A Grand Challenge to A Grand Challenge to Information Systems: Success Information Systems: Success in Infectious Disease Control in in Infectious Disease Control in

the Asiathe Asia Pacific Pacific

Ann Marie Kimball, MD, MPH, Ann Marie Kimball, MD, MPH, Director, APEC EINetDirector, APEC EINet

University of WashingtonUniversity of Washington

OutlineOutline

Challenge, Overall Goal- “Working” Virtual Challenge, Overall Goal- “Working” Virtual Public Health community across the Asia Public Health community across the Asia PacificPacificRationale- Increasing integration through Rationale- Increasing integration through trade, finance, travel creating increased trade, finance, travel creating increased risk of pandemicsrisk of pandemicsMethods-EINet and beyondMethods-EINet and beyondWhat next? The grand challenge of What next? The grand challenge of situation awareness, prediction, control situation awareness, prediction, control and successand success

Background: APEC Emerging Background: APEC Emerging Infections Network (EINet)Infections Network (EINet)

Founded 1996, first “proof of concept” Founded 1996, first “proof of concept” project in “health” in economic cooperation project in “health” in economic cooperation (APEC)(APEC)APEC-approved project based at the APEC-approved project based at the University of Washington in Seattle, USA.University of Washington in Seattle, USA.Dedicated in providing timely information on Dedicated in providing timely information on emerging infectious diseases (EID’s) in the emerging infectious diseases (EID’s) in the Asia Pacific. Our goal is to promote Asia Pacific. Our goal is to promote collaboration to enhance bio-preparedness in collaboration to enhance bio-preparedness in the APEC region. the APEC region.

Background: APEC Emerging Background: APEC Emerging Infections Network (EINet)Infections Network (EINet)

Evolving methods: “user driven through Evolving methods: “user driven through APEC Health Task force, Steering Committee APEC Health Task force, Steering Committee and “e surveys”and “e surveys”Weekly web and email “Newsbrief” of Weekly web and email “Newsbrief” of emerging infectious disease news emerging infectious disease news Network of peopleNetwork of peopleNetwork of research universities (often with Network of research universities (often with associated hospitals), first “portal” for many associated hospitals), first “portal” for many countries in 1990’s to NLM collections.countries in 1990’s to NLM collections.Network of R&E networks and technology Network of R&E networks and technology institutionsinstitutions

APEC EINet NewsbriefAPEC EINet Newsbrief

Two coincident challenges:1) Pandemic Two coincident challenges:1) Pandemic Preparedness,2) Implementation of the International Preparedness,2) Implementation of the International

Health RegulationsHealth Regulations

The new International The new International Health Regulations Health Regulations approved by the WHA approved by the WHA 2005, 2005, RequireRequire countries to control countries to control outbreaks within their outbreaks within their bordersborders

Assessments by 2008, Assessments by 2008, plans by 2009plans by 2009

Is the event serious?

No

Is the event unexpected?

Yes

Yes

Could it (or has it) spread internationally?

No

Notify the event under the International Health Regulations

Yes

Yes

Is the event unexpected?

Yes No

Risk for international sanctions?No

Reassess when more information

available

No

1) THE INTERNATIONAL HEALTH REGULATIONS; A WHOLE NEW PARADIGM

Challenge 2) Influenza, a global threatChallenge 2) Influenza, a global threat

Avian influenza H5N1 virus Avian influenza H5N1 virus has manifested itself globallyhas manifested itself globally– Asia Pacific community Asia Pacific community

has been hit hardest.has been hit hardest.– Economic, agricultural, Economic, agricultural,

and public health and public health impacts.impacts.

– Potential to turn into a Potential to turn into a pandemic influenza and pandemic influenza and become a substantially become a substantially greater global threat. greater global threat.

What is next with Avian What is next with Avian Influenza?Influenza?

Active Surveillance in Active Surveillance in place ,sub-regional exercises place ,sub-regional exercises in pandemic preparedness, in pandemic preparedness, APEC, ASEAN,WHO APEC, ASEAN,WHO High human mortality, poor High human mortality, poor transmissiontransmission200 deaths in 328 cases 200 deaths in 328 cases worldwide (173 deaths in 265 worldwide (173 deaths in 265 cases in Asia)cases in Asia)““Threshold” for pandemic is Threshold” for pandemic is not known.not known.

PANDEMICPANDEMICTertiaryTertiary: :

Geographically Geographically Dispersed ClustersDispersed Clusters

Secondary:Local extension

Primary:Point of Emergence

Species jumping, Ecological pressure

Levels of Prevention: Levels of Microbial Traffic

Mechanisms

Trade, Travel

DirectContagion

TR

AN

SN

ATIO

NA

L TR

AFFIC

Disease Transmission and Interruption: The Race between Traffic, Transmission and Control

PANDEMICPANDEMICTertiaryTertiary: :

Geographically Geographically Dispersed ClustersDispersed Clusters

Secondary:Local extension

Primary:Point of Emergence

Species jumping, Ecological pressure

WHO-IHR, WTO(International)

National Agencies,Local Public Health

Levels of Prevention: Levels of Microbial Traffic

Mechanisms

Trade, Travel

DirectContagion

TR

AN

SN

ATIO

NA

L

TR

AFFIC

Remedies

TR

AN

SN

ATIO

NA

L P

UB

LIC

HEA

LTH

P

RA

CTIC

E

THE NEW IMPERATIVE FOR GLOBAL POPULATION SAFETY

The Preparedness Imperative: The Preparedness Imperative:

Preparedness against the threat of Preparedness against the threat of pandemic influenzapandemic influenza– Little transnational exchange of preparedness Little transnational exchange of preparedness

plans.plans.– Communication is one key for improving Communication is one key for improving

preparedness and responsepreparedness and response– Collaboration between public and private Collaboration between public and private

sectors highly variable in APEC economiessectors highly variable in APEC economies– Capacity for “on the ground investigation” is Capacity for “on the ground investigation” is

very uneven.very uneven.

Why videoconferencingWhy videoconferencing??

– Facilitates “high level” but informal discussions Facilitates “high level” but informal discussions (non-representational) (non-representational)

– Real-time communication with multiple sites Real-time communication with multiple sites (can simulate face-to face meeting--more cues (can simulate face-to face meeting--more cues than teleconferencing).than teleconferencing).

– Virtual medium is unaffected by travel Virtual medium is unaffected by travel advisories or restrictions (potential for use advisories or restrictions (potential for use during actual pandemic).during actual pandemic).

– Tested systems—e.g. Access Grid Tested systems—e.g. Access Grid (was used (was used during SARS outbreak in Taiwan)during SARS outbreak in Taiwan)..

Why Access Grid Why Access Grid videoconferencing?videoconferencing?

Use research networks rather than Use research networks rather than congested commodity Internet)congested commodity Internet)Open source software Open source software Fairly wide acceptance in international R&E Fairly wide acceptance in international R&E community.community.Can share applications (e.g. slideshows, X-Can share applications (e.g. slideshows, X-rays,..).rays,..).

Virtual SymposiumVirtual Symposium

To discuss pandemic influenza To discuss pandemic influenza preparedness and response in the Asia preparedness and response in the Asia Pacific Region.Pacific Region.– Thoroughly “vetted” agenda, previewed Thoroughly “vetted” agenda, previewed

slidesslides– Technology testingTechnology testing– Interactive with experienced facilitatorInteractive with experienced facilitator

Methods: the EINet linkMethods: the EINet link

EINet linked public health to technology EINet linked public health to technology counterparts for each participating economycounterparts for each participating economy– E.g. In Australia, Australia’s Academic and E.g. In Australia, Australia’s Academic and

Research Network (AARNet) worked with the Research Network (AARNet) worked with the Dept. of Health and AgeingDept. of Health and Ageing

– Build on preexisting relationships among and Build on preexisting relationships among and with advanced networks and research with advanced networks and research institutions institutions

– Request technology partners to host public Request technology partners to host public healthhealth

PLAY VIDEOPLAY VIDEO

First Virtual Symposium 2006First Virtual Symposium 2006

QuickTime™ and aSorenson Video 3 decompressorare needed to see this picture.

Results: Successful “Beta” Results: Successful “Beta” Virtual SymposiumVirtual Symposium

10 APEC economies presented their 10 APEC economies presented their epidemiologic situation and pandemic epidemiologic situation and pandemic planningplanning– 210 minute real-time virtual meeting.210 minute real-time virtual meeting.– Few technical difficulties.Few technical difficulties.– Consensus on follow-up discussions.Consensus on follow-up discussions.

Results: Results: Major topics discussedMajor topics discussed

Importance of regional communication and Importance of regional communication and collaboration.collaboration.National/local scenario exercises.National/local scenario exercises.Geographic and national tailoring of international Geographic and national tailoring of international guidelines.guidelines.Enhanced surveillance, clinical and public health Enhanced surveillance, clinical and public health collaborations.collaborations.Public education and risk communication.Public education and risk communication.Business continuity planning.Business continuity planning.Surge capacity and mental health.Surge capacity and mental health.Vaccines and antiviral stockpiling.Vaccines and antiviral stockpiling.

Discussion: SuccessesDiscussion: Successes

Enhanced communication and collaboration—Enhanced communication and collaboration—preparedness activities that are recommended preparedness activities that are recommended by APEC and WHO.by APEC and WHO.Linked public health and their technology Linked public health and their technology counterparts, often unaware of each other counterparts, often unaware of each other and/or not having worked together.and/or not having worked together.Saved travel time and costs associated with Saved travel time and costs associated with traditional conferences.traditional conferences.Create redundancy to “commodity internet” Create redundancy to “commodity internet” dependency in crisesdependency in crises

LimitationsLimitations

Access to technology: Access to technology: – Those economies Those economies without Access Grid (i.e., without Access Grid (i.e.,

Chile and Peru) were unable to participate. Chile and Peru) were unable to participate. – Viet Nam was hosted in Thailand, but such Viet Nam was hosted in Thailand, but such

a model is not sustainablea model is not sustainable– We need a working plan for Indonesian We need a working plan for Indonesian

participation this round. participation this round. – Currently planning on technical outreach to Currently planning on technical outreach to

these economies to allow for future these economies to allow for future participation. participation.

And next strategiesAnd next strategies

““High Level” discussions plagued with the High Level” discussions plagued with the “emperor’s new clothes” optique“emperor’s new clothes” optiqueTop level communications should be Top level communications should be synergized with national/local level roll out of synergized with national/local level roll out of new capacity for control and responsenew capacity for control and responseEfforts are under way (FETP, Disweb, China Efforts are under way (FETP, Disweb, China CDC) and systematization will occur with IHR CDC) and systematization will occur with IHR implementation.implementation.Problems with usability, interoperability of Problems with usability, interoperability of systems at each step of local/national control systems at each step of local/national control process.process.

CaveatCaveatTechnology is a moving targetTechnology is a moving targetAccess Grid was the appropriate technology to Access Grid was the appropriate technology to use at the time, combined with polycom for use at the time, combined with polycom for second symposiumsecond symposiumAccess Grid demands significant technical Access Grid demands significant technical support, unreliable for extended symposiumsupport, unreliable for extended symposiumPromising technologies are much needed Promising technologies are much needed – Easier to set upEasier to set up– Have the same functionality as Access GridHave the same functionality as Access Grid– Can work on dialup lines and advanced networksCan work on dialup lines and advanced networks

Discussion: Second Virtual SymposiumDiscussion: Second Virtual Symposium

Second Virtual Symposium executed May Second Virtual Symposium executed May 29,30(Asia) 2008 29,30(Asia) 2008 Content focused on public/private cooperation in Content focused on public/private cooperation in Pandemic planning. Pandemic planning. Sixteen of twenty one APEC economies Sixteen of twenty one APEC economies participated.participated.Peru and Vietnam were able to participate in Lima Peru and Vietnam were able to participate in Lima and Hanoi initiating their experience with highspeed and Hanoi initiating their experience with highspeed networks and health networks and health Highly variable public-private experience within Highly variable public-private experience within economies from no collaborative planning to fully economies from no collaborative planning to fully integrated partnerships (Canada most notably) integrated partnerships (Canada most notably)

Conclusions: “High Level”Conclusions: “High Level”

Partnership of public health and advanced Partnership of public health and advanced network communities holds promise in network communities holds promise in planning pandemic preparedness and planning pandemic preparedness and response in the Asia Pacific region.response in the Asia Pacific region.Deployment and utilization of common Deployment and utilization of common videoconferencing technology should be videoconferencing technology should be considered for pandemic influenza considered for pandemic influenza preparedness. preparedness.

Conclusions: The local and Conclusions: The local and national “working” levelnational “working” level

The importance of human networks reigns The importance of human networks reigns supreme: EINET and APAN collaborations supreme: EINET and APAN collaborations have “positioned” our ability to contributehave “positioned” our ability to contribute

UW entering collaboration with PRC/CDC, UW entering collaboration with PRC/CDC, US CDC for Field epidemiology trainingUS CDC for Field epidemiology training

Working with Thailand, MBDS in same Working with Thailand, MBDS in same domaindomain

Ongoing team member is senior adviser to Ongoing team member is senior adviser to Japan FETP.Japan FETP.

Some “Some “Grand ChallengeGrand Challenge” elements ” elements for Communicable Disease Controlfor Communicable Disease Control

Ability to compile micro Ability to compile micro to macro information , to macro information , visualize and analyzevisualize and analyzeExplore “prediction” Explore “prediction” with non traditional with non traditional information sources, information sources, modeling. e.g, travel modeling. e.g, travel routes and volumes, routes and volumes, trade flows, linked to trade flows, linked to genomicsgenomics

Standard platforms for Standard platforms for lab/reporting which lab/reporting which includes geospatialincludes geospatialGeneralized field Generalized field epidemiology epidemiology competence with competence with continuing educationcontinuing educationPersistent Persistent communicationscommunicationsFull text library access Full text library access

AcknowledgmentsAcknowledgments

Funding: APEC, IBM, and the Global Funding: APEC, IBM, and the Global Health and Securities Initiative (NTI).Health and Securities Initiative (NTI).

Participants: All participating public health Participants: All participating public health institutions and advanced networks.institutions and advanced networks.

Technical support: Pacific Northwest Technical support: Pacific Northwest Gigapop and UWTV. Gigapop and UWTV.

Participating Economies from the Public Participating Economies from the Public Health sector: 2Health sector: 2ndnd Virtual Symposium Virtual Symposium

Brunei Department of Health Brunei Department of Health Peru Ministry of Health, National Institutes of HealthPeru Ministry of Health, National Institutes of HealthAustralia Dept of Health and AgeingAustralia Dept of Health and AgeingPublic Health Agency of CanadaPublic Health Agency of CanadaPeople’s Republic of China: Ministry of HealthPeople’s Republic of China: Ministry of Health Ministry of Health JapanMinistry of Health JapanKorea Center for Disease Control and PreventionKorea Center for Disease Control and PreventionMalaysia Ministry of HealthMalaysia Ministry of HealthMinistry of Health Papua New GuineaMinistry of Health Papua New GuineaIndonesian Ministry of Health Indonesian Ministry of Health Philippines Dept of HealthPhilippines Dept of HealthSingapore Ministry of HealthSingapore Ministry of HealthChinese Taipei: Taiwan Center for Disease ControlChinese Taipei: Taiwan Center for Disease ControlThailand Ministry of Public HealthThailand Ministry of Public HealthUSA: Georgia State Department of Health; US Centers for Disease USA: Georgia State Department of Health; US Centers for Disease Control and PreventionControl and PreventionViet Nam Institute of Hygiene and EpidemiologyViet Nam Institute of Hygiene and Epidemiology

Technology CollaboratorsTechnology Collaborators

Australian Academic and Research Network (AARNet)Australian Academic and Research Network (AARNet)Canada’s Research and Education Network (CANARIE)Canada’s Research and Education Network (CANARIE)China Education and Research Network (CERNET)China Education and Research Network (CERNET)Republic of Korea: Seoul National UniversityRepublic of Korea: Seoul National UniversityPhilippines: Advanced Science and Technology Institute Philippines: Advanced Science and Technology Institute (ASTI)(ASTI)Singapore: National Grid Project (NGP)Singapore: National Grid Project (NGP)Chinese Taipei: National Center for High-Performance Chinese Taipei: National Center for High-Performance Computing (NCHC)Computing (NCHC)Thailand: Asian Institute of Technology (AIT)Thailand: Asian Institute of Technology (AIT)USA: Pacific Northwest Gigapop/Pacific WaveUSA: Pacific Northwest Gigapop/Pacific Wave

For more informationFor more informationabout EINetabout EINet

apecein@u.washington.eduapecein@u.washington.edu

http://depts.washington.edu/einet http://depts.washington.edu/einet