FEATURE
True multi-sector partnerships must be built on mutual understanding and trust that each sector will contribute as it is best able to meet the collective need .
For a true One Health approach , all sectors need to have equally strong seats at the table , said Beth Skaggs , PhD , laboratory team lead of US CDC ’ s Division of Global Health Protection Thailand office . That can be a challenge when the sectors do not have the same capabilities and resources , setting up inequities that must constantly be addressed . Continuity of funding is a constant challenge . In the absence of a threat like the pandemic , funding for surveillance gets cut , Skaggs said .
“ We end up having to do patchwork approaches to sustain surveillance when things are calm — which is unfortunate , but that ’ s the reality ,” she said . Continuous , reliable funding for sustained surveillance efforts would go a long way toward easing imbalances . So would an established data system compatible across sectors and datasharing agreements that allow real-time analysis for decision making .
Data Modernization
Despite clear benefits to the global population when countries share surveillance data , such as through the
GISAID platform , data sharing is an ongoing challenge . Country-specific laws and concerns about data privacy and security can create barriers to transparency and openness , and there are often delays . For avian influenza surveillance work in Thailand , Prasarnphanich said , it took six months to a year to get the needed representatives from both public health and animal health sectors on board before establishing a platform for sharing information . That investment is key to building the foundational relationships , Prasarnphanich said . “ Once that platform [ and ] the trust is established , I think it ’ s easier to continue that kind of communication among different sectors .”
It ’ s well known , though , that infrastructure to support public health data collection — whether in support of surveillance , response or even research — is in dire need of updating and expansion .
Those needs have been exacerbated by the demands of COVID-19 , said Xenophon Santas , associate director of Informatics at US CDC ’ s
Center for Global Health . After years of advocacy work by the APHL and other partners , CDC ’ s
Data Modernization Initiative received a large infusion of funding through the CARES Act and the American Rescue Plan to update public health data infrastructure and processes throughout the US . In recognition that other countries face similar challenges , the American Rescue Plan included $ 140 million over three years for a project that will expand similar efforts globally .
Now , Santas said , there is an opportunity to assist global partners to modernize and strengthen their data infrastructure and data governance to better enable data collection and sharing . “ The world benefits by having better ways of sharing data in order to be able to detect [ and ] respond to emerging health threats .”
The CDC-led and APHL-supported project adopts a two-pronged strategy : focus on solutions that can demonstrate immediate impact and serve as proof-ofconcept for one or more countries , while simultaneously working on longer-term governance initiatives to ensure sustained and continued use of modernized systems and approaches . Multiple components will address data automation to streamline electronic capture of laboratory results internally within a testing laboratory and external reporting from a testing laboratory to relevant public health systems and stakeholders , electronic laboratory reporting , and data analytics for rapid and informed decision making .
APHL will help each host country government define a locally appropriate system architecture for consolidating data and systems . Importantly , the project will also draw on lessons learned from the US Data Modernization Initiative to address concerns around cloud hosting of laboratory data . These issues include the use of cloud infrastructure and shared services , required governance , and legal and policy development to protect data ownership , storage and sharing . Additional components will target workforce strengthening and coordination and communication , with efforts made to adapt progress from the US Data
Modernization Initiative . These efforts are underway in 10 countries : three in Asia , four in Africa and three in Latin America .
“ Data infrastructure needs to be thought of as a consolidated activity , not a one-off , so that we ’ re not reinventing the wheel every time we have a new public health threat ,” Santas said . An effective information management system should be in place before it ’ s needed . “ Prior to the current modernization efforts , it could take longer to design and stand up a system than it would for an outbreak to mature and peak and be finished .”
Preparing for the Future
Ultimately , the global community is interconnected , and now is the time to build strong structures and partnerships to sustain that community through whatever is coming next . “ You cannot spend much time building your capacity during wartime . During war , you go with whatever tools that you have ,” Kebede said . “ We need to do a lot of investment during normal time .”
That also means shaping preparedness efforts around the priorities that should be reflected during active outbreaks . Prasarnphanich ’ s vision is to formalize One Health within the structure of organizations and integrate interagency coordination as part of the routine work of each : “ To make One Health not just an approach , but more of the culture ,” she said .
Asked what a successful surveillance program would look like , Cognat emphasized real-time information sharing in support of decision making , with mutual trust across sectors . It ’ s also essential , he said , to ensure that the people and systems who are providing the data receive equitable benefit from the vaccines , therapeutics and knowledge that emerge from that data .
“ At the moment , we can ’ t tell what will come next . Robust surveillance activities will be a key tool to identify potential future pandemics and elicit public health response in very good time ,” Otieno said . “ There have been a lot of lessons learned from COVID-19 , and we should not make a repeat of those same mistakes .” g