The COVID-19 pandemic exposed significant weaknesses in how governments and the medical community handle infectious diseases, including viruses. It also identified opportunities to strengthen health systems to address future outbreaks of infectious diseases. For decades, FHI 360 has been deeply involved in efforts to strengthen health systems, knowing the essential role in delivering promising public health outcomes.
Our work to strengthen laboratory and health systems featured prominently in our early response to HIV. This commitment continues today through the FHI 360 Emerging Infectious Diseases and Health Security (EIDHS) division’s response to outbreaks such as Ebola, avian flu, H1N1, Dengue fever, Zika and more recently COVID-19. We recognize that laboratory systems are crucial in detecting both known and new diseases.
“Prevent, detect and respond” is an approach promoted by the Global Health Security Agenda, a multisectoral collaborative effort launched in 2014 in response to the West Africa Ebola epidemic. Our disease-fighting activities are organized around this framework.
Prevent. Antimicrobial resistance (AMR) is often at the center of the global disease prevention conversation. AMR — when antibiotics will not work because the bacteria are resistant to them — is a problem that already claims about 700,000 lives each year, according to the World Health Organization (WHO). Many things can cause this resistance, like over-prescription. New research shows that many COVID-19 patients are being overprescribed antibiotics, potentially worsening our AMR problem.
Overuse of antibiotics can especially be a problem in low- and middle-income countries, due to the scarcity of laboratory resources, limited diagnostic tests, low awareness of the problems of antibiotic overuse, inadequate farming practices and other factors.
Our work in Nepal and Vietnam and other countries, through the Fleming Fund (a United Kingdom aid program that fights AMR), aims to strengthen the tracking of antibiotic-resistant bacteria. We partner with local organizations to develop and implement national AMR plans and with public officials to ensure that AMR data is reported in the Global Antimicrobial Resistance Surveillance System (GLASS), a WHO initiative tracking this resistance.
Three laboratories in Vietnam earned the official designation of National Reference Laboratories, which are laboratories known to track resistance. Our teams also provided assessments and improvement plans for 19 other human-health laboratories and three animal-health laboratories, as well as developed national protocols for AMR surveillance in poultry.
Detect. Laboratories must have the ability to detect resistant pathogens. But too often in resource-limited settings, laboratory staff have limited skills and resources to be able to do this.
Our teams noted in 2019 in Vietnam that only nine of the country’s 19 AMR clinical laboratories participated in routine AMR-related training programs for staff. Thereafter, through the Fleming Fund, we led efforts to design and implement an AMR training program. Nearly 240 people from both Vietnam and Nepal participated.
Respond. At the beginning of the COVID-19 pandemic, many countries did not have the resources to meet testing demand. International donors and agencies rapidly worked to get resources where they were needed most. The USAID Infectious Disease Detection and Surveillance (IDDS) project, in which FHI 360 is a core consortium partner, set out to address the inability to get testing specimens to the laboratory. Our teams developed a specimen and transportation collection model tailored to countries’ individual needs. Other improvements identified by laboratory professionals included a need to create biosafety and testing curriculum; provide training in COVID-19 testing; and purchase equipment, testing reagents and other necessary laboratory supplies.
Results were dramatic. In the Philippines, the number of collected laboratory specimens grew from 55 to 214 per day. Before our intervention, specimens took three days to get to the laboratories. Our specimen collection model reduced that time to about one day. Polymerase chain reaction (PCR) COVID-19 testing, the more sophisticated method for detecting the presence of the virus, increased from 350 to 1,500 per day. Our staff trained more than 600 health care workers in the Philippines in specimen collection and helped increase the number of facilities collecting specimens from 29 to 100.
Health system improvements achieved during COVID-19 better prepare us for the next major global health crisis. Our teams are ready to uncover new ways to unite the global community in the fight against infectious diseases.
