Preventing all the infectious diseases that threaten global health security from happening is ideal, but impractical. Therefore, the next best action would be optimizing our methods to detect and respond to these threats. In the Centers for Disease Control and Prevention (CDC) Emerging Infectious Disease journal, investigators have written several articles focused on these 2 components, that, if done poorly, can truly hinder or hasten an outbreak.
Detection is the first step to health security. When prevention efforts fail, it is critical that laboratory and surveillance systems pick up cases in a timely and accurate manner. The first component to detection is within the laboratory setting. In the United States, we are fortunate to have a well-supported laboratory infrastructure and national reporting system. The tricky part about laboratory efforts is that it’s not enough to have the equipment and personnel; biosafety and biosecurity efforts also need to be in place. Ensuring laboratory workers are handling organisms safely and that there are appropriate security measures within the lab to prevent nefarious actors from gaining access, are all imperative to these detection efforts.
Ogee-Nwankwo et al. recently assessed the national public health and reference laboratory framework in one country, Ghana, using a newly-created CDC lab assessment tool. “Results for the tool showed that the laboratory is well-organized, has a good capacity for handling specimens, has a good biosafety system, and is proficient for diagnosis of measles and rubella by serologic analysis,” the authors wrote. Unfortunately, they also found that there was limited knowledge of molecular biology and virology activities such as isolating a virus on a tissue culture, which highlighted the need to train lab personnel. Such assessments are necessary to help enhance the laboratory response network within countries.
Parker et al. looked to improve South Korea’s laboratory response network in this capacity. They came across several interesting findings, such as how leveraging technology for continuing education can be beneficial, and that supporting and facilitating partnerships within a national laboratory response network is vital. Overall, supporting laboratory network at a national level only serves to strengthen health security at a global level.
The second component to detection is surveillance, which relies heavily on epidemiology. Frontline field epidemiology response teams are a critical component to not only the early detection of an outbreak, but also for responding to it. The ability to perform contact-tracing has been a staple of epidemiology since John Snow first took the handle off the Broad Street pump, but it was immensely important during the 2014-2015 Ebola outbreak. The CDC maintains a field epidemiology training program for frontline epidemiologists (FETP-Frontline), which does training for 3 months and focuses on ministry of health staff across the world. In fact, since December 2016, they have trained 1354 individuals across 24 countries. Having field epidemiologists trained to rapidly respond to outbreaks is a significant tool in the health security toolbox. These surveillance efforts and the ability to deploy trained field epidemiologists are a cornerstone for detection and response efforts.
When an outbreak does occur though, an appropriate and rapid response is critical. If prevention efforts fail, and cases are detected, our response processes are up to bat. In the past, there have been times when the response has been late (ie, the 2014-2015 Ebola outbreak) and it’s often that the best-laid plans simply don’t work.
There are many components that go into outbreak response: public health emergency operations, rapid response teams, vaccination or mass prophylaxis distributions, infection prevention and control, etc. The 2014-2015 Ebola outbreak taught us a lot about what we could do better in health security and outbreak response. The CDC even established a Global Rapid Response Team that has a wide range of expertise that can be mobilized to help strengthen emergency response.
Response efforts often point to gaps within our plans, like the need to train staff on enhanced use of personal protective equipment during the Ebola outbreak, or cultural dynamics that challenge public health education efforts. Public health response is an evolving process and with each new challenge, lessons are learned and we hope that we can appropriately apply them in the future. The most important lesson is the global aspect of health security—an outbreak anywhere is an outbreak anywhere. Strengthening national prevention, detection, and response efforts will only serve to protect us all.
