Session 5: Advancing Public Health - Strengthening Collaboration for Surveillance and Response
On February 8, 2024, IANPHI held a session of its annual meeting on "Advancing Public Health - Strengthening Collaboration for Surveillance and Response".
Under the moderation of Dr. Johanna Hanefeld, Vice President of the Robert Koch Institute (RKI) in Germany, and Dr. Natalie Mayet, Deputy Director of the National Institute for Communicable Diseases (NICD) of South Africa, this session covered various aspects of strengthening global surveillance, emergency response, and pandemic preparedness.
Key themes included the importance of collaborative methodologies in surveillance, the necessity of global collaboration in pandemic response, and the need for capacity building and multi-sectoral collaboration. Initiatives such as collaborative surveillance networks, the Global Health Emergency Corps (GHEC), and regional action plans were highlighted as essential tools for strengthening response capabilities. The importance of integrating diverse data streams, establishing strategic partnerships, and leveraging existing mechanisms for capacity building and resource sharing was emphasized across all presentations. Overall, the presentations highlighted the critical role of collaboration and collective action in effectively addressing global health emergencies.
Dr. Hanefeld opened the session by acknowledging the importance of National Public Health Institutes (NPHls) in epidemic response and preparedness, especially highlighted by the COVID-19 pandemic. She mentioned ongoing global initiatives aiming to enhance NPHls' coordination and effectiveness. The session featured presentations from six speakers followed by a discussion to share experiences and insights.
The speakers included Mrs. Sara Hersey, Director of Collaborative Intelligence in the WHO Health Emergencies Program, Dr. Scott Dowell, Senior Advisor of the Global Health Emergency Corps (GHEC) at the World Health Organization (WHO), Dr. Raji Tajudeen, Head of Division Public Health Institutes and Research at Africa CDC, Dr. Joy St. John, Executive Director of the Caribbean Public Health Agency (CARPHA) in Trinidad and Tobago, Prof. Aamer lkram, IANPHI Executive Board Strategic Adviser, and Prof. Steven Riley, Director General of Data, Analytics and Surveillance at the UK Health Security Agency (UKHSA) in the United Kingdom (England).
Strengthening Collaboration for Surveillance and Response
By Sara Hersey, Director of Collaborative Intelligence, Division of Health Emergency Intelligenceand Surveillance Systems (WSE). WHO Health Emergencies Program.
Sara Hersey presented on the evolving landscape of surveillance within health emergencies, notably drawing from experiences during events like the COVID-19 pandemic. Her talk underscored the necessity of building collaboration and capacity building to strengthen surveillance systems, as well as non-traditional data sources to improve timely and informed decision-making.
Mrs. Hersey introduced the concept of "collaborative surveillance", which transcends conventional approaches by integrating diverse data streams, such as epidemiological, clinical, environmental, and social data, and outlined the multifaceted nature of decision-making during emergencies, ranging from initial outbreak assessment to containment strategies and monitoring of response effectiveness. To support this paradigm shift, WHO has established new divisions and initiatives. Notably, the Division of Health Emergency Intelligence and Surveillance Systems IWSEl, including departments in Geneva and Berlin, focuses on developing innovative tools and fostering collaboration. Mrs. Hersey stressed the importance of capacity building and collaboration, highlighting efforts to support national public health agencies through peer-to-peer learning and sustainable financing models.
Additionally, Mrs. Hersey talked about the International Pathogen Surveillance Network IIPSNl, aiming to enhance global public health by ensuring equitable access to genomic sequencing and analytics. She emphasized the network's focus on capacity building at the country level, envisioning integrated genomic surveillance within national systems.
Concluding her presentation, Mrs. Hersey invited participation in various initiatives aimed at bolstering surveillance capabilities worldwide, including funding opportunities and collaborative projects. Overall, her message underscored the imperative of adapting surveillance approaches to the complex realities of health emergencies, with collaboration and capacity building at the forefront.
Building Emergency Response Capacity - The Global Health Emergency Corps (GHEC)
ByDr.ScottDowell,SeniorAdvisoroftheGlobalHealthEmergencyCorps(GHEC)ofthe
World Health Organization (WHO).
Dr. Scott Dowell delivered insights into the Global Health Emergency Corps (GHEC) initiative, contextualizing it within the diverse experiences of the COVID-19 pandemic across the globe. He emphasized the essential nature of global collaboration in pandemic response, stressing that countries alone don’t possess the capacity to fight pandemics and must work together. Reflecting on his experience from leading the COVID-19 pandemic response for the Bill & MelindaGates Foundation in Seattle and later transitioning to work on the emergency core at WHO, Dr. Dowell acknowledged the pivotal role of countries in the Western Pacific, such as Singapore, China, Australia, and New Zealand, in mounting aggressive and successful early responses to COVID-19. However, he noted that, ultimately, the virus reached every corner of the world, demonstrating the interconnectedness of global health.
In his presentation, Dr. Dowell introduced the structure of the GHEC, which comprises of three key layers: the emergency workforce at the national level, surge response teams, and regionally- and globally-connected national leaders. He underscored the importance of these layers functioning cohesively and with interoperability to ensure an effective global response to health emergencies. In particular, Dr. Dowell delved into the concept of connected leaders, envisioning a network of top public health officials worldwide who can exchange critical information and collaborate in real time during health emergencies. He underlined the necessity of coordination and information sharing among these leaders to inform key decisions such as border closures, vaccine campaigns, and other public health containment strategies.
In conclusion, Dr. Dowell emphasized the vital role of such a connected network in anticipating and responding to future pandemics. He underscores the imperative of collective action, information exchange, and global cooperation to enhance the probability of effectively containing and mitigating the impacts of future health crises.
By Dr. Raji Tajudeen, Head of Division Public Health Institutes and Research, Africa CDC.
Dr. Raji Tajudeen began his presentation by highlighting Africa CDC's strategic priority of emergency preparedness and response, emphasizing the need for collaboration given the continent's history of frequent disease outbreaks. Dr. Tajudeen discussed the oint Emergency Preparedness and ResponseAction Plan (IEAP), a five-year strategic collaboration between Africa CDC, WHOAFRO, and WHO EMRO, which aims to bolster member states' capacities to manage disease outbreaks efficiently. The Action Plan focuses on key priority areas, including genomic sequencing, surveillance, and disease intelligence, stockpiling of emergency supplies, response readiness and coordination, and workforce readiness and deployment. Dr. Tajudeen elaborated on each area, emphasizing the importance of enhancing workforce capacity, establishing Public Health Emergency Operation Centers, strengthening surveillance systems, and improving data access and sharing.
Additionally, Dr.Tajudeen highlighted the efforts to scale up the African Volunteers Health Corps(AVoHC) and collaborate with WHO on the AVoHC-SURGE (AVoHC - Strengthening & Utilizing Response Groups for Emergencies) initiative. He also discussed the importance of establishing robust incident management structures and improving event-based surveillance systems to enhance early detection and response to outbreaks. Additionally, he underscores the need for a robust governance structure to facilitate data access, sharing, and collaboration among member states.
Finally, Dr. Tajudeen emphasizes Africa CDC's commitment to prioritizing multi-sectoral collaborative surveillance and ensuring the operationalization of the JEAP. He stressed the importance of effective implementation to strengthen Africa's public health ecosystem and enhance the continent's capacity to respond to health emergencies effectively.
By Dr. Joy St. John, Executive Director, Caribbean Public Health Agency (CARPHA), Trinidad and Tobago.
Dr. Joy St. John shared insights into the Pandemic Fund initiative, born out of the COVID-19 pandemic, which aims to support regional public health efforts. The Caribbean Public Health Agency (CARPHA), an institution within the Carribean Community (CARICOM), focuses on all aspects of public health, with a regional mandate from 26 member states. Dr. St. John emphasized CARPHA's role in
implementing regional public health strategies, including the Caribbean Cooperation in Health and an integrated surveillance strategy.
The Pandemic Fund proposal, which led to the successful grant award and was established through collaboration with member states and international partners, aims at enhancing national and regional capacities for pandemic preparedness and response. Dr. St. John outlined the iterative process involved in developing and implementing the award from the Pandemic Fund, which includes input from member states, Heads of Government, and international stakeholders. Key pillars of the Pandemic Fund grant will include strengthening human resource capacity, implementing field epidemiology and lab training programs, adopting a One Health approach, addressing climate change implications, improving data collection and analysis at the frontline level, and establishing a regional deployment network for rapid response teams. Collaboration with other CARICOM institutions, particularly in disaster preparedness and health security, is integral to the fund's implementation.
Overall, Dr. St. John underscored CARPHA's commitment to strengthening public health capacities at both national and regional levels, leveraging existing mechanisms and partnerships to enhance resilience and response capabilities in the Caribbean region.
Prof. Aamer lkram shared Pakistan's experience in strengthening Integrated Disease Surveillance (IDS). He began his talk by highlighting Pakistan's early adoption of the International Health Regulations(IHR) in 2005, which emphasized real-time surveillance. In 2016, Pakistan underwent a Joint External Evaluation (JEE), becoming one of the first countries in the region and third in the world to do so. The JEE identified gaps in surveillance, prompting Pakistan to pilot integrated disease surveillance and response programs with support from partners like the UK Health Security Agency (UKHSA).
The surveillance efforts focused on three pillars: structure, human resources, and core functions. Dedicated teams were established at the federal, provincial, and regional levels, with training provided to enhance capacity. The surveillance system expanded gradually, covering priority diseases, and establishing disease surveillance units in all 159 districts. Additionally, Pakistan invested in public health laboratory networks, data systems, and genomic surveillance, with support from several partners like the US CDC, USAID, and the Fleming Fund.
Key achievements include the establishment of a national data center for health informatics and the successful integration of cancer and non-communicable disease registries. Pakistan emphasizes data driven policymaking and aims to strengthen its emergency operations center and human resource training further. Prof. lkram concluded by emphasizing the importance of teamwork in overcoming challenges and achieving success in public health surveillance.
By Prof. Steven Riley, Director General of Data, Analytics and Surveillance, UK Health Security Agency (UKHSA), United Kingdom England.
Prof. Steven Riley discussed the development of a Centre for Pandemic preparedness within the UK Health Security Agency (UKHSA) and its linkages to global initiatives, such as the InternationalPathogen Surveillance Network (IPSN). UKHSA was formed in 2021, merging Public Health England (PHE) with pandemic entities like NHS Test and Trace and the Joint Biosecurity Centre (JBC). The agency's mission is to prepare for, prevent, and respond to emergencies. The Centre for Pandemic Preparedness, established as part of a bilateral agreement with the United States, aims to provide a strategic approach across the Government of the United Kingdom to enhance response capabilities.
Prof. Riley emphasized that UKHSA is just one part of the pandemic response, highlighting the importance of collaboration with other stakeholders. He discussed international partnerships, including the novel variant assessment platform and the IPSN, which increase the speed and volume of COVID-19 sequencing, and suggested that preparedness planning should involve analyzing past threats to inform future responses. While modeling is valuable, understanding previous threats' characteristics is crucial. He also pointed out the need for a shared vision to present the benefits of surveillance effectively and address resource allocation challenges. Overall, Prof. Steven Riley encouraged health security leaders to be self-critical in discussions about pandemic preparedness and response efforts so as to facilitate cooperation from across national governments in achieving the correct levels of investment.
The panel discussion opened with reflections on the presentations made, highlighting the effort to replicate the collaborative spirit of IANPHI within formal mechanisms.
The first audience intervention highlighted the importance of cooperative surveillance, emphasizing the need to understand and address both human and animal health aspects to effectively manage outbreaks. Subsequent comments from the audience touched on various topics, including the importance of rapid response protocols during outbreaks, the need for international collaboration beyond bilateral meetings, the establishment of pandemic preparedness centers covering multiple sectors, and the necessity of multi-sectoral risk assessments. Panelists responded with additional insights, emphasizing the need for integrated approaches involving various sectors beyond health, such as agriculture and environment. They highlighted ongoing efforts to establish partnerships and share resources, the importance of scenario planning and addressing potential collateral damage from pandemic responses.
The discussion concluded with an emphasis on the importance of strengthening national capacities at the district level, simplifying initiatives for implementation, and addressing broader public health challenges beyond infectious diseases. Overall, the discussion underscored the need for collaborative, multi-sectoral approaches to pandemic preparedness and response, with a focus on practical implementation at the local level.
CLOSINGTHOUGHTSANDREMARKS
By Dr. Natalie Mayet, Deputy Director of the National Institute for Communicable Diseases (NICD) of South Africa
Dr. Natalie Mayet concluded the session with a reflection on collaboration, using the analogy of ropemaking. She emphasized the importance of intention, integration, consolidation, and collaboration at various levels, from grassroots level to institutional level and beyond. Collaboration is depicted by Dr. Mayet as a process of weaving together weak and strong threads, navigating strengths and weaknesses, tying knots, and continuously strengthening and redirecting efforts with NPHls being the "anchor". Trust and relationship building were highlighted as essential components of effective collaboration.