The WHO Hub for Pandemic and Epidemic Intelligence; supporting better preparedness for future health emergencies

Strengthening disease surveillance capacity at national level across five countries: a qualitative study

OBJECTIVES

Disease surveillance is an essential component of public health and a core function of National Public Health Institutes (NPHIs), including to better prepare and respond to infectious diseases outbreaks. Strengthening NPHIs in their efforts to establish and maintain efficient surveillance systems is an opportunity to ensure future outbreak preparedness and response; yet, guidance on how to increase and prioritise capacity building efforts is limited. This study sought to investigate approaches to capacity building and training for disease surveillance at national level and understand the potential role of NPHIs.

STUDY DESIGN

Qualitative study.

METHODS

This is a qualitative study, based on a literature review and interviews undertaken between June and November 2022. Fifty seven in-depth interviews were conducted in five countries: Côte d'Ivoire, Ecuador, Madagascar, Namibia, and the Kingdom of Saudi Arabia. Participants included a range of professionals from government, NPHIs, academic institutions and the private sector. Interviews were thematically analysed.

RESULTS

Selected countries varied in terms of their disease surveillance capacities, as well as in the structure of their surveillance systems and decision-making. Research identified shared priority areas for action at national level, identifying common challenges and opportunities: 1) capacity building, here specifically the need for a training agenda at national level to ensure sustainability and guide donor funded training offers; 2) data tools and technology-to help decision-makers select the best software tool to address countries' identified need; 3) data sharing-the need for clear data sharing standards and norms for national to international data sharing; and 4) genomic sequencing-the need for national genomic surveillance strategies and reporting guidelines.

CONCLUSION

Addressing challenges and using opportunities to strengthen disease surveillance at national level is an important step to build capacity in this area and to help prevent future epidemic and pandemics globally. The findings of this study help decision-makers to identify priority areas for capacity building and understand the potential role and significance of NPHIs.

Epidemic intelligence in Europe: a user needs perspective to foster innovation in digital health surveillance

BACKGROUND

European epidemic intelligence (EI) systems receive vast amounts of information and data on disease outbreaks and potential health threats. The quantity and variety of available data sources for EI, as well as the available methods to manage and analyse these data sources, are constantly increasing. Our aim was to identify the difficulties encountered in this context and which innovations, according to EI practitioners, could improve the detection, monitoring and analysis of disease outbreaks and the emergence of new pathogens.

METHODS

We conducted a qualitative study to identify the need for innovation expressed by 33 EI practitioners of national public health and animal health agencies in five European countries and at the European Centre for Disease Prevention and Control (ECDC). We adopted a stepwise approach to identify the EI stakeholders, to understand the problems they faced concerning their EI activities, and to validate and further define with practitioners the problems to address and the most adapted solutions to their work conditions. We characterized their EI activities, professional logics, and desired changes in their activities using NvivoⓇ software.

RESULTS

Our analysis highlights that EI practitioners wished to collectively review their EI strategy to enhance their preparedness for emerging infectious diseases, adapt their routines to manage an increasing amount of data and have methodological support for cross-sectoral analysis. Practitioners were in demand of timely, validated and standardized data acquisition processes by text mining of various sources; better validated dataflows respecting the data protection rules; and more interoperable data with homogeneous quality levels and standardized covariate sets for epidemiological assessments of national EI. The set of solutions identified to facilitate risk detection and risk assessment included visualization, text mining, and predefined analytical tools combined with methodological guidance. Practitioners also highlighted their preference for partial rather than full automation of analyses to maintain control over the data and inputs and to adapt parameters to versatile objectives and characteristics.

CONCLUSIONS

The study showed that the set of solutions needed by practitioners had to be based on holistic and integrated approaches for monitoring zoonosis and antimicrobial resistance and on harmonization between agencies and sectors while maintaining flexibility in the choice of tools and methods. The technical requirements should be defined in detail by iterative exchanges with EI practitioners and decision-makers.

Greater agreement is required to harness the potential of health intelligence: a critical interpretive synthesis

OBJECTIVES

To synthesize existing knowledge on the features of, and approaches to, health intelligence, including definitions, key concepts, frameworks, methods and tools, types of evidence used, and research gaps.

STUDY DESIGN AND SETTING

We applied a critical interpretive synthesis methodology, combining systematic searching, purposive sampling, and inductive analysis to explore the topic. We conducted electronic and supplementary searches to identify records (papers, books, websites) based on their potential relevance to health intelligence. The key themes identified in the literature were combined under each of the compass subquestions and circulated among the research team for discussion and interpretation.

RESULTS

Of the 290 records screened, 40 were included in the synthesis. There is no clear definition of health intelligence in the literature. Some records describe it in similar terms as public health surveillance. Some focus on the use of artificial intelligence, while others refer to health intelligence in a military or security sense. And some authors have suggested a broader definition of health intelligence that explicitly includes the concepts of synthesis of research evidence for informed decision making.

CONCLUSION

Rather than developing a new or all-encompassing definition, we suggest incorporating the concept and scope of health intelligence within the evidence ecosystem.

Epidemic intelligence activities among national public and animal health agencies: a European cross-sectional study

Epidemic Intelligence (EI) encompasses all activities related to early identification, verification, analysis, assessment, and investigation of health threats. It integrates an indicator-based (IBS) component using systematically collected surveillance data, and an event-based component (EBS), using non-official, non-verified, non-structured data from multiple sources. We described current EI practices in Europe by conducting a survey of national Public Health (PH) and Animal Health (AH) agencies. We included generic questions on the structure, mandate and scope of the institute, on the existence and coordination of EI activities, followed by a section where respondents provided a description of EI activities for three diseases out of seven disease models. Out of 81 gatekeeper agencies from 41 countries contacted, 34 agencies (42%) from 26 (63%) different countries responded, out of which, 32 conducted EI activities. Less than half (15/32; 47%) had teams dedicated to EI activities and 56% (18/34) had Standard Operating Procedures (SOPs) in place. On a national level, a combination of IBS and EBS was the most common data source. Most respondents monitored the epidemiological situation in bordering countries, the rest of Europe and the world. EI systems were heterogeneous across countries and diseases. National IBS activities strongly relied on mandatory laboratory-based surveillance systems. The collection, analysis and interpretation of IBS information was performed manually for most disease models. Depending on the disease, some respondents did not have any EBS activity. Most respondents conducted signal assessment manually through expert review. Cross-sectoral collaboration was heterogeneous. More than half of the responding institutes collaborated on various levels (data sharing, communication, etc.) with neighbouring countries and/or international structures, across most disease models. Our findings emphasise a notable engagement in EI activities across PH and AH institutes of Europe, but opportunities exist for better integration, standardisation, and automatization of these efforts. A strong reliance on traditional IBS and laboratory-based surveillance systems, emphasises the key role of in-country laboratories networks. EI activities may benefit particularly from investments in cross-border collaboration, the development of methods that can automatise signal assessment in both IBS and EBS data, as well as further investments in the collection of EBS data beyond scientific literature and mainstream media.

The values and risks of an Intergovernmental Panel for One Health to strengthen pandemic prevention, preparedness, and response

The COVID-19 pandemic has shown the need for better global governance of pandemic prevention, preparedness, and response (PPR) and has emphasised the importance of organised knowledge production and uptake. In this Health Policy, we assess the potential values and risks of establishing an Intergovernmental Panel for One Health (IPOH). Similar to the Intergovernmental Panel on Climate Change, an IPOH would facilitate knowledge uptake in policy making via a multisectoral approach, and hence support the addressing of infectious disease emergence and re-emergence at the human-animal-environment interface. The potential benefits to pandemic PPR include a clear, unified, and authoritative voice from the scientific community, support to help donors and institutions to prioritise their investments, evidence-based policies for implementation, and guidance on defragmenting the global health system. Potential risks include a scope not encompassing all pandemic origins, unclear efficacy in fostering knowledge uptake by policy makers, potentially inadequate speed in facilitating response efforts, and coordination challenges among an already dense set of stakeholders. We recommend weighing these factors when designing institutional reforms for a more effective global health system.

Emerging data inputs for infectious diseases surveillance and decision making

Infectious diseases create a significant health and social burden globally and can lead to outbreaks and epidemics. Timely surveillance for infectious diseases is required to inform both short and long term public responses and health policies. Novel data inputs for infectious disease surveillance and public health decision making are emerging, accelerated by the COVID-19 pandemic. These include the use of technology-enabled physiological measurements, crowd sourcing, field experiments, and artificial intelligence (AI). These technologies may provide benefits in relation to improved timeliness and reduced resource requirements in comparison to traditional methods. In this review paper, we describe current and emerging data inputs being used for infectious disease surveillance and summarize key benefits and limitations.

Leveraging the HIV response to strengthen pandemic preparedness

The COVID-19 pandemic and the expectation of future pandemic threats have generated a global dialogue on strengthening pandemic preparedness and response (PPR). Thus far, this dialogue has largely failed to fully consider the critical role that established, disease-specific programs played in national and regional COVID-19 responses, and the potential for these programs to contribute to stronger pandemic preparedness for the future. The HIV response is an important example of a global health initiative that is already making substantial contributions to PPR. Both the infrastructure and core principles of the HIV response have much to contribute towards pandemic preparedness that is more effective and equitable than seen in the response to COVID-19. This review examines how HIV-related resources and principles can support communities and countries in being better prepared for emerging disease threats, with a specific focus on evidence from the COVID-19 pandemic. Drawing on the current literature, the review explores the clear, multi-faceted intersection between the HIV response and the central elements of pandemic preparedness in areas including surveillance; supply chain; primary care; health care workforce; community engagement; biomedical research; universal access without discrimination; political leadership; governance; and financing. There are many opportunities to be more strategic and purposeful in leveraging HIV programs and approaches for preparedness. Avoiding the longstanding temptation in global health to create new siloes, PPR initiatives, including the new Pandemic Fund at the World Bank, should invest in and build out from existing programs that are already making health systems more inclusive and resilient, including the global response to HIV.

Lessons from Nigeria's Adaptation of Global Health Initiatives during the COVID-19 Pandemic

Nigeria receives funds from several global health initiatives that are aimed at addressing elevated risks and overall burden of infectious disease outbreaks. These funds include the Global Fund to Fight AIDS, Tuberculosis and Malaria; US President's Emergency Plan for AIDS Relief; US President's Malaria Initiative; and Global Polio Eradication Initiative. These initiatives have contributed to a substantial reduction in illness and death from HIV, tuberculosis, malaria, and polio. However, Nigeria has experienced mixed success with leveraging the capacities built through these donor-funded vertical programs to respond to new health threats. This report describes experiences using resources from vertical disease programs by the Nigeria Centre for Disease Control in response to the 2014-2016 Ebola outbreak in West Africa and the COVID-19 pandemic. Integrating resources from different disease programs with government-led systems and institutions will improve responses to endemic outbreaks and preparedness for future pandemics in Nigeria.