Building Comprehensive Capacity

for Global Health Security

Seminar Presentation
Asia Development Bank
January 21, 2016
Rod Hoff
Department of Global Health
University of Washington
Disclaimer: The views expressed in this paper/presentation are the views of the author and do not necessarily reflect the views or policies of the Asian Development Bank (ADB), or its
Board of Governors, or the governments they represent. ADB does not guarantee the accuracy of the data included in this paper and accepts no responsibility for any consequence of
their use. Terminology used may not necessarily be consistent with ADB official terms.

Global Health Security

Chain of Health Resilience

Prevent

Mitigate

Respond

Recover

Transform

Countering Global Health Security Threats

There is critical need for increased public awareness and political
commitment to prepare for and to address emerging health threats.
The WHO International Health Regulations (IHR) need to be
strengthened to ensure more effective international cooperation in
identifying and responding to health impacts.
Increased public funding is needed for research on and development
of more effective measures for the prevention, control and treatment
of emerging infectious diseases and for emergency preparedness for
addressing the health risks from environmental change.
Countries need to establish comprehensive strategies and
operational plans for establishing and maintain global health security

Challenges for Building Effective Capacity for

Global Health Security
Integration of existing parallel
initiatives/systems: e.g. surveillance,
lab preparedness and response
Improved capacity to process,
interpret and act on information from
multiple sources to assess health risks
and threats
Coordination and control of
operations and risk communication

Multi-sector collaboration and

coordination
Capability to act at local, district and
national and sub-regional levels
Tools for evaluation of capability and
capacity and operational readiness
Ability to exercise and test the overall
effectiveness of the system for
responding to events

REDI Centre
An inter-governmental organization based in Singapore
Mission to enhance readiness in dealing with naturallyoccurring infectious disease outbreaks or man-made
health threats
Supports programs to
strengthen regional
preparedness and
response capacity

Surveillance

Acts as a resource for

training and research
Promotes international
exchange of
information, knowledge
and expertise

Clinical

Laboratory

 Avian influenza control in a geographically

defined area (Indonesia)
o Surveillance
o Training and research

Strengthen
regional
response
capacity

Case management and infection control

of avian influenza at 100 nationally
designated referral hospitals (Indonesia)
o Guideline development
o Training and research
Infection prevention and control
programs prepared to detect and manage
outbreaks, epidemics and pandemics
(regional)

Laboratory diagnostic and surveillance

capacity for influenza and dengue, (regional)

Information Exchange
Regional Scientific Conferences
o Hand Foot & Mouth Disease (2008)

Regional
exchange of
information,
knowledge
and expertise

o Chikungunya (2009)
o Dealing with HIV Drug Resistance in
AP Region (USJCMSP) 2010
o ASEAN Tropical Medicine (2010)
o Biomedical Research on EIDs (2011)

EINet Hot Topics Virtual Symposia

o Pandemic Influenza Preparedness (2008)
o Pandemic Influenza Planning for the
Second Wave (2009)
o Lessons learned from the 2009/2010
Pandemic (2010)
o ID Outbreaks Related to Climate Change
and Disasters (2010)
o Implications of Expanded Global Trade
on Infectious Disease Risk (2011)

Relationship and partners

Regional and
Singapore:
Indonesia:
Global/
International
National agencies
Partners

International

MOH
National
andPublic
associated
Singapore
MOH
Agencies:
Health Lab,
agencies
forCDC,
public
WHO
WHO
WPRO,
SEARO
Environmental
health
(CDC) and
APSED
US
CDC(SEARO,WPRO)
Health
research
Institute
(NIHRD)
GOARN
European
CDC
Academic
Public
Hospitals
centers
Institute
Pasteur
National
Influenza
University
Academic
centers CC

ASEAN
of Singapore,
University
of DukeDHHS
Indonesia,
Eikmann
NUS,
Polytechnics
US CDC
Institute
Public
Hospitals GEIS/NAMRU-2
TTS, SGH, NUH
European CDC
Institute Pasteur (SEA )

UW DGH Programs for Support of Global Health Security

Health impact
at scale

With implementation science

as a signature methodology of
UW DGH

Metrics, policy, program

Prevention & care delivery and health systems strengthening
Clinical epidemiology and intervention development
Pathogenesis and translational research

UW Department of Global Health

Health Challenges

Education &
Training

CVD prevention/care
Mental health

Drug access & safety

Service

Injury/violence prevention/care

UG minor
PhD, GH Metrics & IS

E-learning
DrGH
Asia

+ FP
SSA

Inf. Diseases (HIV/STIs)

GHS/(re)emerging ID

Pathobiology

Methods

MPH
PhD in Pathobiology

Research &
Evaluation

Environmental change

RH/MCH

Metrics & evaluation

Clinical trials

Implementation Science

Kenya
Mozambique
RSA
Uganda

L. America
Peru

Vulnerable Popns
HIV MARPS
Children
Women

Adolescents

Bangladesh
Cambodia
China
India
Nepal
Vietnam

Populations

I-TECH is a Center at the University of Washington that

supports health workforce development globally

The accuracy,
timeliness and
reliability of test
results requires
close
management of
12 key areas of
laboratory
operations:

Personnel

Equipment

Process
Control

Information
Management

Documents
&
Records

Occurrence
Management

Assessment

Process
Improvement

Customer
Service

Facilities &
Safety

Organization

Purchasing
&
Inventory

I-TECHs goal in Cambodia:

To improve laboratory
operations for enhanced
disease detection, surveillance
and biosecurity through
improved laboratory quality
assurance and management
practices in CPA3 and National
Referral Hospital Laboratories,
in line with national and
international standards and
regulations.

The LQSI Process:

Phase 4
Phase 3
Phase 2
Phase 1
Phase 1: Assure technical competency of testing
Phase 2: Implement QC measures, create traceability
Phase 3: Establish the policy cycle with proper management,
leadership and planning
Phase 4: Create CQI, document progress

QMS Implementation Sites:

I-TECH LQSI
sites-Cohort 1
I-TECH LQSI
sites-Cohort 2
CDC SLMTA
sites

QMS Training of Cohort 1:

Sihanoukville, August 2014

Looking ahead: More QMS Training and

LQSI review workshops

Phase 1

Phase 2
Phase 3
Phase 4
Phase 1
Phase 2
Phase 3

Cohort 1
Cohort 2
Cohort 3
LQSI Review
QMS Training

Phase 4

Phase 1
Phase 2
Phase 3

Oct

Sept

Q4
Aug

Jun
Jul

Q3
May

Q2

Mar
Apr

2016
Feb

Jan

Q1
Nov
Dec

Sept
Oct

Q4
Aug

Jun
Jul

Q3
May

Q2

Mar
Apr

Feb

Dec
Jan

Q1
Nov

Sept
Oct

Q4

2015

CHanGE:
Center for Health and
the Global Environment
Kristie L. Ebi, Ph.D., MPH
Jeremy J. Hess, M.D., MPH

CHanGE Core
Kristie L. Ebi

Jeremy Hess

Jason Gordon

Dr. George Luber, CDC

CHanGE Collaborators
School of Public Health

School of Medicine

Global Health
Environmental and Occupational Health Sciences
Institute for Health Metrics and Evaluation
College of the Environment
Forest Sciences
Oceanography

Program on Climate
Change
Climate Impacts Group
Marine and Environmental Affairs
Aquatic and Fishery
Sciences

College of Built Environments

Civil and Environmental
Engineering
Landscape
Architecture
Urban Design and Planning
Evans School of Public Policy and
Governance

Mission
CHanGE collaboratively develops and promotes innovative
approaches to understanding and managing the risks of global
environmental change, focusing on improving individual and
community health and well-being in a changing environment

CHanGE and its affiliates conduct research and policy analysis,

provide education and training, deliver technical assistance, and
build capacity using an interdisciplinary framework and approach

Approach
CHanGEs goal is to: accurately characterize, efficiently reduce,
and effectively manage the health risks of environmental
change
CHanGE pursues this goal by facilitating risk characterization,
risk reduction, and risk management activities
Our intention is to empower communities, states, and nations
with the knowledge, capacity, and tools to effectively
characterize, project, reduce, and manage the risks that global
environmental change presents to human health and wellbeing

CHanGE: Education
Accomplished
Graduate level course in climate change and health starts in January
2016
Student mentoring - one Ph.D. and two MPH students

Planned
Graduate and undergraduate introductory courses on global change
and health
Courses on methods and analytic approaches, disaster risk
management, food / water security and safety
Certificate in global change and health
Become a hub for global change education in Western US and major
regional resource for Asia and globally

CHanGE: Research
Areas of focus include estimating the:
Current harms and projected risks of global change
Focus on maternal and child health, particularly undernutrition, emerging
infectious diseases, heat and other extreme events

Effectiveness of policies, programs, and approaches to prepare for,

cope with, respond to, and recover from health impacts
Monitoring and evaluation of adaptation policies and programs

Health co-benefits of mitigation policies

Symposium in Sept 2016 on health co-benefits

Planned: collaborations within and outside UW on

Applications to Wellcome Trust (climate change / micronutrients
/ food security) and NIH (heatwave early warning system in
India, multiple others)
NOAA and others as opportunities arise

CHanGE: Implementation
Accomplished: technical support for climate-resilient health
systems
Mozambique: understanding current and likely future burden of
undernutrition and vectorborne diseases, in support of USAID initiative
India & Thailand: facilitated design and implementation of heatwave
early warning & response systems
Indonesia & Sri Lanka: evaluated the robustness of health systems to
changing health burdens
Five day train-the-trainer materials on understanding and managing
the health risks of climate change for WHO South East Asia & Western
Pacific Offices

Planned
Grow implementation work to include more regions and countries,
with significant student involvement