GDIN Infectious Diseases Working Group Concept of Operation

Summary

The GDIN Working Group on Infectious Diseases recognizes the importance of global infectious disease surveillance and response in the interest of minimizing the impact of natural disasters on personal lives, national economy, and global security.

Changes in global ecology and climatology, human demographics and behavior, industry, international travel, pathogen adaptations, deterioration or loss of public health infrastructure, and decline in international support have contributed to global infectious disease incidence. As a result, emergence of new infectious agents and reemergence of previously contained infectious diseases have occurred.

Local, national, and regional outbreaks of infectious diseases can be considered 'disasters'. Biologic agents can not only have devastating effects on human morbidity and mortality but also national agricultural industries such as livestock and food crops.

Typically, outbreak response by the international community is grossly delayed. Due to scarcity and delays in reporting and global alerting, outbreak verification, decision by the international community to provide assistance, coordination, and implementation of response have resulted in team placements weeks to months after an outbreak is underway. Improvements are needed at multiple points in the chain of events that lead to efficient and cost-effective outbreak response.

GDIN's operational role as a Non-Governmental Organization (NGO), unique expertise in coordination of disaster response, and ability to provide information support will enable more efficient global infectious disease outbreak alerting, verification, and response.

GDIN Infectious Diseases Working Group Objectives

  1. Epidemic Intelligence: Global Alerting and Outbreak Verification
  2. Information Support
  3. Promotion of Connectivity

Epidemic Intelligence: Global Alerting and Outbreak Verification

Sources of epidemic intelligence can be considered in 3 categories (Heymann, DL and GR Rodier- Global Surveillance of Communicable Disease, JEID vol.4 no.3): 1) formal, 2) informal, and 3) legally mandated sources. Formal sources include government and academic institutions tasked with public health initiatives. Informal sources include media and Internet reporting systems. Legal mandates such as the International Health Regulations are closely tied to formal sources such as the World Health Organization.

Several global infectious disease surveillance systems exist for alerting purposes such as the Global Public Health Information Network (GPHIN) and ProMED. Each system has its own unique data capture mechanisms and reporting schemes. Gaps in data capture exist for all global systems currently in operation. With the addition of new reporting sources, global surveillance is enhanced through increased reporting sensitivity. GDIN's objective will be to address these gaps and provide greater global reporting sensitivity due to its unique capacity to utilize resources in the disaster response community.

Once an outbreak alert has been initiated, verification is needed to evaluate the need for international response. Verification is typically achieved through formal sources- in other words, government and academic institutions with expertise in infectious diseases. Occasionally, verification is provided through field personnel with appropriate experience. WHO currently utilizes the Outbreak Verification List (OVL) for use in selected infectious diseases of serious international concern. Limitations of this system have included reliance primarily upon outbreak reporting through official government channels, geographic emphasis (usually excludes Central and South America), and the restricted list of diseases addressed. Reliance upon government admission to outbreaks is a major limitation, as accurate reporting either is delayed significantly or never occurs. Outbreaks involving pathogens of international concern can smolder for months, increasing overall morbidity and mortality and the chance of extension of the pathogen to other countries by ground or air. Rapid containment and management then becomes compromised.

GDIN will operate as an NGO, and as such will able to utilize its unique input of epidemic intelligence and associated expertise free of political constraints. This will enable more flexible outbreak reporting and verification that does not rely upon established official mechanisms. Ultimately, this will enhance not only surveillance sensitivity but timely verification and credibility of reporting. Through GDIN's international community, the current geographic emphasis can be expanded and enable a broader list of diseases examined. Information regarding verification can be forwarded rapidly via the GDIN network to enable rapid communication between international partners and coordination of response efforts.

Information Support

Due to multiple data sources, information retrieval becomes cumbersome in the midst of a crisis situation. Rapid, easy data access has been and will continue to be a critical issue in disaster response.

The GDIN Working Group on Infectious Diseases will compile a readily accessible list of information and data pertaining to global infectious disease surveillance and response in the following categories:

  1. Epidemic intelligence
    • Indicators and Warnings
      • Medical climatology
        • Outbreak forecasting
        • Remotely sensed epidemic intelligence (RSEPI)
      • Refugee / Internally Displaced Persons (IDPs) concentrations
      • Presence of armed conflict
      • Loss of national public health infrastructure or precipitous failure of NGO function in-field
    • Alerting
    • Outbreak verification
  2. Ground support and logistics
    • Communications / connectivity
      • Assurance of proper communication capability in-field
      • In-field access to data and information
    • Local Points of Contact (POCs)
    • Catalog of NGO presence
    • Ground security (i.e., presence of armed conflict)
    • Demographics (i.e., locations and movement vectors)
    • Orienteering and tools for epidemiologic investigation
      • Remote sensing
      • Geographic Information System (GIS) databases
      • Models of outbreak propagation (i.e., anticipated geographic spread of an epidemic)
      • Climatology
        • Baseline climate patterns
        • Real time climate forecasting (e.g., anticipation or presence of excessive rainfall which can inhibit response team transport)
      • Updated mapping resources
        • Topography
        • Hydrology
        • Road access

        • - Anticipatory overlays indicating access during flood conditions
        • Airstrips

No readily accessible universal global infectious disease database currently exists. Likewise, no formal archiving of in-country POCs, ground security information, RS, GIS, climatologic, or mapping resources has been accomplished. GDIN will facilitate archiving and integration data by 1) epidemic intelligence and 2) ground support and logistics with the goal of efficient access for rapid retrieval in crisis scenarios. Data archived and integrated will be available for rapid, efficient access through the GDIN website. Medical term referencing in the form of an online thesaurus and search engine will further enhance access.

Promotion of connectivity

Unique expertise in disaster response, information sourcing, and connectivity are major strengths of the GDIN international community. GDIN will promote connectivity through the following mechanisms:

Facilitation of open communication

Crisis management requires open communication. GDIN will serve as a catalyst for enhanced communication between multiple agencies involved in disease surveillance and response.

One example of connectivity is response management using multi-media communications at the Alliance Center for Collaboration, Education, Science, and Software (ACCESS). In such an environment, multiple international participants can converse audio-visually with sub-windows devoted to image display. Remotely sensed imagery and GIS-generated maps of road access can be displayed for open discussion to enable more efficient, timely response.

Connectivity ultimately contributes to data capture, universal archiving, and access for more efficient disaster response. GDIN personnel will be available on an on-call basis 24 hours a day / 7 days a week for assistance in communication between agencies and ground personnel and the transfer of information needed in situation management.

Promotion of Innovation and Change

GDIN will enhance funding opportunities for proposals designed to enhance data capture, archiving, networking, and reporting. Many health ministries report high temporal and spatial resolution infectious disease data online. This is a major resource for determining areas of need and emergence of novel pathogens. GDIN will promote the assistance of technologically challenged national health ministries by funding efforts to enhance access to the Internet. GDIN will also promote innovative data mergers that ultimately enhance disaster response.

Members of the GDIN international community are leaders in the field of disaster response. GDIN will promote 'think tank' environments for innovation and forward-thinking planning. This approach will enable responding agencies to constantly adapt for more efficient, cost-effective response to international emergencies.

Conclusion

GDIN will function independently from official infectious disease reporting and verification systems. Its role will be the facilitator of more efficient, rapid, cost-effective response by the international community and individual governments through better communication and information support.