Culturing action: the new global health initiative for biosurveillance

Posted by () on Feb 25 2014
VERTIC Blog >> Verification and Monitoring
Russell Moul, London
On 13 February 2014, 26 countries met with the World Health Organization (WHO), the Food and Agriculture Organisation (FAO), and the World Organisation for Animal Health (OIE) in Washington, DC, to launch the new Global Health Security Agenda(GHS Agenda).
Over the next five years the US, other WHO member states and international organisations will assist at least 30 partner countries to fulfil the three principles of prevention, detection and response to disease outbreaks at the source of those outbreaks – be they naturally occurring or caused by the accidental or intentional release of dangerous pathogens.
The US Centers for Disease Control and Prevention (CDC) and the Defence Threat Reduction Agency hope to improve activities focused on threat detection and the mobilisation of effective responses to contain new outbreaks. As part of the GHS Agenda, they have allocated $40 million for the current fiscal year to projects in at least 10 countries, with an additional $45 million set to follow in the 2015 fiscal year.
Part of the impetus behind the initiative is the drive to help WHO member states to implement the International Health Regulations (IHR) that entered into force in 2007. These regulations are legally-binding and form a significant component of global public health security. They provide a framework for coordinating the management of events that may constitute a public health emergency of international concern. However, although all 194 WHO member states have adopted in principle the infectious disease measures outlined in the IHR, at least 80 per cent have not yet met the regulations’ capacity requirements for the prevention, detection and response to infectious disease events or bioterrorist attacks.
In order to address this, the GHS Agenda will require WHO member states to implement the three principles of the IHR at the state level through national legislation. For example, member states will be encouraged to strengthen their regulatory framework governing food safety in order to help prevent the emergence and spread of antimicrobial drug resistant organisms or emerging zoonotic diseases – that is, those that can spread between species. In addition, member states will need to accelerate their national methods for detecting new emerging threats and their ability to respond rapidly and effectively – which is crucial for coordinating public health responses.
In essence, there is little difference between public health responses for either naturally occurring outbreaks or those caused by bioterrorist activities: both begin with the recognition of the event by public health systems following the detection of an outbreak, what is referred to as biosurvelliance.
In general, a biosurveillance system can be understood as consisting of three elements: firstly, a clinical facility or other suitable location to identify and report effected or exposed individuals; secondly, epidemiologic capacity (that is, a means for studying the patterns, causes and effects of disease events, to identify additional cases and determine the source and mode of transmission); and thirdly, laboratories in order to identify the disease agent.
Under the GHS Agenda, states will be assisted in strengthening their own biosurveillance systems in order to contribute to a global network for real-time information sharing. This will include the training and deployment of field epidemiologists, as well as the development of new diagnostic tests and building of greater capacities for detecting emerging pathogens – while strengthening capabilities for reporting information to the WHO, OIE and FAO during emergencies.
The GHS Agenda marks an important and promising development in the global monitoring of infectious disease threats through enhanced biosurveillance networks. However, there are a number of challenges that face it. For example, there is currently little consensus over the types of data to be collected, what the source for this data should be, and what analytical techniques and technologies are most suitable, sensitive and specific for detecting bioterrorist attacks or related emerging diseases.
Furthermore, research has demonstrated that the ability to control the spread of a new pathogen is greatly dependent upon the rate of transmission that occurs before overt symptoms appear. As such, a strong biosurveillance system needs to be sensitive enough to detect infectious disease agents that have not led to a large number of diagnosed cases.
The consequence of potential disease outbreaks or bioterrorist attacks can be devastating. In 2003 the severe acute respiratory syndrome (SARS) caused over $30 billon in economic damages in only four months, while the 2009 H1N1 avian influenza pandemic claimed 284,000 lives in its first year alone. In addition to these naturally-occurring infections, concern for bioterrorism has been increasing since the Japanese millenarian cult, Aum Shinrikyo, attempted to weaponise botulinum toxin in 1995 while, in 2001, anthrax was used in a series of attacks in the US that infected 22 people and killed 5 others.
Now, within the last year alone two new diseases have emerged: the Middle East respiratory syndrome coronavirus (MERS-CoV) and a new avian influenza strain: the H7N9 virus. There is relatively limited information surrounding these new outbreaks due to their recent emergence. By assisting nations to improve their biosurveillance capacities, the GHS Agenda will help provide crucial information for helping the world respond to new infections like these. Without this information, however, decision makers, clinicians and public health officers are operating with little scientific evidence to lead them.

Last changed: May 09 2014 at 5:32 PM