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Keita M, Boland ST, Okeibunor J, Chamla D, Gueye AS, Moeti M. 10 years after the 2014-16 Ebola epidemic in west Africa: advances and challenges in African epidemic preparedness. Lancet 2024; 403:2573-2575. [PMID: 38527478 DOI: 10.1016/s0140-6736(24)00583-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 03/19/2024] [Indexed: 03/27/2024]
Affiliation(s)
- Mory Keita
- WHO Regional Office for Africa, Cité de Djoué, PO Box 06, Brazzaville, Congo
| | - Samuel T Boland
- WHO Regional Office for Africa, Cité de Djoué, PO Box 06, Brazzaville, Congo.
| | - Joseph Okeibunor
- WHO Regional Office for Africa, Cité de Djoué, PO Box 06, Brazzaville, Congo
| | - Dick Chamla
- WHO Regional Office for Africa, Cité de Djoué, PO Box 06, Brazzaville, Congo
| | - Abdou Salam Gueye
- WHO Regional Office for Africa, Cité de Djoué, PO Box 06, Brazzaville, Congo
| | - Matshidiso Moeti
- WHO Regional Office for Africa, Cité de Djoué, PO Box 06, Brazzaville, Congo
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Duran-Fernandez R, Bernal-Serrano D, Garcia-Huitron JA, Hutubessy R. Financing for pandemic preparedness and response measures: a systematic scoping review. Bull World Health Organ 2024; 102:314-322F. [PMID: 38680465 PMCID: PMC11046164 DOI: 10.2471/blt.23.290207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 12/07/2023] [Accepted: 01/25/2024] [Indexed: 05/01/2024] Open
Abstract
Objective To obtain insights into reducing the shortfall in financing for pandemic preparedness and response measures, and reducing the risk of another pandemic with social and economic costs comparable to those of the coronavirus disease. Methods We conducted a systematic scoping review using the databases ScienceDirect, Scopus, JSTOR, PubMed® and EconLit. We included articles published in any language until 1 August 2023, and excluded grey literature and publications on epidemics. We categorized eligible studies according to the elements of a framework proposed by the World Health Organization Council on the Economy of Health for All: (i) root/structural causes; (ii) social position/foundations; (iii) infrastructure and systems; and (iv) communities, households and individuals. Findings Of the 188 initially identified articles, we included 60 in our review. Most (53/60) were published after 2020, when academic interest had shifted towards global financing mechanisms. Most (37/60) addressed two or more of the council framework elements. The most frequently addressed element was infrastructure and systems (54/60), discussing topics such as health systems, financial markets and innovation ecosystems. The roots/structural causes were discussed in 25 articles; communities, households and individuals in 22 articles; and social positions/foundations in 11. Conclusion Our review identified three important gaps: a formal definition of pandemic preparedness and response, impeding the accurate quantification of the financing shortfall; research on the extent to which financing for pandemic preparedness and response has been targeted at the most vulnerable households; and an analysis of specific financial instruments and an evaluation of the feasibility of their implementation.
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Affiliation(s)
- Roberto Duran-Fernandez
- Tecnológico de Monterrey, Escuela de Gobierno y Transformación Pública, Eugenio Garza Lagüera y, Av. Rufino Tamayo, Valle Oriente, San Pedro Garza García 66269, Mexico
| | - Daniel Bernal-Serrano
- Tecnológico de Monterrey, Escuela de Gobierno y Transformación Pública, Eugenio Garza Lagüera y, Av. Rufino Tamayo, Valle Oriente, San Pedro Garza García 66269, Mexico
| | | | - Raymond Hutubessy
- Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
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Lee ACK, Iversen BG, Lynes S, Desenclos JC, Bezuidenhoudt JE, Flodgren GM, Pyone T. The state of integrated disease surveillance globally: synthesis report of a mixed methods study. Public Health 2024; 228:85-91. [PMID: 38340506 DOI: 10.1016/j.puhe.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 12/18/2023] [Accepted: 01/09/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVES Disease surveillance is an essential public health function needed to prevent, detect, monitor and respond to health threats. Integrated disease surveillance (IDS) enhances its utility and has been advocated for decades by the World Health Organization. This study sought to examine the state of IDS implementation worldwide. STUDY DESIGN The study used a concurrent mixed methods approach consisting of a systematic scoping review of the literature on IDS, a survey of International Association of National Public Health Institutes (IANPHI) members and qualitative deep dive case studies in seven countries. METHODS This report collates, analyses and synthesises the findings from the three components. The scoping review consisted of a review of summarised evidence on IDS. Eight reviews and five primary studies were included. The cross-sectional survey was conducted of 110 IANPHI members representing ninety-five countries. Qualitative case studies were conducted in Malawi, Mozambique, Uganda, Pakistan, Canada, Sweden, and England, which involved thirty-four focus group discussions and forty-eight key informant interviews. RESULTS In the different countries, IDS is conceptualised differently and there are differing levels of maturity of IDS functions. Although the role of National Public Health Institutes has not been well defined in the IDS, they play a significant role in IDS in many countries. Fragmentation between sectors and resourcing (human and financial) issues were common. Good governance measures such as appropriate legislative and regulatory frameworks and roles and responsibilities for IDS were often unclear. The COVID-19 pandemic has strengthened some surveillance systems, often through leveraging existing respiratory surveillance systems. In some instances, improvements were seen only for COVID-19 related data but these changes were not sustained. Evaluation of IDS was also reported to be weak. CONCLUSIONS Integration should be driven by a clear purpose and contextualised. Political commitment, clear governance, and resourcing are needed. Technology and the establishment of technical communities of practice may help. However, the complexity and cost of integration should not be under-estimated, and further economic and impact evaluations of IDS are needed.
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Affiliation(s)
- Andrew C K Lee
- The UK Health Security Agency, UK; The University of Sheffield, Sheffield, UK.
| | | | - Sadaf Lynes
- International Association of National Public Health Institutes, Belgium
| | - Jean-Claude Desenclos
- the University of Sheffield, Sheffield, UK; The University of Sheffield, Sheffield, UK
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Martin R, Maleche A, Gay J, Fatima H. Lessons learnt from COVID-19 to reduce mortality and morbidity in the Global South: addressing global vaccine equity for future pandemics. BMJ Glob Health 2024; 9:e013680. [PMID: 38167259 PMCID: PMC10773420 DOI: 10.1136/bmjgh-2023-013680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 11/06/2023] [Indexed: 01/05/2024] Open
Abstract
COVID-19, which killed more than 6 million people, will not be the last pandemic. Vaccines are key to preventing and ending pandemics. Therefore, it is critical to move now, before the next pandemic, towards global vaccine equity with shared goals, intermediate steps and long-term advocacy goals. Scientific integrity, ethical development, transparency, accountability and communication are critical. Countries can draw on lessons learnt from their response to the HIV pandemics, which has been at the vanguard of ensuring equitable access to rights-based services, to create shared goals and engage communities to increase access to and delivery of safe, quality vaccines. Access can be increased by: fostering the spread of mRNA intellectual property (IP) rights, with mRNA vaccine manufacturing on more continents; creating price transparency for vaccines; creating easily understandable, accessible and transparent data on vaccines; creating demand for a new international legal framework that allows IP rights to be waived quickly once a global pandemic is identified; and drawing on scientific expertise from around the world. Delivery can be improved by: creating strong public health systems that can deliver vaccines through the lifespan; creating or strengthening national regulatory agencies and independent national scientific advisory committees for vaccines; disseminating information from reliable, transparent national and subnational surveillance systems; improving global understanding that as more scientific data become available, this may result in changes to public health guidance; prioritising access to vaccines based on scientific criteria during an epidemic; and developing strategies to vaccinate those at highest risk with available vaccines.
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Affiliation(s)
- Rebecca Martin
- Global Health Institute, Emory University, Atlanta, Georgia, USA
| | - Allan Maleche
- Kenya Legal & Ethical Issues Network on HIV and AIDS (KELIN), Nairobi, Kenya
| | - Jill Gay
- Global Health Institute, Emory University, Atlanta, Georgia, USA
- J Gay Associates, Takoma Park, Maryland, USA
| | - Haram Fatima
- Global Health Institute, Emory University, Atlanta, Georgia, USA
- Georgia State University, Atlanta, Georgia, USA
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Jamil B, Nair D, Thekkur P, Laeeq N, Adil A, Khogali M, Zachariah R, Dar Berger S, Satyanarayana S, Kumar AMV, Bochner A, McClelland A, Fatima R, Harries AD. Feasibility, enablers and challenges of using timeliness metrics for household contact tracing and TB preventive therapy in Pakistan. PLoS One 2023; 18:e0295580. [PMID: 38079438 PMCID: PMC10712885 DOI: 10.1371/journal.pone.0295580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 11/23/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Screening household contacts of TB patients and providing TB preventive therapy (TPT) is a key intervention to end the TB epidemic. Global and timely implementation of TPT in household contacts, however, is dismal. We adapted the 7-1-7 timeliness metric designed to evaluate and respond to infectious disease outbreaks or pandemics, and assessed the feasibility, enablers and challenges of implementing this metric for screening and management of household contacts of index patients with bacteriologically-confirmed pulmonary TB in Karachi city, Pakistan. METHODS We conducted an explanatory mixed methods study with a quantitative component (cohort design) followed by a qualitative component (descriptive design with focus group discussions). RESULTS From January-June 2023, 92% of 450 index patients had their household contacts line-listed within seven days of initiating anti-TB treatment ("first 7"). In 84% of 1342 household contacts, screening outcomes were ascertained within one day of line-listing ("next 1"). In 35% of 256 household contacts eligible for further evaluation by a medical officer (aged ≤5 years or with chest symptoms), anti-tuberculosis treatment, TPT or a decision for no drugs was made within seven days of symptom screening ("second 7"). The principal reason for not starting anti-tuberculosis treatment or TPT was failure to consult a medical officer: only 129(50%) of 256 contacts consulted a medical officer. Reasons for poor performance in the "second 7" component included travel costs to see a medical officer, loss of daily earnings and fear of a TB diagnosis. Field staff reported that timeliness metrics motivated them to take prompt action in household contact screening and TPT provision and they suggested these be included in national guidelines. CONCLUSIONS Field staff found "7-1-7" timeliness metrics to be feasible and useful. Integration of these metrics into national guidelines could improve timeliness of diagnosis, treatment and prevention of TB within households of index patients.
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Affiliation(s)
- Bushra Jamil
- Department of Medicine, Aga Khan University, Karachi, Sindh, Pakistan
| | - Divya Nair
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| | - Pruthu Thekkur
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| | - Neelofar Laeeq
- Department of Medicine, Aga Khan University, Karachi, Sindh, Pakistan
| | - Anum Adil
- Department of Medicine, Aga Khan University, Karachi, Sindh, Pakistan
| | - Mohammed Khogali
- Institute of Public Health (IPH), College of Medicine and Health Sciences (CMHS), United Arab Emirates University (UAEU), Al Ain, United Arab Emirates
| | - Rony Zachariah
- United Nations Children Fund, United Nations Development Programme, World Bank, World Health Organization, Special Programme for Research and Training in Tropical Diseases (TDR), WHO, Geneva, Switzerland
| | - Selma Dar Berger
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| | - Srinath Satyanarayana
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
- The Union South-East Asia Office, New Delhi, India
| | - Ajay M. V. Kumar
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
- The Union South-East Asia Office, New Delhi, India
- Department of Community Medicine, Yenepoya Medical College, Yenepoya (Deemed to be University), University Road, Deralakatte, Mangalore, India
| | - Aaron Bochner
- Resolve to Save Lives, New York City, New York, United States of America
| | - Amanda McClelland
- Resolve to Save Lives, New York City, New York, United States of America
| | - Razia Fatima
- Common Management Unit (TB, HIV/AIDS & Malaria), Islamabad, Pakistan
| | - Anthony D. Harries
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Chawla M, Schmunis R, Zindel M. Strategic prioritisation: Three principles for an affordable and essential preparedness package. J Glob Health 2023; 13:03052. [PMID: 37883201 PMCID: PMC10602203 DOI: 10.7189/jogh.13.03052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023] Open
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Meena P, Abdellatif D, Tiwari V, Chatterjee S, Luyckx VA. Health Systems Preparedness for Infectious Disease Outbreaks: Relevance for Nephrology. Semin Nephrol 2023; 43:151465. [PMID: 38199828 DOI: 10.1016/j.semnephrol.2023.151465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
The coronavirus disease (COVID-19) crisis glaringly highlighted the critical need to develop resilient health care systems that are better prepared for epidemics. Millions of people died from COVID-19 itself, but almost three times as many died from health system disruptions. People living with kidney disease are highly vulnerable during outbreaks and pandemics and their needs must be included in preparedness planning. Health systems preparedness requires not only early identification and containment of outbreaks and maintenance of critical services during crises, but also bolstering population resilience and ensuring the safety of both health personnel and patients. Planning for surge capacity in an outbreak must include provision for both acute and chronic dialysis, and ensure access to medications for people with kidney diseases. Quality of care should not be compromised and must be monitored and improved where necessary. Technology, such as telemedicine, can support quality and continuity of care and minimize infection risks. Communication at all levels is crucial to ensure all stakeholders, including communities, have the necessary information to support cooperation and collaboration in effective outbreak responses. Research is important during and after pandemics to improve knowledge and build resilience at all levels, from outbreak detection to the development of therapeutics and optimizing equity in access to interventions. Only with adequate preparation and more resilient health systems can we hope, as a global community, to build on the harsh lessons learned during COVID-19, and improve the response to the next infectious disease outbreak, epidemic, or even pandemic.
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Affiliation(s)
- Priti Meena
- Department of Nephrology, All India Institute of Medical Sciences, Bhubaneswar, India
| | | | - Vaibhav Tiwari
- Institute of Renal Sciences, Sir Ganga Ram Hospital, New Delhi, India
| | | | - Valerie A Luyckx
- Department of Public and Global Health, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland; Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa.
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Ongarello S, Bausch DG, Hannay E, Bright RA. Current testing systems are a barrier to achieving the 7-1-7 target for detection, notification, and response to public health threats. Lancet Glob Health 2023; 11:e1340. [PMID: 37591580 DOI: 10.1016/s2214-109x(23)00306-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 06/21/2023] [Indexed: 08/19/2023]
Affiliation(s)
| | | | - Emma Hannay
- FIND, Campus Biotech, Geneva 1202, Switzerland
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