Global Health Security

The International Health Regulations (IHR) 2005, provides a framework that supports efforts to improve global health security and requires that, member states develop and strengthen systems and capacity for disease surveillance and detection and response to public health threats. To contribute to this global agenda, an international collaborative comprising of personnel from the Health Protection Agency, West Midlands, United Kingdom (HPA); the Indian Institute of Public Health (IIPH), Hyderabad, Andhra Pradesh (AP) state, India and the Department of Community Medicine, Rajarajeswari Medical College and Hospital (RRMCH), Bangalore, Karnataka state, India was established with funding from the HPA Global Health Fund to deliver the objectives stated above.

Objective:

This project aimed to contribute to ongoing efforts to improve the capability and capacity to undertake disease surveillance and Emergency Preparedness and Response (EPR) activities in India. The main outcome measure was to empower a cadre of trainers through the inter-related streams of training & education to enhance knowledge and skills and the development of collaborative networks in the regions.

In 1969, the Twenty-Second World Health Assembly revised and consolidated the International Sanitary Regulations into what is known today as the International Health Regulations (IHR). The IHR promote a global collaboration to prepare for, respond to, and prevent the spread of infectious disease and other public health threats. In 2005, the IHR was once again reviewed and expanded to address the increasing threat of emerging infectious disease due to globalization and urbanization. 195 State Parties agreed to adopt and implement IHR (2005); however, as of May 2013, over 100 of these States still had not yet met the eight core capacities outlined in the IHR (2005). In February 2014, the Obama administration launched the Global Health Security Agenda with the aim of moving toward a world safe and secure from infectious disease threats. The Global Health Security Agenda offers a path forward to support countries in achieving the core capacities of the IHR. APHL proposes leveraging the distributed structure of the US managed Laboratory Response Network for Biological Threats Preparedness (LRN-B) to develop the core capacity of laboratory testing and to fulfill the laboratory strengthening component of the Global Health Security Agenda. The LRN supports five of the eight core capacities and could serve as a model for State Parties lacking resources and an implementation plan. The LRN, founded in 1999 by Centers for Disease Control and Prevention (CDC), Federal Bureau of Investigation (FBI) and the Association of Public Health Laboratories (APHL), is a specialized network of laboratories that are capable of an all-hazard response to a variety public health threats. Leveraging LRN assets internationally would provide a standardized approach toward IHR (2005) implementation and ensure a global collaboration to defend against public health threats.

Objective

To promote the Laboratory Response Network (LRN) as a model that supports global health initiatives, strengthens worldwide laboratory systems, and advances international partnerships to prepare for and respond to infectious disease threats.

The outbreaks of Severe Acute Respiratory Syndrome (SARS) in 2003, influenza A (H1N1) in 2009 and Ebola in 2014 have shown increasingly that infectious diseases can spread globally in a short timeframe, affecting both high- and low-income countries. Taking action to mitigate the impact of future crises relies on sharing public health surveillance data across national borders in an efficient and effective way. However, data users, particularly in high-income countries, often use surveillance data, particularly from low- and middle-income countries, with little or no benefit to the data generator. As Indonesia’s refusal to share influenza virus sequences during the 2006 H5N1 outbreak illustrates, this imbalance increases reluctance to share and jeopardizes the global good that can be achieved. In order to share public health surveillance data internationally in an equitable way, technical, political, ethical, and legal issues need to be addressed. The Centre on Global Health Security at Chatham House is producing guidance that will address both the policy and technical issues with the aim of establishing new norms so that data can be shared in an open, transparent and equitable way.

Objective

To address both the policy and technical issues of sharing public health surveillance data across national borders with the aim of establishing new norms so that data can be shared in an open, transparent and equitable way.

Improving surveillance and response is a critical component of the Global Health Security Agenda. While it is impossible to predict where the next Ebola outbreak will occur, it is very likely that another outbreak will occur in the DRC. Of the 20 known outbreaks, 7 have occurred in the DRC, one as recently as 2014. To rapidly detect and respond to an Ebola outbreak, we sought to develop a real-time surveillance and response system for use in DRC and similar settings. RTI International developed Coconut Surveillance mobile software, which is currently used for real-time malaria surveillance and response in Zanzibar, Africa, where malaria elimination efforts are underway. We took this system and adapted it for Ebola as a possible tool for surveillance and response to Ebola and other (re)emerging diseases. Plans include pilot testing functionality at clinical sites in DRC, where surveillance infrastructure is limited at the local level. Coconut Surveillance is a mobile disease surveillance and rapid response system currently used for malaria elimination activities. It receives suspected positive case alerts from the field via mobile phones and uses mobile software to guide surveillance officers through a follow-up process. Coconut Surveillance runs on Android mobile devices that are used to coordinate work in the field as well as provide decision support during data collection and case management. In addition to standard case information, the GPS coordinates of the case’s household are captured as well as malaria status of all household members. Data are collected and accessed off-line, and are synchronized with a shared database when Internet connectivity is available. This tool has been used successfully in Zanzibar for more than three years and has been recognized as one of the most advanced applications of its kind.

Objective

We will describe a real-time mobile surveillance and case management system designed to organize data collected by multiple officers about cases and their contacts. We will discuss this surveillance system and its application for Ebola and other infectious diseases in the Democratic Republic of the Congo (DRC) and other similar settings. We will review the technology, results, challenges, lessons-learned, and applicability to other contexts.

In the Kingdom of Swaziland, a baseline assessment found that multiple functional units within the Ministry of Health (MoH) perform PHS activities. There is limited data sharing and coordination between units; roles and responsibilities are unclear. The Epidemiology and Disease Control Unit (EDCU) is mandated to coordinate efforts and strengthen PHS through implementing Integrated Disease Surveillance and Response (IDSR) to fulfill requirements of International Health Regulations (2005) (IHR[2005]), and the Global Health Security Agenda (GHSA).

Objective

To enable coordination of Swaziland Ministry of Health units for public health surveillance (PHS).

Since the majority of emerging infectious diseases over the past several decades have been zoonotic, animal health surveillance is now recognized as a key element in predicting public health risks. Surveillance of animal populations can provide important early warnings of emerging threats to human populations from bioterrorism or naturally occurring infectious disease epidemics. This study investigated current animal data collection and surveillance systems, isolated major gaps in state and national surveillance capabilities, and provided recommendations to fill those gaps.

Objective

To identify gaps in current U.S. animal data collection and surveillance systems, describe how surveillance of animal populations can provide important early warnings of emerging threats to human populations from infectious disease epidemics, and explain the benefits of integrating human and animal surveillance data into a common linked system.

Multiple agencies are involved in global disease surveillance and coordination of activities is essential to achieve broad public health impact. Multiple examples of effective and collaborative initiatives exist. The WHO/AFRO developed Integrated Disease Surveillance and Response (IDSR) framework, adopted by 43 of the 46 AFRO member states and applied in other WHO regions, was the first framework designed to strengthen national disease surveillance and response systems. The WHO International Health Regulations (IHR) 2005 are an agreement between 196 countries to prevent, detect and respond to the international spread of disease. In 2013 CDC worked with Uganda and Vietnam to demonstrate the development of surveillance, laboratory, and emergency response center capacity and link data systems for six outbreak prone diseases. More recently, the Global Health Security Agenda (GHSA) was launched with the support of 28 countries, WHO, OIE and FAO just as Ebola was beginning to emerge in West Africa. This panel brings together CDC, local implementing partners, academic technical partners, and international non-government donor to discuss current and evolving strategies for prevention, detection, and response activities needed for global health security. 

Objective

The session will discuss strategies for outbreak prevention, detection, and response for global health security and explore how these activities inform both domestic and international initiatives. Innovations in epidemiology, laboratory, informatics, investment, and coordination for disease surveillance will be discussed.