Promoting Trans-national Collaboration in Disease Surveillance and Control
Remarks by Katherine Bond, ScD Assoc. Dir., The Rockefeller Foundation Africa Regional Office; Nairobi, Kenya
The world is now facing a global pandemic threat. The outbreak of swine flu in Mexico and the United States once again highlights, as did SARS and avian influenza, that in the 21st Century globalized and connected world, viruses don’t respect borders. The H1N1 strain detected in Mexico suggests that the dreaded mix of influenza strains from swine, birds and humans may have occurred.
The World Health Organization’s Director General, Dr. Margaret Chan, declared during the weekend that current events constitute a public health emergency of international concern, under the International Health Regulations. Countries around the world are stepping up their surveillance for influenza-like symptoms.
Now, more than ever, the world needs a coordinated and collaborative response to this pandemic threat, and there is no better time to launch CHORDS – Connecting Health Organizations for Regional Disease Surveillance.
Under its Disease Surveillance Network Initiative, The Rockefeller Foundation is investing over $20 million in strengthening and connecting regional disease surveillance networks to respond to this type of threat.
Regional Disease Surveillance Networks are comprised of technical specialists from Ministries of Health in a given region, who collaborate on harmonizing disease definitions, communicating outbreak information, and responding to health emergencies of international concern.
Disease surveillance networks have demonstrated themselves to be a flexible and responsive means to work with, through and around more static institutional structures.
Using this new form of global health diplomacy, leaders from disease surveillance networks from the Middle East to the Mekong recognize that collaboration is key to achieving their goals of:
- strengthening sub-national and national capacity to detect and respond to disease outbreaks;
- complying with the International Health Regulations in reporting diseases of international concern and collaborating in the response; and 3
- promoting peace, prosperity and development in areas that face endemic disease, poverty and conflict.
The Rockefeller Foundation is one of the founding partners of the Mekong Basin Disease Surveillance Network; the East African Infectious Disease Network under the East African Community; and the Southern African Center for Infectious Diseases. We are proud to support CHORDS, which will provide a valuable means to link these and other networks to each other and to catalyze learning and action.
Why are regional networks critical to the global pandemic response?
Regional trade blocks promote regional integration through trade and investment and are considered a key vehicle through which to address economic, social and security concerns. Among them are the North American Free Trade Agreement, the Greater Mekong Sub-region, The Association of Southeast Asian Nations, the Southern African Development Community, the East African Community, the Common Market for Eastern and Southern Africa, and the African Union.
In order for regional development efforts to successfully reduce poverty and support development, they also need to promote resilience to the drivers of emerging infectious diseases.
These drives include cross-border trade, mobility and migration of humans and animals, livestock production systems, population density, viral adaptation, and ecological shifts as a result of climate change.
These drivers facilitate the rapid spread of diseases in and between animals and humans, threatening the health and livelihoods of poor people, and raising concerns about national security, the safety of the food chain and supply, and global public health in general.
Animals are the likely source of 70% of the world’s emerging infections. Yet half of the world’s 1.2 billion extreme poor depend on livestock production for their livelihoods and primary source of protein. In the event of an outbreak, these are the people likely to be hit the hardest with threats of disease, malnutrition and economic destitution.
Outbreaks such as avian influenza in Southeast Asia, and Rift Valley Fever in East Africa, have caused losses of between 2-5% of GDP. Already we are seeing the impact of swine flu on Mexico’s pork exports and tourism.
Should swine flu hit the world’s poorest regions, or should another pathogen of pandemic potential emerge, we need in place:
- rapid detection, confirmation and notification not only at airport screening centers but land-border crossings;
- clear communications messages and channels that minimize panic and maximize prevention;
- adequate supplies of personal protective equipment and anti-viral medications; and
- plans for the deployment of health workers and social isolation measures.
The presentations today will give us some indication as to how ready we are.
What can we do to support the regional and global response?
Three things are needed:
- first, better skilled people, deployed to optimum efficiency;
- second, improved use of communications and diagnostics technologies to speed up detection and response; and
- third, improved collaboration across borders and across sectors.
First, a skilled workforce and smart deployment is essential.
Infectious disease outbreaks place a great burden on already weak health systems. The Cholera outbreak in Zimbabwe is a tragic indicator of what happens to countries in short supply of health personnel, facilities, supplies and clean water: countless unnecessary deaths.
Success in detecting and responding to outbreaks is hindered by the sub-optimal use of both local and regional health resources. According to leading experts, the tasks required to control a pandemic are “nearly impossible to perform reliably in countries that lack adequate numbers of veterinarians, public health experts, laboratory scientists and health-care workers.”
The regions need diverse and flexible skill sets, and better deployment of these skill sets, with attention to distribution, incentives and management processes.
We are working with others to develop a new cadre of multi-faceted health workers skilled in field epidemiology, veterinary epidemiology and public health informatics who will be equipped to detect “weak signals” when outbreaks begin to occur in both animals and humans and respond rapidly.
We are supporting novel analytic approaches that apply geographic information systems to map how resources required in a pandemic are distributed so that in a pandemic “war room,” information is readily available to enable decisive action.
And we are contributing to policy analysis of workforce needs and distribution so that countries can better deploy the resources they have now, and plan for the future.
Second, new tools and technologies can help to speed up reporting and response.
Many current disease surveillance systems in Asia and Africa still depend on slow paper-based processes or unstructured reporting via telephone, fax, or radio. In the case of a pandemic outbreak, the current communications infrastructure is not sufficient to gather information and send instructions back out to the field. Real-time pandemics response is reliant upon real-time communications and information, and these capabilities have been largely lacking.
Improving the overall flow of information in the health system, while strengthening disease surveillance both for extreme events such as pandemics as well as routine reporting for other diseases, will lead to much more robust systems that can be relied upon in case of a crisis.
Partnerships between the regional surveillance networks, universities and the private sector are yielding impressive advances in applying the new tools of information technology to disease reporting. Let me give you three examples:
- The first example is ProMED-mail - the Program for Monitoring Emerging Diseases - an Internet-based reporting system dedicated to rapid global dissemination of information on outbreaks of infectious diseases that affect human health, including those in animals and plants. ProMED-mail’s PRO-MBDS list-serve notifications are among the first alerts that Ministries of Health in the Mekong region receive about outbreaks in neighboring countries.
Often preceding formal confirmations by a matter of days, they give officials a “heads-up,” and prompt them to consult each other about an appropriate course of action. - The second example is InSTEDD, which stands for Innovative Support to Emergencies, Diseases and Disasters. Inspired by Larry Brilliant, and with support from Google.org and the Rockefeller Foundation, InSTEDD was set up to harness the power of technology to improve collaboration for global health and humanitarian action. InSTEDD’s engineers have been working closely with Cambodia’s Ministry of Health and others, and now more broadly through the Mekong Basin Disease Surveillance Network, to develop and test “GeoChat,” an open-source SMS and mapping tool designed for complex emergencies. GeoChat is now being piloted as a reporting tool in cross-border and regional settings in the Mekong region.
- The third example is BIOPHICS, a center of excellence for Biomedical and Public Health Informatics located at the Faculty of Tropical Medicine (FTM), Mahidol University, Bangkok, Thailand. The Foundation supported the creation of BIOPHICS to ensure that state-of-the-art developments in informatics are accessible to and used by national and sub-regional surveillance systems.
It is our hope that through CHORDS, other regional networks will access these and other advances in technologies.
Third, improved collaboration across borders, sectors and institutions will fill gaps and reduce fragmentation.
As we are witnessing with the response to swine flu, collaboration across borders and sectors is essential to an effective global response.
In collaboration with NTI, the RAND Corporation, the World Health Organization and Ministries of Health and Agriculture in Asia and Africa, we have supported a series of cross-border, national, and regional pandemic preparedness simulation exercises that have brought multiple sectors and countries to the table for the first time to develop and operationalize plans for action.
Already, we are seeing greater collaboration across borders, including joint outbreak investigations of avian influenza and cholera in the Mekong region; and the East African Community is undertaking joint animal-human health preparedness activities connecting the borders of Burundi, Uganda, Rwanda, Kenya and Tanzania.
We are also working to bring together human health, livestock health and wildlife officers and climate scientists under a “One Health” framework. Many of the regional networks are reaching out to find new ways of collaborating across traditional silos.
And regional networks are serving as a common platform through which to coordinate efforts of multiple donors and other institutional partners. They support the work of the World Health Organization by creating bridges across regional offices, communicating across borders, and collaborating with the Global Outbreak Alert and Response Network.
They work to build capacity on the ground with others such as the US Centers for Disease Control.
And they support coordinated funding efforts with bilateral and multilateral agencies like USAID, AusAID, the French Development Bank, the European Union, the Food and Agriculture Organization, the UN Office for Coordination of Humanitarian, and with the Asian and African Development Banks.
Now, by engaging with each other directly and through CHORDS, they will be able strengthen their own networks, share lessons across regions, and enhance global monitoring and reporting efforts.
Finally, Regional Networks Contribute to Global Health Diplomacy.
Global health diplomacy is concerned with the negotiation processes that shape and manage the policy environment for health and its determinants. It implies an aspiration to greater policy coherence, strategic direction and a common value in global health, involving national governments, civil society, the private sector and foundations.
Technical networks are a tool for foreign policy and diplomacy. A form of “soft-power,” these networks help to share knowledge and information, build trust and more open communication, and generate a sense of collective responsibility and collaborative action.
CHORDS is an appropriate acronym for this effort, as it suggests harmonizing our collective efforts. Please join me in expressing our sincere thanks to Senator Sam Nunn, Terence Taylor and Louise Gresham and their team for their leadership, support and extraordinary contribution to this important endeavor, and our congratulations and best wishes for the success of CHORDS.
