be dampened and changes in the virus to be slowed. If we have reduced infection and fewer cases, it’s likely we’ll have slower change rates, particularly with infections like COVID. I checked the GISAID [Global Initiative on Sharing All Influenza Data] database recently and there are three circulating lineages of COVID now, XFG.6.2, QM.1, and PQ.1. What’s astonishing to me is that the amino acid changes now number in the hundreds, as opposed to only a few when we were first describing COVID-19.
The reduction of disease owing to vaccination has been seen in examples like polio and smallpox. The call to vendors to continue the development of additional assays to track emerging pathogens and provide quality controls, validation materials, and support for assay development will be critical as we’ve stepped into an age of evolution where we see things like SARS change over and over. A more recent example is the influenza H3N2 subclade K. What is it doing to diagnostics? How has vaccination caused pressures and changes within our community that we as diagnostic professionals need to adapt to to ensure we’re able to protect and serve our communities?
Dr. Van Allen, ZeptoMetrix provides important controls and products for laboratories that are doing the testing, but it also plays a big role in helping develop assays.
Dr. Van Allen (ZeptoMetrix): We support end users, clinical laboratories and hospitals, that run patient samples, but we also work with assay developers that need help to rapidly turn around or adjust their assays to react to new variants, clades, et cetera. With this shifting focus to surveillance, it’s important to have rigorous controls in place and monitor assays as new variants occur.
Since the pandemic and with the reemergence of measles, it’s become an issue of public health working so well with vaccination rates in the background that you don’t see an issue until things start to drop away. It’s a scientific perspective to continually research and come out with new and updated vaccines, like we do with flu vaccines every year. It’s one of the best tools we have to safeguard public health.
We don’t play in the vaccine market, but it impacts us as rates of infectious disease climb. We’re always paying attention to it and working with laboratories that deal with it firsthand to supply them with the needed materials to safeguard their assays and patient testing results.
Talk to us about HPV as a model for future molecular testing. We have gone from physician-collected samples to the start of patient self-collection. What is the implication of self-collection for assay sensitivity and sample integrity?
Dr. Van Allen (ZeptoMetrix): Self-collection represents a major, net-positive shift in molecular diagnostics. Many clinical studies have shown that self-collection methods are generally robust, with most studies not showing any major impacts or differences from physician-collected samples. It’s a useful tool to support reaching populations that couldn’t access clinical laboratories because of an inability to get to the doctor, whether for transportation, insurance, or other reasons. Self-collection overcomes a hurdle that became an obvious problem during the pandemic. It’s in its infancy, and I look forward to seeing how we can expand it, because expansion helps the public population and our understanding of infectious diseases and their movement around the country.
Dr. Young, tell us about self-collection in New Mexico.
Dr. Young (TriCore): The HPV vaccine is wonderful and should be widely used, but if we can’t get the diagnostics there, it can be hard to get the vaccination there. This creates gaps and voids. The U.S. is widely considered a first-world country with health care that’s generally accessible, yet we still see pockets of HPV and a lack of diagnostic availability in areas.
Self-collection in New Mexico has been adopted. TriCore’s infectious disease department supports our HPV testing. We have self-collect, but the patient collects in a health care setting, which is another shift and a sentinel step toward at-home collection.
One of the hats I wear for TriCore is clinical trials. There’s a lot of disruption coming to this market in at-home self-collection not only for HPV but also many other devices. I have reviewed the data and clinical study reports and have generated the data at my lab that show noninferiority of those samples in most cases. Of course there are poor collections, but we get those samples and decline them every day anyway. It’s not a massive shift in response. We have to pay attention to and create the methodologies to create controls with the help of vendors and companies like ZeptoMetrix so we can bring the right solutions and make sure we’re providing controls that allow us to make decisions about sample quality.
I switch to my point-of-care hat to say this is one of my favorite things on the planet, the idea of more and more self-collect, to bring care to the patient. A call to action is to not shun different point-of-care metrics and look at them as inferior but help lift those endpoints to create quality assays we can rely on for screening and detection at patients’ homes and nearer to the people whom we have sworn to protect.
The quickest result that’s actionable is the best result in some ways. I’m sure algorithms or cascades of protocols are needed to get to the right diagnosis as quickly as possible at the least cost. Dr. Van Allen, do you have many clients that are invested in this strategy for dealing with infectious disease?
Dr. Van Allen (ZeptoMetrix): Definitely. We work with large laboratories and small hospital laboratories, so we see the gamut of what’s going on in clinical molecular diagnostics. We turn to our partners and end users to understand how we can provide a solution and help support testing and growth in their facilities. There’s no one-size-fits-all answer, but that’s the beauty of what we get to do, which is to connect end users with assay developers and have a three-way conversation about what we’re seeing, what we recommend, how it’s being applied in this scenario, and what we have to change. What can we do to make this work for everyone and have it make sense in this context, because context matters greatly in these scenarios. It’s a problem we constantly face and we like to problem solve. Thankfully our partnerships with laboratories like TriCore and assay developers allow us to move the game along and work rapidly and safely to come up with solutions.
Dr. Young, one of the vectors of emerging infections or pathogens is environmental change. Fungal diseases, among others, are appearing in unexpected ways. Can you comment on what you see in New Mexico?
Dr. Young (TriCore): We’re seeing changes in the environment and have had the mildest winter on record, so we’ll continue to see changes in what our vectors are capable of doing in our state. More and more drought-resistant mosquitoes have made their way into New Mexico. With our climate, which is considerably more temperate than most of the country, survivability of those vectors is becoming a concern. We’re beginning to see vector-borne disease like West Nile reach the corners of our state. These environmental pressures are not new. We think a lot about the impact on fungi to humans, but animals are a big vector. We’ve talked in the news and in webinars about avian flu, H5N1, and our bovine populations since the early 2010s. There’s fungal disease and white-nose syndrome and changes in our bat populations; the reduction in hibernacula means an increase in vectors like mosquitoes because they’re not being controlled. Everything has an ecosystem that plays off one another, causing a shift and a constant ebb-flow flux of pathogens in our area.
This will continue to change and underscores that we have to consider and continually evolve what we see as an emerging threat and partner with our corporate and local academics to make sure we’re serving our patients and can respond appropriately to changes in our pathogen dynamics.
Dr. Van Allen, same question about the sensitivity to environmental change as that helps to foster emerging infections. What is your read on it as you talk to assay developers and large centers such as TriCore?
Dr. Van Allen (ZeptoMetrix): It goes back to surveillance and making sure we’re keeping tabs on mosquito- and tick-borne illnesses, making sure things are still testing positive, or negative, as they should be. I have seen an increase in wastewater testing as a way to monitor pathogens. That’s a useful tool that was underrated prior to the pandemic. For vector-borne diseases like mosquito- and tick-borne illnesses and water-borne illnesses that can be passed around in the South, where there is flooding and eroding swampland, it comes down to surveillance and monitoring assays to make sure we’re catching things as they’re coming out.
Every laboratory in the country—research, clinical, developmental—faces a talent shortage. We’re seeing high rates of retirements among senior laboratory scientists and experienced microbiologists. Dr. Young, tell us about the situation at TriCore.
Dr. Young (TriCore): TriCore is a New Mexican-focused company, so we are well tied to the University of New Mexico. Many of our PhD and MD scientists are sharing roles or are adjunct faculty or subcontracted to TriCore out of UNM. We’re highly invested in MLT and MLS programs and training pathologists and hosting and supporting people who are looking for fellowship roles and internships. Many departments at TriCore allow students in those programs to rotate through our departments of cytology, histology, chemistry, infectious disease.
We are seeing a loss of expertise in this field, but all that is gone is not lost. We’re still able to right the ship; we’re able to engage communities. I often think of clinical science as somewhat of a hidden profession and regularly go to the university to remind undergraduates, even high school students, that there are wonderful careers in laboratory science, clinical laboratory science specifically, that bring value to your life, that allow you to help your brother, sister, mother, extended family—the globe even.
The last plug to our commercialization side is to continue to help us with wonderful automation and support with your controls and assays. We don’t want to bring in automation to reduce staff. We want to bring in automation to make people’s lives easier and increase diagnostic endpoints. Our microbiology lab is our best example of that.
Dr. Van Allen, you’re consulting with laboratories of all kinds, and beyond being a vendor of controls and test systems, you’re a resource for laboratories that need a little extra technical help. Is that correct?
Dr. Van Allen (ZeptoMetrix): Yes, it is. I try to bring that to the forefront when I’m speaking with end users or distributors and assay developers as they’re putting products into laboratories: We’re here for you. It doesn’t help me or the business if you get our product and don’t know what to do and you give up and throw it away. Reach out to me. We can problem-solve it. I enjoy being a liaison to help laboratories. I’m invested in supporting public health and infectious disease diagnostics and making sure you’re able to do your job
CAP TODAY does not endorse named products in commercial roundtables, and the publisher’s comments are his own and not necessarily reflective of CAP TODAY or College of American Pathologists policy.