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Asia’s Visionary Early Warning System Enables Swift Public Health Responses

As a young man in 1998, Dr. Moe Ko Oo began to consider climate and human health after he took a job as a medic on a supply ship ferrying divers who laid offshore gas pipes beneath the high-spirited South China Sea.

“It is a rough sea, with many tropical storms,” he said. “Often there was not much to do on the ship, so I was sitting and thinking all the time.”

Eighteen months after serving as a vessel’s guardian of health, he began to work on malaria control at the Thai-Myanmar frontier, focusing on the tangled ways diseases are transmitted across borders.

All this, combined with Master’s Degrees, prepared him to become Secretariat of the Mekong Basin Disease Surveillance Network (MBDS), a visionary collaboration initiated in 1999 with support from The Rockefeller Foundation and focused on developing an early warning system to detect and control cross-border spread of disease.

“This is The Rockefeller Foundation’s baby,” Dr. Oo said.

Public health officials from six diverse Mekong Basin countries – Cambodia, China, Laos, Myanmar, Thailand, and Vietnam – formed a trust-based network. They regularly exchange information, participate in cross-border meetings, and receive training to enhance surveillance and detection capabilities.

The pioneering model MBDS developed holds global potential for cross-border disease surveillance -- especially as climate change alters disease patterns, and creeping urbanization escalates pathogen transmissions from animals to human.

  • MBDS conducting an exercise in Laos in 2019 for a joint investigation of a disease outbreak (Photo Courtesy of MBDS)
    MBDS conducting an exercise in Laos in 2019 for a joint investigation of a disease outbreak. (Photo courtesy of MBDS)

“From the outset, we recognized that the challenge of infectious diseases in the Mekong Basin region couldn’t be confined within national borders,” said Deepali Khanna, Vice President, Asia Regional Office, The Rockefeller Foundation. “The MBDS Network has proven to be a prototype for other regions around the world, especially in an era where climate change exacerbates health risks.”

Informal Connections Build Trust

The project began with a sense of urgency.

The Mekong Basin, with its expanding agriculture, urban sprawl, extensive animal trade, and large concentration of human and livestock population, is particularly susceptible to climate-triggered disease outbreaks and experiences high incidents of communicable diseases and drug-resistant microorganisms.


An excercise to improve responses to infectious disease outbreaks, Laos, 2019 (Photo Courtesy of MBDS)
An excercise to improve responses to infectious disease outbreaks, Laos, 2019. (Photo courtesy of MBDS)

But with different languages, cultures, and political systems, collaboration wasn’t a given. Building the network took time.

It started with casual connections—health officials in the region sharing meals, coffee breaks, and conversations at various health conferences in the 1990s. As comradery began to develop, the officials decided to meet more formally to discuss regional issues, recognizing that isolated governments alone cannot stop disease spread.

  • Trust is crucial to this kind of sharing, as the Covid-19 pandemic proved. Policymakers have to believe participating means their country will be aided, not ostracized. Ultimately, an early warning system is the only way to choke off deadly diseases before they circulate.
    Manisha Bhinge
    Managing Director, Health Initiative, The Rockefeller Foundation

In February 1999, The Rockefeller Foundation invited Health Ministry representatives from the six Mekong Basin countries to a consultative meeting with the World Health Organization.

They held three meetings but “without political guidance, health officials felt very reluctant to communicate details from their countries,” Dr. Oo said.

Public health ministers from each country met in China in 2001 to sign a Memorandum of Understanding, establishing the network with a coordinating office located in Thailand.

Officially launched, MBDS was quickly in the hot seat.

In a matter of weeks in 2003, the coronavirus that caused SARS (severe acute respiratory syndrome) swept from southern China to 37 countries, killing a tenth of the people it infected. That same year, the H5N1 influenza spread from China across Southeast Asia, causing high death rates.

Making Information-Sharing Easy

MBDS held a series of workshops and meetings from 2003 to 2005 to reach a consensus on which diseases the region would prioritize and how often countries would report on them.

They decided to prioritize ten diseases and set specific reporting periods for each. Generally, reporting was weekly, monthly, or quarterly. But for SARS, cases were reported within 24 hours by fax to all members. They also developed an online presence and became part of the Global Outbreak Alert and Response Network.

MBDS conducts exercises in Thailand in 2018 to respond to a disease outbreak (Photo Courtesy of MBDS)
MBDS conducts exercises in Thailand in 2018 to respond to a disease outbreak. (Photo courtesy of MBDS)

Dr. Oo took a leadership position in 2005 and worked to improve reporting consistency.

The MBDS network also identified its core strategies, and each country took the lead in a particular issue – capacity-building, policy development, laboratory work, risk communications and more. “We started to feel like a team,” Dr. Oo noted.

  • Dr. Oo at work in his MBDS office in Thailand 2023 (Photo Credit Masha Hamilton)
    Dr. Oo at work in his MBDS office in Thailand 2023. (Photo credit Masha Hamilton)

Cyclone Nargis Puts MBDS to the Test

After the deadly Cyclone Nargis struck Myanmar in May 2008, MBDS facilitated and went to Myanmar with a 32-member medical team to assist refugees and address concerns about potential outbreaks of infectious respiratory disease.

From 2007 to 2012, MBDS held three regional forums, both at the national and cross-border level, and asked countries to present their experiences fighting diseases. “The in-person meetings were critical to establishing friendships and building trust,” Dr. Oo said.

Between 2016 and 2018, MBDS developed an Event-Based Surveillance Application for real-time reporting of not only diseases but environmental crises and animal illnesses that could threaten to carry over to humans.

In 2006 and 2007, MBDS held simulation exercises to improve pandemic responses, using an Avian Influenza outbreak scenario. Avian Influenza impacts both domestic and wild birds and can wipe out poultry farmers’ livelihoods, but it can also infect humans, sometimes lethally. The team traveled from country to country to engage with scientists and public health officials, and then met regionally to do a shared tabletop exercise.

In 2007, the participating countries signed another MoU and increased the number of priority diseases to 18, including Ebola, MERS, Zika, malaria, and dengue. They worked on localizing information exchanges even more by securing the participation of public health officials located in cross-border provinces. All of them from all six countries were involved by 2012.

“We wanted to make information-sharing easy, like talking to a family member,” Dr. Oo said.

All the reporting was in English, but from 2018 to 2022, the team worked to encompass local languages to make the application usable and informative on a national level as well as a regional level, and created a manual to teach new users about the application.

It also expanded its biothreat surveillance work and created a separate, tightly focused website. “Knowledge management in an integral part of MBDS regional approach to achieve efficiency and ensure that the right information is available to the right people,” Dr. Oo said.

The network held up during the Covid-19 pandemic, conducting information-sharing exercises and advising one another when cases were reported in their countries, Dr. Oo said. “By that time, trust was established.”

An Africa connection followed when Dr. Oo and cross-border coordinators from China, Laos, and Thailand visited to Tanzania to share their experiences and help set up an information-sharing mechanism.

Regional sharing of health data holds even greater potential than currently realized, particularly given the rise of extreme weather events, Dr. Oo believes.

“I would love to modify the MBDS Regional Collaborative Event-Based-Surveillance application so we can gather climate information, analyze how it impacts human health, and predict disease hotspots based on historical data trends,” he said. “I’d love to see how environmental temperature, air pollution, flooding, and rainfall levels will have an effect on One Health.”

  • MBDS conducts an exercise in Vietnam in 2016 on how to prevent a dengue outbreak. (Photo courtesy of MBDS)