The 9th TEPHINET Global Scientific Conference: Ending Pandemics in our Lifetime Initiative

From August 7th-11th, The Training Programs in Epidemiology and Public Health Interventions Network (TEPHINET) held its 9th Global Scientific Conference and the 23rd National Epidemiology Seminar in Chiang Mai, Thailand. I had the opportunity to listen to a panel presentation on Global Influenza Surveillance as well as the following presentation on Ending Pandemics. The overview I have provided below summarizes Mark Smolinski’s (Director of Global Health Threats at Skoll Global Threat Funds) presentation on innovations in surveillance for personal, national, and global health security. Feel free to listen to the entire presentation (1:17:00-2:16:28)!

  • Epi curves generally focus on human disease but human disease and animal outbreaks coincide or trigger one another. Additionally, bioterrorism can play a role in outbreaks and should be included in epi curves.
  • There are six main opportunities for epidemiologists/public health practitioners to intervene and reduce risk from pandemic threat:
    • Stop the threat in the animal population
    • Reduce the epi curve in the animal population
    • Find the first human cases (quickly)
    • Limit human infections and stop the epi curve in the animal population
    • Ensure strong surveillance/warning systems are in every country so disease doesn’t spread beyond country borders
    • Know and work directly with neighbors across borders so that regional security exists to stop any outbreak/prevent pandemics
  • It costs 3.4 billion dollars to prevent a pandemic by ensuring that developing countries have baseline capacity/public health systems that meet international standards. The return of investment is 10 fold. We are currently at ~450 million dollars.
  • Innovations in Surveillance – Researchers in tech as well as universities are involved in innovative surveillance methods, not necessarily epidemiologists/public health practitioners:
    • Google Flu Trends –predictive of flu and comparable to CDC flu reports (visits to providers), which were delayed by two weeks (80% of ill individuals did not visit a provider)
    • Twitter – University of Rochester developed an algorithm that can predict flu with 90% accuracy and gives an 8-day notice of when someone will get the flu (based off of tweets of others in your community/social circle)
    • HealthMap/Flu Near You – Participatory surveillance system that allows people to check off symptoms, see results on a map, and find where the closest vaccines are; correlates very well with the CDC influenza-like illness surveillance (over 5 years)
    • Epi Hacks – the idea is to bring together human, animal, and environmental health experts for one week to work with developers to come up with open source products for countries to use (for surveillance purposes); at least one has been conducted on each continent
    • PODD – uses a One Health approach as people in villages are tasked with helping find outbreaks quickly and reporting animal morbidity/mortality in real-time
    • KIDENGA – CDC and the University of Arizona are working together on vector-borne surveillance on the U.S/Mexico border, an epi hack will take place to see if they can create a sustainable way to address vector-borne diseases
    • Guardians of Health app – asked attendees to report health issues or symptoms during the World Cup, attendees received health information and program updates/information in return
    • EPICORE – retrospective analysis of public health information related to outbreaks; an automated system that epidemiologists follow-up on (after requests for information have been sent out)
  • When there are no outbreaks, public health gets no credit…
  • All countries cannot meet the International Health Regulations, even if they agree that they SHOULD be met
  • Skoll Global Threats Fund teamed up with Google and examined publicly available data at the World Health Organization (WHO) to determine how long it takes to detect, report, and respond to outbreaks; found that the global community is improving but has plateaued (due to limited data)
  • Research Paper – Finding Outbreaks Faster – Smolinski MS, Crawley AW, Olsen JM. Finding Outbreaks Faster. Health Security. 2017;15(2):215-220. doi:10.1089/hs.2016.0069.
    • There are epidemiologists in 28 countries looking at data from each outbreak to determine 6 metrics that all countries can follow (over past 5-10 years)
    • Countries had never looked closely at this issue and were able to see their strengths and weaknesses in investigating different types of outbreaks
    • Hot Spots of Emerging Infectious Disease – CORDS
      • Build friendship and trust across borders
      • Helps regional disease investigation networks share best practices, scale innovations, optimize informal networks
      • South Asia and West Africa are the most concerning for emerging infectious diseases, in a few years they may have stronger regional networks
  • Ending Pandemics Collective
    • 14 foundations and leaders of companies concerned about social responsibility want to invest in global health, share ideas, coordinate funding for projects, break down barriers in the foundation world
      • Smithsonian Museum of Natural History wants to do a 2-year exhibit called outbreaks, collectively a great chance to improve the knowledge base of people that visit the exhibit (~7 million people)
      • In 10 years the collective sees a world where:
        • Every outbreak is detected within 3 incubations periods of the index case or cluster
        • Every country’s Emergency Operations Center is utilizing an integrated, event-based detection system being used simultaneously by the WHO and G20
        • Human, animal, and environmental health volunteers are verifying rumors or suspected threats within 24 -48 hours through EpiCore
        • Participatory surveillance is engaging communities directly to detect and respond to outbreaks in every disease hotspot across the globe
        • Field epidemiologists in every country are using the latest technology to detect, verify, and respond to outbreaks faster
  • At the end of the day, pandemics can be prevented because “no community is too hard to reach, no community is too poor to innovate, and curiosity outshines fear!” 

     

Global News Round Up

Politics & Policies

The Senate Republican bill to repeal the Affordable Care Act might have failed, but threats to health coverage continue. Despite the Senate’s plans for bipartisan hearings in September on ways to improve the individual insurance market, President Trump has created uncertainty over whether the government will continue providing subsidies that help hard-working American families afford coverage.

Programs, Grants & Awards

The National Institutes of Health has renewed its support for University of Washington (UW) as a leader in developing the next generation of physicians, veterinarians, dentists, and scientists, trained in global health with a $4.5 million grant to extend the Northern Pacific Fogarty Global Health Fellows (NPGH) training program for the next five years (2017–2022).

The U.S. Senate on Thursday confirmed former congressman Mark Green as President Donald Trump’s choice to lead the U.S. Agency for International Development at a time the administration is proposing cuts in foreign aid and a reorganization of the agency.

The 3rd Coordination Conference for the Zoonotic Diseases Action Package (ZDAP) will be held in Da Nang, Vietnam on August 28-30.

Research

According to a series of new reports while number of deaths due to violence in the middle east grew by 850% between 1990 and 2015, incidence and death rates of chronic diseases also rose sharply.

While the utilization of rapid diagnostic tests for malaria resulted in a decrease in the number of prescriptions for artemisinin-based combination therapies, the number of antibiotics prescriptions increased.

Diseases & Disasters

Fifteen years after the declaration that leprosy has been eliminated, experts are now warning that every year, millions of new leprosy cases are going undiagnosed and untreated.

In response to the ongoing food crisis in East Africa, the U.S. Agency for International Development announced more than $169 million in funding on Thursday for humanitarian assistance in Ethiopia and Kenya. The majority of the funds — approximately $137 million — will go to Ethiopia.

When cases of Ebola were detected in the Democratic Republic of the Congo in May, local officials moved swiftly and global resources were rushed to help them. By the time the World Health Organization (WHO) declared the outbreak over on July 2, only four people died, four more had survived the disease, and the outbreak had been contained in a remote region of the country.

The UK has pledged to donate £100m to a global bid to eradicate polio by 2020.

More than a million children already suffering from acute malnutrition are at risk from a cholera outbreak sweeping war-torn Yemen, charity Save the Children warned Wednesday.

Research suggests that the number of blind people across the world is set to triple within the next four decades.

Only six countries have taken steps to evaluate their abilities to withstand a global pandemic, according to a report sponsored by the World Bank.

Three additional human infections with novel influenza A viruses were detected in Ohio during week 31. Three persons, all attendees at the same agricultural fair, were infected with influenza A (H3N2) variant (H3N2v) viruses.

Technology

An inexpensive mobile device with wearable cuffs has been developed by a team from ETH, Zürich shows promise for monitoring dehydration in kids.

The Pratt Pouch, a small ketchup packet-like pouch of antiretroviral drugs developed in 2008 that has saved thousands of lives in Ecuador, Zambia and Tanzania is now expanding to Uganda.

A new Whatsapp-based instant messaging tool has been developed by the “WHO and its partners to detect, verify and log the devastating consequences of such attacks“.

Environmental Health

There is an effort to eradicate the goat plague virus, a disease that costs “between $1.5 and $2 billion in losses annually to 330 million of the world’s poorest people.

A new large-scale review has mapped the spread and changes in the range of spread of 100 infectious diseases due to climate change.

Monsanto produced and sold toxic chemicals known as Polychlorinated biphenyls (PCBs) years after it learned about the health and environmental hazards of PCBs.

Equity & Disparities

Troubling signs of racism in the healthcare system as new report shows evidence of Aboriginal women being coerced into tubal ligation in and around Saskatoon, Canada.

A new study analyses how distinctive traits of African cities and economies are increasing vulnerability and in many cases perpetuating poverty and marginalization.

Affordable housing versus green space has become a point of contention for London’s oldest allotment.

With already high unemployment rates, informal economy in sub-Saharan African countries will not be enough to handle the projected workforce expansion in Africa.

Maternal, Neonatal & Children’s Health

Gestational diabetes rate in India is at 26.3%, the highest in the world and it poses a significant risk to the health of the mother and the fetus.

Young women in their late teens or early twenties in Kashmir are being diagnosed with Polycystic Ovarian Syndrome. Experts believe that Kashmiri women are genetically predisposed but early detection can help with treatment.

After decades of shortages of trained people to help in deliveries, the role of midwives has been growing in recent years in Bolivia, which joined international efforts to improve the skills of midwives and bring them into closer contact with the medical community.

There is debate whether the focus on skilled birth attendants (a measure of progress in the Sustainable Development Goals) is distracting countries with high maternal mortality rates from fundamental health systems reforms.

CUGH Webinar, Global Health at the Centers for Disease Control and Prevention, Now Available

CUGH recently hosted a webinar on Tuesday, August 8, 2017 entitled Global Health at the Centers for Disease Control and Prevention. The recording and slides are now available:

About the Webinar:

Disease knows no borders. CDC’s global activities protect Americans from major health threats such as Ebola, Zika, and pandemic influenza and adverse economic impact. CDC detects and controls outbreaks at their source, saving lives and reducing healthcare costs. As importantly, CDC helps other countries build capacity to prevent, detect, and respond to health threats through its work. The knowledge and lessons learned from CDC’s work abroad are critical to our public health efforts at home, and to protecting Americans.

CDC works in more than 60 countries, working with ministries of health, the World Health Organization (WHO) and many other partners on the front lines where outbreaks may occur. It addresses global health crises that can extend beyond the health sector to contribute to creating more stable societies, including the growing burden of non-communicable diseases.

Join Dr. Hamid Jafari, CDC Center for Global Health Principal Deputy Director, as he walks us through the structure and activities of CDC’s global health center in the United States and abroad.

APHA Climate Changes Health, Pre-Conference Summit, November 4

Climate Changes Health: Ensuring Environmental Justice Underlies Public Health’s Climate Change Work
A Pre-Conference Summit of the APHA Environment Section
November 4, 2017
9am-5pm
Spelman College
Atlanta, GA
This event is free, but space is limited. Registration is required.

This pre-conference workshop is an opportunity for approximately 100 leading EJ leaders and public health practitioners, scholars, and students to advance work towards climate justice. The day will include: 1) storytelling from environmental justice (EJ) leaders about lessons learned in their climate change work, 2) lightning talks to share data, tools, approaches, and resources, 3) facilitated roundtable networking to inform local climate planning efforts in ways that prioritize EJ issues, and 4) a reception and poster session to end the day.

– If you are also interested in presenting a lightning talk or poster, please see additional details and complete this call for presentations here: https://docs.google.com/forms/d/e/1FAIpQLSctZ65klGc9iVegfLIUtQ7chBkF3ZWSbhFXYUBoD_YXuwvRNA/viewform?usp=sf_link

– We have funding for six $500 scholarships for students from backgrounds that are historically disadvantaged or underrepresented in college. If you are interested in attending the pre-conference summit and APHA’s annual meeting with this support, please see additional details and apply here: https://docs.google.com/forms/d/e/1FAIpQLSePaBZUd6IhLIWYk5tZ-QaY8QGcgv_woC7YwoFf5M5Wo71vcA/viewform?usp=sf_link

This event is possible due to the generous support of the Graham Sustainability Institute at the University of Michigan and the Turner Foundation.

Improving LGBT Health Education in South Africa: Addressing the Gap

I first became interested in the topic of lesbian, gay, bisexual, and transgender (LGBT) health care and health education while working as a country lead for the Presidential Emergency Plan for AIDS Relief (PEPFAR). During my time there I had the opportunity to travel to South Africa and understand their community and health care system a bit better, with an emphasis on their HIV/AIDS epidemic. This post focuses on the LGBT history in South Africa, recent developments, addressing that there is a gap between homophobia and non-judgmental care, and the importance of health care workers understanding LGBT health education.

More and more countries around the world are opening their arms to welcome and embrace LGBT pride. South Africa has one of the world’s more progressive constitutions which legally protects LGBT people from discrimination, although current research indicates that they continue to face discrimination and homophobia in many different facets of life. The most recent milestone occurred in 2006 when the country passed a law to recognize same-sex marriages. Nevertheless, LGBT South Africans particularly those outside of the major cities, continue to face some challenges including conservative attitudes, violence, and high rates of disease. As the country continues to grow there seems to be an increase in LGBT representation (with approximately 4,900,000 people identifying as LGBT) whether it is through activism, tourism, the media and society or support from religious groups. So, what about LGBT health education? Continue reading “Improving LGBT Health Education in South Africa: Addressing the Gap”