Review of the DoD-GEIS Influenza Programs Strengthening Global Surveillance and Response (2008) / Chapter Skim
Currently Skimming:
10 Overarching Conclusions and Recommendations
10 Overarching Conclusions and Recommendations
Pages 203-224
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at DoD-GEIS headquarters and at each of the DoD-GEIS-supported laboratories. This chapter outlines the committee's overarching recommendations for the DoD-GEIS influenza program and describes the steps the committee feels that the program should take in order to achieve and strengthen a sustained DoD-GEIS influenza surveillance and response effort.
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with international entities engaged in pandemic preparedness and response. Consistency with DEPARTMENT OF DEFENSE and national plans Department of Defense Plans Executive Agency Before 1997 the DoD influenza surveillance program consisted largely of the surveillance program of the U.S.
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Figure 10-1 sition would strengthen DoD-GEIS headquarters' leadership role in the execution of DoD-GEIS influenza activities as well as improve the execution of the program. Relocating the top-level leadership, data synthesis, and coordination functions to GEIS headquarters makes sense for a number of reasons: GEIS headquarters has growing technical depth with respect to influenza; it is located near the Walter Reed Army Institute of Research and the Naval Medical Research Center headquarters for the DoD overseas labs (which between them are conducting most of the surveillance)
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Examples of possible mechanisms and tools used for coordination by DoD-GEIS would be monthly teleconferences, periodic website surveillance summaries (with host country concurrence) , annual face-to-face meeting -- for example, in conjunction with the annual American Society for Tropical Medicine and Hygiene meeting -- and sharing of information technologies.
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In their continued implementation of AI/PI projects, GEIS headquarters and laboratories should consider the need to establish sustainable efforts to provide capacity to the host country even if funding is cut. As much as possible, in the selection of equipment and the support of influenza activities, specific items should be purchased that give host-country personnel the best chances of sustainability in meeting their needs within their local setting; when making these choices, the directive to coordinate plans and activities with the host country should be kept in mind.
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In general, though, the overseas laboratories have been successful in developing beneficial ties with appropriate host government components and universities in areas of mutual interest or expertise, with the more established laboratories being particularly successful. Strategic long-term planning for pandemic influenza-preparedness surveillance and response programs, supported by stable funding, would enable the DoD laboratories to determine the appropriate combination of research and public health surveillance needed to best meet the challenge of pandemic
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Human Influenza Surveillance Institutionalizing influenza surveillance in host countries and within the populations of these host countries provides DoD-GEIS laboratories with opportunities to assist host governments in using the data to prioritize future surveillance activities. Expanding the scope of data collection and analysis to look beyond H5N1 and developing surveillance activities that are amenable to other emerging diseases would greatly benefit overall public health capacity.
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Inadequate coordination affects both the effectiveness of the DoD laboratories and the quality of integrated information regarding the presence of influenza viruses being reported from the host country. DoD-GEIS laboratory personnel could serve
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NMRCD NMRCD participates in the Global Avian Influenza Network Surveillance, managed by the World Wildlife Conservation Society at the Bronx Zoo as well as provides veterinary diagnostic support for ongoing Peruvian government activities. Source: DoD laboratories, DoD-GEIS annual report.
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to increase laboratory throughput and increase their diagnostic capacity. Many of the sites have also used the supplemental funds to increase the biosafety levels of their laboratory space in order to be able to manage highly pathogenic human and animal influenza A viruses.
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Rapid testing may help limit overreactions and reduce needless depletion of antivirals, vaccines, masks, and other protective stocks. Laboratories must be prepared for expanded laboratory-based surveillance activities during this critical period between the initial epidemiologic harbingers of an influenza pandemic and eventual global spread.
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RECOMMENDATION 10-10. The DoD-GEIS influenza surveillance programs in the overseas laboratories should be complementary to the host-country laboratory system and help to increase surge capacity at the host country levels.
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RECOMMENDATION 10-11. DoD-GEIS influenza surveillance pro grams in the overseas laboratories in each host country should have a written understanding among all national and international partners
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Coordination of efforts with the Centers for disease Control and Prevention, the World Health Organization, and local governments Addressing emerging infectious diseases is an issue of global importance and shared responsibility. It is crucial to the success of a global influenza surveillance system that all of the relevant partners work together to plan and prepare for a possible pandemic.
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At the time of the site visits, DoD-GEIS surveillance activities were integrated with those of U.S. government, host country, and multilateral partners to various degrees often dependent on how long each program had been underway.
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TABLE 10-6 International Partners of DoD Overseas Laboratories DoD Laboratory Global and Host-Country Partners NAMRU-2 Indonesian Ministry of Health, Indonesian Ministry of Figure 10-2 Agriculture and Fisheries, Indonesian National Institutes of Health Research and Development (Litbangkes) , WHO, FAO, other partner governments in the region AFRIMS Royal Thai Army, Thailand Ministry of Public Health, Thai Ministry of Agriculture and Cooperatives, WHO, other partner governments in the region NAMRU-3 Egyptian ministries of health, environment, and agriculture, WHO EMRO, FAO, APHIS, other partner governments in the region USAMRU-K Kenya Medical Research Institute (KEMRI)
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DoD influenza protocols should be executed in such a way that they cause a net strengthening of national and international capacity. As part of these collaborations, the overseas laboratories should also take opportunities to assist the host country in the development and implementation of disease-control guidelines and pandemic preparedness where appropriate and necessary.
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according to the National Strategy for Pandemic Influenza, Implementation Plan (see Box 10-1) , the influenza surveillance activities being conducted at the DoD's domestic and overseas laboratories are producing valuable information on the location and variations of the circulating influenza viruses which can help prepare both U.S.
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As influenza activities evolve, collaboration between the CDC and the DoD will be of utmost importance if TABLE 10-8 U.S. Government Partners of DoD Domestic and Overseas Laboratories DoD Laboratory US Agency Partners NAMRU-2 CDC, USAID, NASA, U.S.
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The preceding sections describe the steps the committee feels that the program should take in order to achieve and strengthen a sustained DoD-GEIS influenza surveillance and response effort. With sustained funding and the implementation of these recommendations, DoD-GEIS has a unique opportunity to further contribute to the evolving global knowledge of highly pathogenic avian influenza virus as well as continue to strengthen global emerging infectious disease surveillance and response.
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2007b. Department of Defense influenza surveillance sites worldwide, 2007 (unpublished)
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