The Ebola epidemic in West Africa in 2014 and the rapid emergence of Zika virus in the Western Hemisphere in 2015 have brought increased attention to the risk that epidemics and pandemics pose to global health security. Under the International Health Regulations, each country is tasked with ensuring their capabilities to detect and report infectious disease outbreaks in a rapid manner. Failure to do so may have dire consequences.
Rapidly detecting, reporting, and responding to the threat or emergence of an infectious disease is critical for containing small outbreaks before they have the opportunity to spread into a regional epidemic or global pandemic threat. As the epidemiologist Larry Brilliant, chairman of the Skoll Global Threats Fund, has noted, “outbreaks are inevitable, but pandemics are preventable.” It is imperative that we detect, report, and respond to early signs of outbreaks anywhere in the world. To do so we must also measure progress, identify successful interventions, and build upon those achievements.
Ensuring and measuring progress in this space is a challenging endeavor and the global health community must leverage a variety of approaches to ensure that we improve our ability to keep infectious disease outbreaks contained. Easily understood and comparable measures for tracking progress and encouraging investment in disease surveillance are sorely needed. Frameworks such as the Joint External Evaluation process must be complemented by other measures that allow countries to measure progress over time.
The reaction time of the public health system to infectious disease threats – or timeliness – is one specific metric through which we can assess progress. At the Skoll Global Threats Fund, the Ending Pandemics team has worked with a number of partners to advance a framework for measuring the timeliness of outbreak detection, reporting, laboratory confirmation, response, and appropriate public communication for infectious disease outbreaks.
Rapid detection of emerging health threats depends on effective disease surveillance systems that leverage a variety of data from both traditional and non-traditional sources. Regardless of the source of information, timeliness can serve as a key criterion for evaluating the effectiveness of a surveillance system. The speed with which a system can detect a health threat – such as the initial cases of a suspected outbreak – is critical for ensuring population health. Surveillance systems designed for different diseases need to operate at different speeds. Factors such as the transmissibility of the disease, the incubation period, how long a person with the disease remains infectious, and how severe the outcomes of a disease are all play a role in how one optimizes a system. How these data are captured and stored – if they are at all – pose additional challenges for measuring the timeliness of surveillance systems. Despite this complexity, we believe a set of standardized metrics is plausible, if not essential, for monitoring progress toward improved disease surveillance.
This is why our team has collaborated with TEPHINET and their associated field epidemiology training programs around the world to pilot this framework, and partnered with the Mekong Basin Disease Surveillance Network and Southeast European Center for Surveillance and Control of Infectious Diseases to implement these measures in multiple countries. Throughout 2017 we will be assessing our methodology and working with these partners to improve our approach.
Through the use of these measures, nations will be able to learn whether changes to reporting policies, use of novel disease reporting systems, or increased investments in disease surveillance impact the speed of outbreak detection, reporting, and response. Governments, NGOs, and philanthropies, working in partnership, will be able to better understand which investments have the biggest impact in the area of outbreak surveillance and can share this knowledge to ensure efficient use of limited resources. Ultimately, we hope to demonstrate that more timely performance results in reduced morbidity and mortality. We will continue to work with individual nations and regional networks to refine our approach and look forward to sharing our collective knowledge with the global health community.