Janet Robinson, portfolio director of FHI 360’s Emerging Infectious Diseases and Health Security (EIDHS) group, speaks about a now-familiar type of humanitarian crisis: infectious disease outbreaks.
What is the broad framework in which you and others in the global health community are thinking about global health security?
There are three primary objectives of global health security: (1) We want to prevent an infectious disease outbreak; (2) if it happens, we want to detect it; and (3) if we detect it, we want to rapidly respond. We work to fortify our systems — to improve the ability of laboratories to diagnose diseases and to ensure that rapid reporting systems alert us when an outbreak starts — so that when an outbreak like monkeypox occurs, we can respond quickly and effectively.
The reality is that the world will always face the emergence and reemergence of new and existing pathogens. At FHI 360, we view our investment in global health security as critical to the health and well-being of communities, countries and the planet.
We have spent the last 2 1/2 years living with COVID-19, and while we continue to fight it, we are now facing a new infectious disease outbreak: monkeypox. What should we do differently to be ready for new epidemics going forward?
Since the mid-’90s, each time there is an outbreak, the global community rushes in to deal with the immediate crisis. Once it is over, the capacity for responding is often not sustained. Now is the time when we must sustain capacities. We need to localize the development so that countries can have the capacity to respond to outbreaks without needing to wait for the World Health Organization (WHO), the U.S. Centers for Disease Control and Prevention (CDC) and other agencies to rush in.
Each country has different needs because they have different challenges. We have demonstrated that if you give countries resources and knowledge by working with them locally, you leave some sustainable capacity for the next outbreak.
How do low- or middle-income countries tend to fare when it comes to global health security?
Already, the countries that are least able to cope with difficulties are the ones that have the least access to rapid, timely and quality services.
You only have to look at the COVID-19 vaccination rates in North America and Europe versus those in Africa. There is much more access to COVID-19 vaccines in the countries that are manufacturing many of them. The same is also true of diagnostics, although to a lesser extent. One obvious solution, which is becoming more widespread, is to build capacity to develop and manufacture these supplies locally, which ensures better and more affordable access while building local economies.
Could you provide an example of a project in which FHI 360 is working to build a country’s local capacity for handling infectious disease outbreaks?
In Nigeria, we are working on a project called Enhancing Global Health Security (EGHS), funded by the U.S. CDC, which aims to build the country’s ability to respond to global health security crises both locally and regionally. We are working with the CDC office in Nigeria, specifically their Regional Centre for Surveillance and Disease Control (RCSDC), to understand what capacities are lacking (such as people, skills or infrastructure) and then strengthen those pillars.
Specifically, we helped the RCSDC strengthen their communication systems and set up an operations center that coordinates the resources needed when outbreaks occur. To improve disease detection and control along Nigerian borders, we assisted the RCSDC with developing points-of-entry procedures and systems. This is how we take a systems-wide approach to building local, sustainable capacity.
A nurse in the Democratic Republic of the Congo was selected by a leader in her community to take part in safe and dignified burial training in early 2021 for bodies of people who died from Ebola. Photo credit: Carly Madison Underwood for FHI 360
How are outbreaks of infectious disease affected by other humanitarian crises?
A war or humanitarian crisis can lead to an increased risk of infectious disease outbreaks. People fleeing from a crisis, such as that in Ukraine, may take refuge in crowded displacement camps, where infectious diseases can quickly spread. In conflict situations, health facilities may be destroyed, meaning that infectious diseases may go undetected or untreated.
However, when these outbreaks do happen, part of the global response is humanitarian aid workers coming to cope with the crisis. Unfortunately, we have seen with Ebola and COVID-19 that it is often the frontline health workers who are first to get infected.
In a humanitarian crisis, prevention, detection and response often fall on humanitarian organizations. How can they better prepare for this work, especially as we encounter another global health emergency?
Global health systems cannot cope with a new outbreak very easily. Many of our essential health services, particularly our preventive services, have not recovered from the COVID-19 pandemic. A new outbreak would be both a public health and humanitarian crisis.
Humanitarian organizations can better prepare by investing in key competencies needed to respond to outbreaks, including surveillance and contact tracing, testing, case management, infection prevention and control, analytics and logistics — to name a few. They should also strengthen communication with local communities affected by crises and outbreaks.