Early Insights

We started with the four phases of epidemic preparedness and response as defined by the Global Health Security Index project in 2019. Each phase—(1) prevent, (2) detect, (3) respond: contain, and (4) respond: treat—comprises its own set of key actions; at the same time, the four phases are inextricably linked, because success or failure in one phase determines the priorities for subsequent phases. In general, the shape of a country’s epidemic curve depends on its performance during each phase of its response.

As the COVID-19 pandemic continued, with multiple surges in cases and deaths in many countries, it became clearer than ever that the four phases are sequential but not linear: countries can move through them in either direction. As part of Exemplars’ ongoing work on COVID-19 response, we are elaborating a more explanatory conceptual framework that accounts for other contextual and systems factors and interventions, including public-health and other social measures. The new framework will help illustrate how these factors contribute to the outcomes we are using to define “success” in controlling the pandemic and mitigating against its indirect effects; it will also allow us to begin to quantify how much of these outcomes can be attributed to particular components of the framework.

Learning from past outbreaks and epidemics

While the effects of previous outbreaks of other diseases have not been nearly as extensive as those from the COVID-19 pandemic, we can learn relevant lessons from each of them—and from the countries that successfully controlled them. EGH and its partners worked to identify those lessons, along with the ways in which individual countries have applied them to truncate or mitigate the COVID-19 pandemic. For example, the reforms and measures South Korea and Vietnam implemented in response to the MERS and SARS epidemics respectively have served them well during the COVID-19 pandemic.

Partner Case Studies

Preventing Ebola in Uganda

A case study from the Makerere University School of Public Health and the Johns Hopkins Center for Health Security

The Kivu Ebola epidemic began on August 1, 2018, when four cases were confirmed in North Kivu Province in eastern Democratic Republic of the Congo (DRC). To date, the epidemic has led to over 3,400 confirmed and suspected cases in the DRC and over 2,200 deaths. Because there is frequent movement from North Kivu across the border into Uganda, including a regular influx of refugees, the Ugandan government and its partners put themselves on high alert and mobilized resources to prevent the importation of cases, detect imported disease quickly, contain the spread of imported disease, and treat sick people appropriately.

In June 2019 the virus reached Uganda, but only four imported cases have been reported as of May 2020 and no in-country transmission has occurred. Uganda has focused on preventing an outbreak and detecting cases. Prevention activities included assembling a multisectoral team and establishing robust coordinating mechanisms, running simulation exercises to assess the country’s readiness, and implementing a prophylactic vaccination effort among frontline workers and contacts of suspected cases. Detection activities included health communications and messaging and cross-border surveillance in collaboration with officials from the DRC.

These accomplishments, despite foundational challenges facing Uganda’s health system, prompted Makerere University School of Public Health and the Johns Hopkins Center for Health Security to conduct this study, based on an in-depth gray literature review and key informant interviews.

Surveillance Technology in Thailand, Cambodia, and Tanzania

A case study from Ending Pandemics

San Francisco-based nonprofit Ending Pandemics works with partners in lower-income countries using innovative methods to prevent, detect, and contain disease outbreaks. Its collaborations take a “One Health” approach, which starts from the evidence that because three in four emerging infectious diseases arise in animals before spreading to humans, detecting disease in animals faster can prevent outbreaks in humans. This approach enables early detection of and rapid response to outbreaks in human populations.

Working with local organizations, Ending Pandemics supports the development of technology-enabled surveillance systems that rely on community input. These systems include mobile applications in Tanzania and Thailand and a digital hotline in Cambodia. In both cases, Ending Pandemics and its partners hosted in-country EpiHacks (epidemiology hack-a-thons) to engage local software developers in the challenge of building efficient, robust surveillance systems. These sessions also generated buy-in from local health professionals, communities, and the private sector- generating early buy-in from the key stakeholders. As implementation partners continued fine-tuning the technology, they began recruiting community volunteers and raising citizen awareness to empower people to use the systems to the greatest effect.

Thailand’s Participatory One Health Disease Detection (PODD) project launched in 2015 and Cambodia’s 115 Hotline launched in 2016. Both systems have effectively reduced detection and response time and limited the spread of animal disease, clearly establishing that user-friendly technology alongside community mobilization can facilitate successful “bottom-up” disease surveillance.

The two systems have since been adapted to serve other public health purposes, including early warning of weather shocks and, more recently, COVID-19 surveillance. With continued support from Ending Pandemics and buy-in from other local governments, they are being extended and replicated in other countries. In Tanzania, a project built on the PODD experience and led by the SACIDS Foundation at Sokoine University of Agriculture is demonstrating promising early results.

Additional Resources

H1N1

SARS

MERS

Ebola

Our Collaborators