Global Outbreak Alert Research Articles

Training for outbreak response through the Global Outbreak Alert and Response Network

Abstract The WHO designated the Information Centre for International Health Protection (INIG/ZIG 1) at the Robert Koch Institute as the first WHO Collaborating Centre for Global Outbreak Alert and Response (WHO CC GOARN). Its mandate is to aid WHO’s efforts in improving the detection of public health events and enhancing preparedness, readiness, and capabilities for alerts and rapid responses. The main focus of WHO CC GOARN at RKI include supporting WHO in the development and implementation of the GOARN training programme on international outbreak alert and response, as well as facilitating knowledge exchange and information dissemination. GOARN’s extensive engagement in international public health response underscores the need to complement technical expertise with human-centred competencies like effective communication and teamwork, while respecting diversity. On 18 -22 September 2023, WHO CC GOARN at RKI hosted the first “GOARN Outbreak Response Leadership Training Programme”, inviting 24 public health leaders plus highly experienced mentors from all WHO. The training was designed to enhance leadership mind-sets and practices, including advanced interpersonal and situational awareness, managing polarised tension, establishing trusted relationships with stakeholders, and influencing collective decision-making. Alongside expert facilitators and experienced mentors from various fields, participants engaged in open discussion, shared experiences and reflected on lessons from the COVID-19 pandemic and other recent outbreaks. This course provided an opportunity to engage with diverse, experienced and highly regarded leaders, sharing their views and personal experiences on what it means to practise leadership in health emergency response. This training also aimed to build a network of diverse, well-trained and interconnected public health leaders, upholding the principles of diversity, equity and inclusion to ensure that our response efforts resonate with the communities we serve.

One response: Global Outbreak Alert and Response Network supporting the COVID-19 response, Kiribati.

In January 2022, Kiribati experienced widespread community transmission of COVID-19, leading to high rates of infection among health-care workers (HCWs), which reduced essential HCWs during a period of increased hospital admissions. Kiribati, a Pacific island country made up of a remote group of 33 low-lying atolls in the Pacific Ocean, experienced its first surge of COVID-19 cases beginning on 24 January 2022. Reports of increasing numbers of COVID-19 cases in South Tarawa prompted the Kiribati Ministry of Health and Medical Services to request assistance from the international community, including the World Health Organization's Global Outbreak Alert and Response Network (GOARN), to support national COVID-19 response operations. Specialists in infection prevention and control (IPC) were deployed to Kiribati in February 2022 to assist the Ministry's National COVID-19 Taskforce in collaboration with national partners. These specialists helped review and strengthen IPC capacities to accommodate a potential patient surge and consequent demands for medical consumables in health-care facilities in South Tarawa. Strengthened knowledge about and processes for IPC among HCWs prevented health care-associated infections and reduced community disease transmission during the first surge of COVID-19 cases in Kiribati. GOARN has the capacity and ability to rapidly deploy experts to support requests for assistance. Outbreak response activities can be enhanced and sustained by using GOARN's resources and collaborating with all partners, as necessary.

Global Outbreak Alert and Response Network deployments during the COVID-19 pandemic, WHO Western Pacific Region.

The Global Outbreak Alert and Response Network (GOARN) has responded to more than 100 outbreaks during the past 23 years. The coronavirus disease (COVID-19) pandemic presented unprecedented operational constraints that challenged GOARN's core mission to rapidly deploy technical experts from its partners to support national in-country responses to public health emergencies. This paper describes the type and duration of GOARN deployments to and within the World Health Organization's (WHO's) Western Pacific Region during the COVID-19 pandemic. Despite strict border closures and ever-changing vaccination and quarantine requirements, GOARN continued to deploy international technical assistance to strengthen COVID-19 response operations within the Region, as requested. Data were analysed from the GOARN Knowledge Platform about deployments to and within the Region for responses to the COVID-19 pandemic between 1 January 2020 and 5 May 2023. Data were available about deployment duration, technical role requested, country or area, partner organization and deployed expert's demographics. Feedback from postdeployment briefings with the experts was collected and thematically analysed to determine ongoing needs and gaps to help improve deployment operations. There were 72 experts deployed on 89 missions through GOARN to 12 countries and areas in the Region, for a total of 4558 field days, to support the response to the COVID-19 pandemic. The volume of requests for assistance from countries and areas in the Region to respond to the COVID-19 pandemic uncovered a deficit in human resources available for domestic response to outbreaks and the reliance on international assistance. Strengthening the in-country capacity of ready-to-respond public health emergency staff is critical to meet the needs for outbreak response. The ongoing demand for technical experts to support national responses means that these lessons may have immediate implications.

Outbreak response capacity of the Global Outbreak Alert and Response Network across WHO's South-East Asia and Western Pacific regions.

The COVID-19 pandemic challenged the Global Outbreak Alert and Response Network's (GOARN) mechanism used to rapidly deploy technical support for international responses and highlighted areas that require strengthened capacity within the Network. GOARN's partners in the World Health Organization's (WHO) South-East Asia and Western Pacific regions were engaged to explore their levels of preparedness, readiness and ability to respond to international public health emergencies. Consultative discussions were held and a survey was conducted with GOARN's partners from the two WHO regions. Discussion topics included partners' capacity to support and participate in a GOARN deployment, training, research and collaboration. Descriptive and content analyses were conducted. Barriers to engaging in GOARN's international outbreak response efforts included limited numbers of personnel trained to respond to outbreaks; institutional, financial and administrative hurdles; and limited collaboration opportunities. Partners identified innovative solutions that could strengthen their engagement with deployment, such as financial subsidies, mentorship for less experienced staff, and the ability to provide remote support. GOARN plays an important role in enabling WHO to fulfil its international alert and response duties during disease outbreaks and humanitarian crises that have the potential to spark disease outbreaks. Yet without systematic improvement to strengthen national outbreak capacity and regional connectedness, support for international outbreak responses may remain limited. Thus, it is necessary to integrate novel approaches to support international deployments, as identified in this study.

Global Outbreak Alert and Response Network (GOARN) focal point engagement meeting with partners in Japan.

Global Outbreak Alert and Response Network (GOARN) focal point engagement meeting with partners in Japan.

Beyond deployments: Australia's strategic contributions to the Global Outbreak Alert and Response Network.

Beyond deployments: Australia's strategic contributions to the Global Outbreak Alert and Response Network.

Inaugural meeting of Global Outbreak Alert and Response Network partners from Australia.

Inaugural meeting of Global Outbreak Alert and Response Network partners from Australia.

Go.Data as a digital tool for case investigation and contact tracing in the context of COVID-19: a mixed-methods study

BackgroundA manual approach to case investigation and contact tracing can introduce delays in response and challenges for field teams. Go.Data, an outbreak response tool developed by the World Health Organization (WHO) in collaboration with the Global Outbreak Alert and Response Network, streamlines data collection and analysis during outbreaks. This study aimed to characterize Go.Data use during COVID-19, elicit shared benefits and challenges, and highlight key opportunities for enhancement.MethodsThis study utilized mixed methods through qualitative interviews and a quantitative survey with Go.Data implementors on their experiences during COVID-19. Survey data was analyzed for basic univariate statistics. Interview data were coded using deductive and inductive reasoning and thematic analysis of categories. Overarching themes were triangulated with survey data to clarify key findings.ResultsFrom April to June 2022, the research team conducted 33 interviews and collected 41 survey responses. Participants were distributed across all six WHO regions and 28 countries. While most implementations represented government actors at national or subnational levels, additional inputs were collected from United Nations agencies and universities. Results highlighted WHO endorsement, accessibility, adaptability, and flexible support modalities as main enabling factors. Formalization and standardization of data systems and people processes to prepare for future outbreaks were a welcomed byproduct of implementation, as 76% used paper-based reporting prior and benefited from increased coordination around a shared platform. Several challenges surfaced, including shortage of the appropriate personnel and skill-mix within teams to ensure smooth implementation. Among opportunities for enhancements were improved product documentation and features to improve usability with large data volumes.ConclusionsThis study was the first to provide a comprehensive picture of Go.Data implementations during COVID-19 and what joint lessons could be learned. It ultimately demonstrated that Go.Data was a useful complement to responses across diverse contexts, and helped set a reproducible foundation for future outbreaks. Concerted preparedness efforts across the domains of workforce composition, data architecture and political sensitization should be prioritized as key ingredients for future Go.Data implementations. While major developments in Go.Data functionality have addressed some key gaps highlighted during the pandemic, continued dialogue between WHO and implementors, including cross-country experience sharing, is needed ensure the tool is reactive to evolving user needs.

Rapid Response Mobile Laboratories (RRML): Standardization as a Tool to Maximize Interoperability

Background/Introduction:Rapid Response Mobile Laboratories (RRML) are a crucial component of preparedness and response to health emergencies, both as a stand-alone asset and in conjunction with other rapid response capacities. The development of an RRML classification system in 20191 both defines laboratory structure and provides a foundation for the development of RRML minimum standards under the umbrella of the WHO Global Outbreak Alert and Response Network (GOARN).Objectives:These minimum standards define the requirements for RRMLs/GOARN in the field and facilitate their interoperability with other important operational assets of WHO, including Emergency Medical Teams (EMTs), contributing to the overall response and to enhanced collaboration among national and international health partners.Method/Description:The development of minimum standards brought together over 30 technical experts in various disciplines from European GOARN partner institutions to conduct a systematic applied literature review and consolidate field experiences and lessons learned from infectious disease outbreaks globally, as well as addressing the complete RRML deployment life cycle2 and for each RRML type.The RRML minimum standards focus on four workstreams: Operational Support & Logistics; Laboratory Information Management System; Biosafety & Biosecurity; and Quality Management Systems.Results/Outcomes:This standardization will ensure predictable response in the field and is the first step in strengthening RRML interoperability with other capacities and members of the global health emergency workforce, such as EMTs and Rapid Response Teams, as well as national-level counterparts.Conclusion:The standards contribute to strengthening of National Laboratory capacities, provide the basis for a forthcoming monitoring and evaluation Framework, and WHO RRML recognition process.

One Health security lessons from a year-long webinar series on international COVID-19 response

Following the principles outlined by the Global Outbreak Alert and Response Network, the Federal Bureau of Investigation’s International Biosecurity and Prevention Forum, the European Commission’s Joint Research Centre, and the Middlebury Institute of International Studies’ James Martin Center for Nonproliferation Studies cohosted a webinar series from April 2020 to January 2021 on COVID-19 management across Africa, Europe, and North America. We provide here an overview of the webinar series and discuss how lessons learned during the COVID-19 pandemic and debated during the webinars can be used to bridge One Health with biological threat-driven health security. This report can be used to inform recommendations for future One Health security approaches to strengthen global capacity and multidisciplinary cooperation.

Perspectives on deployment of humanitarian workers through operational partnerships during the acute emergency health response to the Rohingya refugee crisis in Cox\u2019s Bazar

BackgroundThe unprecedented influx of Rohingya refugees into Cox’s Bazar, Bangladesh, in 2017 led to a humanitarian emergency requiring large numbers of humanitarian workers to be deployed to the region. The World Health Organization (WHO) contributed to this effort through well-established deployment mechanisms: the Global Outbreak Alert and Response Network (GOARN) and the Standby Partnerships (SBP). The study captures the views and experiences of those humanitarian workers deployed by WHO through operational partnerships between December 2017 and February 2019 with the purpose of identifying challenges and good practice during the deployment process, and steps to their improvement.MethodsA mixed methods design was used. A desktop review was conducted to describe the demographics of the humanitarian workers deployed to Cox’s Bazar and the work that was undertaken. Interviews were conducted with a subset of the respondents to elicit their views relating to their experiences of working as part of the humanitarian response. Thematic analysis was used to identify key themes.ResultsWe identified sixty-five deployments during the study period. Respondents’ previous experience ranged between 3 and 28 years (mean 9.7 years). The duration of deployment ranged from 8 to 278 days (mean 67 days) and there was a higher representation of workers from Western Pacific and European regions. Forty-one interviews were conducted with people who experienced differing aspects of the deployment process. Key themes elicited from interviews related to staffing, the deployment process, the office environment and capacity building. Various issues raised have since been addressed, including the establishment of a sub-office structure, introduction of online training prior to deployment, and a staff wellbeing committee.ConclusionsThis study identified successes and areas for improvement for deployments during emergencies. The themes and subthemes elicited can be used to inform policy and practice changes, as well as the development of performance indicators. Common findings between this study and previous literature indicate the pivotal role of staff deployments through partnership agreements during health emergency response operations and a need for continuous improvements of processes to ensure maximum effectiveness.

Facilitating the deployment of Japanese human resources for responding global outbreaks of emerging and Re-emerging infectious diseases: A cross-sectional study

IntroductionIn response to global outbreaks of infectious diseases, the need for support from organizations such as the World Health Organization Global Outbreak Alert and Response Network (GOARN) is increasing. Identifying the obstacles and support needs for applicants could increase GOARN deployments from Japan. MethodsThis cross-sectional study involved a web-based, self-administered questionnaire survey targeting Japanese participants in the GOARN Tier 1.5 training workshop, held in Tokyo in December 2019. ResultsAll 47 Japanese participants in the workshop responded to the survey. Most responders were male and in their 30s and 40s. Participants specialized in case management (42.6%), infection prevention and control (25.6%), epidemiology and surveillance (19.1%). Only two participants (4.6%) had experienced a GOARN deployment. Their motivations for joining the GOARN training workshop were “Desire to be part of an international emerging infectious disease response team” (44.6%), “Interest in making an international contribution” (19.1%), and “Interest in working for the Japanese government in the field of international infectious diseases” (14.9%). Obstacles to GOARN deployments were “Making time for deployments” (45.7%) and “Lack of required professional skills and knowledge” (40.4%). The support needs for GOARN deployments constituted “Periodic simulation training” (51.1%), “Financial support during deployments” (44.7%), and “Technical support for deployments” (40.4%). ConclusionsOur study revealed the obstacles and support needs of Japanese candidates for GOARN deployment. Making time and upskilling for GOARN deployment were the main obstacles. More practical training (like GOARN Tier 2.0) with other supports are needed. The national framework is desirable to realize these supports.

Electronic data collection, management and analysis tools used for outbreak response in low- and middle-income countries: a systematic review and stakeholder survey

BackgroundUse of electronic data collection, management and analysis tools to support outbreak response is limited, especially in low income countries. This can hamper timely decision-making during outbreak response. Identifying available tools and assessing their functions in the context of outbreak response would support appropriate selection and use, and likely more timely data-driven decision-making during outbreaks.MethodsWe conducted a systematic review and a stakeholder survey of the Global Outbreak Alert and Response Network and other partners to identify and describe the use of, and technical characteristics of, electronic data tools used for outbreak response in low- and middle-income countries. Databases included were MEDLINE, EMBASE, Global Health, Web of Science and CINAHL with publications related to tools for outbreak response included from January 2010–May 2020. Software tool websites of identified tools were also reviewed. Inclusion and exclusion criteria were applied and counts, and proportions of data obtained from the review or stakeholder survey were calculated.ResultsWe identified 75 electronic tools including for data collection (33/75), management (13/75) and analysis (49/75) based on data from the review and survey. Twenty-eight tools integrated all three functionalities upon collection of additional information from the tool developer websites. The majority were open source, capable of offline data collection and data visualisation. EpiInfo, KoBoCollect and Open Data Kit had the broadest use, including for health promotion, infection prevention and control, and surveillance data capture. Survey participants highlighted harmonisation of data tools as a key challenge in outbreaks and the need for preparedness through training front-line responders on data tools. In partnership with the Global Health Network, we created an online interactive decision-making tool using data derived from the survey and review.ConclusionsMany electronic tools are available for data -collection, −management and -analysis in outbreak response, but appropriate tool selection depends on knowledge of tools’ functionalities and capabilities. The online decision-making tool created to assist selection of the most appropriate tool(s) for outbreak response helps by matching requirements with functionality. Applying the tool together with harmonisation of data formats, and training of front-line responders outside of epidemic periods can support more timely data-driven decision making in outbreaks.

Role of Information Technology in COVID-19 Vaccination Drive: An Analysis of the COVID-19 Global Beliefs, Behaviors, and Norms Survey.

With the onset of the COVID-19 pandemic, information technology has played a critical role in healthcare. A broad spectrum of information technology tools and applications played an essential role to create awareness of the COVID-19 vaccination drive and its health benefits. Research conducted by Massachusetts Institute of Technology (MIT) in collaboration with information technology platforms like Facebook with inputs from World Health Organization (WHO), John Hopkins University (JHU), and Global Outbreak Alert and Response Network (GOARN) shows that 65.06% of people all over the globe are willing to get vaccinated. Vaccine acceptance depends upon social norms and human behavior. These organizations conducted the global survey in over 60 countries with a sample size of 437,236 responses. The international survey was organized using a pre-registered randomized experiment demonstrating the role of technology in reaching out to people based in diverse communities and evaluating their beliefs, behavior, and social norms. The study shows that vaccine acceptance can vary due to descriptive norms. All the respondents in the study were adults with access to the internet. Moreover, a large proportion of the population thinks that the COVID-19 pandemic is a viable threat to the community and preventive measures need to be taken including vaccination drives to eradicate the menace. The survey consisted of five blocks involving questions related to healthcare, demographics, vaccines, knowledge, and information exposure. Sampling and weighting were done using a pool of 3,000 respondents over two weeks, and weights were provided per respondent to represent the target population as a whole. It reduces the representation error and minimizes non-response biases.

Librarian Reserve Corps: Literature indexing and metadata enhancement (LIME) observations from a year in the field

The Literature Indexing Metadata and Enhancement subgroup of the Librarian Reserve Corps was first formed to assist with the indexing of daily publication lists for distribution within the World Health Organization’s Global Outbreak Alert & Response Network (GOARN). Here we reflect on the trends that emerged from this work from a year of cataloguing COVID-19 literature. Preprints are now a crucial part of academic research. It is evident that librarianship is evolving and should continue to evolve post COVID-19. Open Access literature has been beneficial for everyone, including librarians, researchers, the media, and the public. Global collaboration is beneficial to seeing new perspectives. It was also evident during this year that trends in literature took about 10 days to cross over to the media.

Aftermath Melancholy of Devastating COVID-19 Issues

It is difficult to say authentically whether the COVID-19 virus is being developed in Chinese laboratory or shredded from the vet market of China. In any case it’s a Chinese virus affecting the human population, and one such major public health event occurs approximately one in every 100 years. It is as devastating, if not more, than the dinosaurs of past millennia, but as the size reduced from animal to nano particle, the devastating capability also increased in million times. The major pandemics have been usually pneumonic in nature whether plague, flue or Covid. The Global Outbreak Alert and Response Network (GOARN) of WHO (World Health Organization) has been launched as a Knowledge resource. But the role of China or WHO in declaring this pandemic is suspicious even today. This arouses a question, was the discovery actually Chinese in nature and with the help of higher public health organization (WHO?) the matter was hidden and bio-weapon was developed by China to be used for Indian, Taiwan, US or Japanese soldiers in cold seasons, with whom China is engaged in territorial expansion through encroachment? As such excepting US president Mr. Donald Trump, no one expresses it aloud. There has been economic crisis, socio-psycho-political melancholy, vaccine development delays and global health system failure.

Public Perception About the Zika Virus in Working Professionals: A Qualitative Inquiry

The Global Outbreak Alert and Response Network recently warned that the Zika virus-containing mosquitoes are being found in Pakistan and the health sector is on high alert. It is thus significant to understand public beliefs and perceptions of the Zika virus and vaccination in the current scenario of Pakistan. Twenty semistructured qualitative interviews were conducted and analyzed through an inductive approach to analysis. The findings were presented in three main categories which were coded: Reality vs. Conspiracy, Vaccination Concerns, and Public Worries. The majority believed that the Zika virus is a real problem and that authorities might be trying to hide the Zika cases in Pakistan. Moreover, they believed that health organizations are being incompetent by failing to take timely remedial measures to manage the Zika. However, 20% have an opposing view and believed that the Zika virus is a conspiracy against Pakistan from the West. Overall, most participants were concerned about the lack of treatment and preventive methods and emphasized the need to create awareness among the public. It is observed that the participants' perceptions ranged from perceiving the Zika virus as real to as a conspiracy.

Pandemics those struck and those averted: How humanity survived!

Humanity has been exposed to and challenged by epidemics and pandemics from times immemorial. Humans have either lost the battle or won over these pandemics. Bacterial pandemics such as typhoid, plague, and cholera wiped off cities and civilizations altogether. Notable viral pandemics include influenza and smallpox. Influenza has been etched in the history of mankind as a recurring pandemic due to its antigenic variation. A few viruses such as yellow fever, ebola, severe acute respiratory syndrome, Nipah virus, and Zika virus have caused epidemics in the new millennium, although they have been identified a long time back. Human immunodeficiency virus/AIDS is a slow pandemic present since the 1980s, and COVID 19 is the pandemic that the world is facing presently. An effort is made to recall, compare various infectious pandemics, and to understand how humanity has fought back. Furthermore, we try to unravel lessons from history, global, and local health measures such as GSIRS, International Health Regulations, and Global Outbreak Alert and Response Network that were introduced to tackle many such pandemics and an ongoing effort to overcome the present-day pandemic – COVID-19.

Emergency government response team for global infectious disease outbreaks-a Japanese challenge.

The Ebola virus outbreak in West Africa made it clear that international emergency assistance must be strengthened [1]. The Japanese government has contributed to combating infectious disease outbreaks by extending emergency aid to affected countries through international organizations, such as the World Health Organization (WHO) and the Red Cross, and by providing emergency relief directly to affected countries. The Japanese government also dispatches individual experts on infectious diseases to affected regions through the Global Outbreak Alert and Response Network of the WHO [2]. During the Ebola virus outbreak, Japan contributed approximately USD173 million in emergency aid and through various technical cooperation programs, and dispatched 20 experts to the affected countries through the WHO [3].

Residency Training at the Front of the West African Ebola Outbreak: Adapting for a Rare Opportunity.

Medical trainees face multiple barriers to participation in major outbreak responses such as that required for Ebola Virus Disease through 2014-2015 in West Africa. Hurdles include fear of contracting and importing the disease, residency requirements, scheduling conflicts, family obligations and lack of experience and maturity. We describe the successful four-week deployment to Liberia of a first year infectious diseases trainee through the mechanism of the Global Outbreak Alert and Response Network of the World Health Organization. The posting received prospective approval from the residency supervisory committees and employing hospital management and was designed with components fulfilling the Accreditation Council for Graduate Medical Education (ACGME) core competencies. It mirrored conventional training with regards to learning objectives, supervisory framework and assessment methods. Together with Centers for Disease Control and Prevention and many other partners, the team joined the infection prevention and control efforts in Monrovia. Contributions were made to a 'ring fencing' infection control approach that was being introduced, including enhancement of triage, training and providing supplies in high priority health-care facilities in the capital and border zones. In addition the fellow produced an electronic database that enabled monitoring infection control standards in health facilities. This successful elective posting illustrates that quality training can be achieved, even in the most challenging environments, with support from the pedagogic and sponsoring institutions. Such experiential learning opportunities benefit both the outbreak response and the trainee, and if scaled up would contribute towards building a global health emergency workforce. More should be done from residency accreditation bodies in facilitating postings in outbreak settings.