Demonstration Projects Show Global Health Security Begins at the Local Level

A detection team of men in a remote village in Uganda prepare to assess an individual whose recent death may have been caused by the Ebola virus. Such on-the-ground detection teams are key elements in global health security. (Image: Justin Williams/Centers for Disease Control and Prevention)

A detection team in a remote village in Uganda prepare to assess an individual whose recent death may have been caused by the Ebola virus. Such on-the-ground detection teams are key elements in global health security. (Image: Justin Williams/Centers for Disease Control and Prevention)

Infectious disease threats know no borders, especially in a world where a potentially deadly infectious disease is only a 24-hour plane flight from anywhere in the world. So it’s not surprising that nations are increasingly recognizing the need for global health security, for strengthening local capacity to prevent, detect, and respond to public health threats that have global implications.

Such a challenge is an ambitious one, especially for developing countries without a strong public health infrastructure. To help develop an approach for achieving this goal, the US Centers for Disease Control and Prevention (CDC), partnered with the ministries of health in Vietnam and Uganda, conducted demonstration projects in 2013 in those countries. Findings from these projects, appearing today in the CDC’s Morbidity and Mortality Weekly Report, may help provide templates that other nations can use to both enhance their own health and contribute to global health security.

Addressing Global Health Threats

These efforts could also help nations keep their promises to meet core surveillance and response requirements of the International Health Regulations, which in 2005 were revised by the World Health Organization (WHO) in response to the need to address existing, new, and reemerging infectious diseases and other health threats, including chemical, biological, or radiological public health emergencies. The regulations, which are binding on 194 countries (including all WHO member states), are geared toward ensuring rapid gathering of information about a possible health threat, fostering an understanding of what may constitute a public health emergency of international concern, and making international assistance available.

The countries that signed on to the International Health Regulations had until June 2012 to meet the core surveillance and response requirements, but more than 80% of them failed to meet this deadline and have been given a 2-year extension.

CDC Director Thomas R. Frieden, MD, MPH, said he hopes countries can learn from the demonstration projects and implement effective measures to meet the regulations’ requirements. Doing so should help manage disease outbreaks within countries and prevent or minimize their spread to other countries, he said.

“We have unprecedented opportunity,” Frieden said, in the form of better technology for rapid detection and response and effective communication tools to report cases, such as social media and texting. “We have a different world now than we had just a few years back.”

In Vietnam, the CDC, Vietnam’s ministry of health, and certain international organization personnel launched a demonstration project from March 2013 to September 2013 to improve the country’s capacity to detect and respond to public health emergencies. The project team, which focused on establishing an emergency operations center that would receive, evaluate, and distribute information and coordinate response operations to a disease outbreak, demonstrated that early detection of and response to diseases and outbreaks could be made through this and other enhancements to the country’s health system, such as improving laboratory operations by increasing the capacity of diagnostic and specimen referral networks.

Michelle McConnell, MD, country director, CDC Vietnam, said enhancing information systems proved to be the most difficult challenge. “This system, by definition, encompassed many different institutions and levels of the public health system from the national to the provincial and district levels of the public health system,” McConnell said in an e-mail exchange. “Intra- and interdepartmental coordination and communication are critical to global health security, but also one of the greatest challenges.”

McConnell added that it is challenging for developing countries to focus on global health security because of economic constraints and other health priorities, but that Vietnam made it a priority. “The Vietnam ministry of health is very aware of the importance and priority of global health security and led with the highest level of commitment,” McConnell wrote. “Vietnam was one of the first nations in Asia to stop having new cases of SARS during that epidemic and, more recently, has stepped up efforts to prevent, detect, and respond to outbreaks of novel influenza viruses, such as H7N9.”

Mock Outbreaks and Preparedness

The demonstration project in Uganda focused on similar priorities: strengthening the public health laboratory system by increasing the capacity of diagnostic and specimen referral networks, enhancing existing communications and information systems for outbreak responses, developing an emergency operations center to serve as the focal point for communication, and assessing information emerging from the front lines of response to outbreak threats. To simulate the challenges Ugandan public health workers might encounter in reality, the project created mock outbreaks of multidrug-resistant tuberculosis, cholera, and viral hemorrhagic fever.

At the end of the project, 14 of 16 sites demonstrated they had improved in disease recognition, communication, and specimen transport. Laboratories showed an average 14% improvement from the baseline assessment.

“The exercise emphasized the importance of preparedness activities in the steps of preparedness, response, and recovery,” said Jeff Borchert, MSEH, from the CDC’s Office of Infectious Disease, who worked in Uganda on the project, in an e-mail exchange. “Next steps could include increased focus on preparedness planning in addition to the response aspect so that plans and supplies are in place ahead of any incident that might occur.”

In addition to demonstration projects, the CDC is also working in other areas to improve global health security. “CDC has been working with ministries of health around the world in a variety of public health activities, such as training epidemiologists to have core capacities to monitor infectious and noninfectious agents,” said Jordan W. Tappero, MD, MPH, director of CDC’s division of global health protection, Center for Global Health. “We really need to improve our surveillance capacity, the ability to track an event if it happens. Most countries have some way of tracking infectious disease, but those that don’t need to get it.”

Such improvements benefit individual countries as well as the global community, Frieden said. “What’s encouraging is when we do this in a country, it doesn’t just make that country safer from a particular threat; it improves the country’s ability to meet any health threat,” he said. “That ability is transferable.”

Categories: Bioterrorism, Infectious Diseases, Public Health, World Health

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