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Plenary Session:1��Topic: Global Health

Security Agenda�

Ms.Sangita Patel

Director, Health Office,

US Agency for International

Development (USAID), India

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Master’s in Strategic Studies from the U.S. Army War College;
Master’s in Public Health from Tulane University School of Public health
Supported the Carter Presidential Centre’s Global Development Initiative, the Centres for Disease Control and Prevention’s Special Pathogens Division, as well as the Peace Corps and German Development Organization in Madagascar
Since 2020 – She managed USAID programs to advance public health, improve education, promote economic resiliency, provide humanitarian assistance, and strengthen social protection
Then worked with USAID in Pakistan, Zambia, Armenia, Namibia, and Washington D.C.
U.S. Senior Foreign Service Officer serving as the Director, Health Office at USAID/India since July 2019.

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Global Health Security

The Time is Now

Preparing our World for Future

Health Threats

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COVID-19

Millions of people lost lives and livelihoods.
The global economy lost trillions.
Disinformation flourished.
All countries struggled with inequitable response.
The world experienced health, development, and life expectancy setbacks.

And…this is not the first, last, or worst pandemic.

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GHS in Context

The world is under-prepared for health emergencies.

The world is even more under-prepared for worst-case scenarios.

Biological Threats

Deliberate

Naturally Occurring

Accidental

Outbreaks

Epidemics

Pandemics

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PREVENT avoidable outbreaks

DETECT

threats early

RESPOND

rapidly and effectively when outbreaks occur

Global Health Security

Global Health Security: Defined

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Ebola (Uganda, Sudan Strain)

2022

Monkeypox

2022

MERS (South Korea)

2015

Zika

2015

H1N1 Influenza Pandemic

2009

Ebola West Africa

2014

Ebola (DRC, Guinea)

2021

H5N1 (birds, United States, Europe)

2022

African Swine Fever (Hispaniola)

2021

Polio cases (in the United States)

2022

Ebola (DRC)

2018

COVID-19 Pandemic

2020

Global Health

Health Systems

Health Security

Pandemics & Catastrophic Biological Events

Global Health Security: in Context

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GHS Architecture

GHS Country Capacity

Political Will Leadership

Accountability

Health Systems

Access to Counter

Measures

Preparedness & Response

Financing

Measurable capacity to prevent, detect, respond to any biological threat.

Sustainable, predictable financing.

Consistent political will.

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Challenge

75 percent of emerging infectious disease outbreaks are zoonotic. Outbreaks are more frequent as interactions between humans, animals, and the environment increase.�
Emerging infectious diseases are defined by WHO as affecting a population for the first time, or have existed before but is rapidly spreading to more people or new locales.

Many EIDs are zoonotic in origin, which means that the disease has emerged from an animal and spilled over to infect humans. According to NIH, emerging diseases also includes AMR.

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Opportunity

Spur investments and build capacities to prevent, detect, and respond to emerging infectious diseases

Link efforts to other development platforms include climate change, poverty reduction, and governance

Global Health Security: Challenge & Opportunity

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EIDs was the missing link in the global health architecture
Health systems, Maternal, Newborn Child Health, major endemic diseases of HIV/AID, TB, & malaria remain critical priorities, but now we are facing new threats
This year alone outbreaks of Marburg, Lassa fever, yellow fever, Monkeypox in over a 100 countries, resurgence of measles, cholera in multiple countries, Dengue fever, and now a major Ebola outbreak in Uganda
In 2023, most countries will experience a major outbreak, or have one in a neighboring country, or deal with a regional epidemic, or another pandemic (and COVID)
And these events will be threats to development programs and country governance
And it will likely become worse in the years ahead

Emerging Infectious Diseases

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Emergence of infectious diseases and Antimicrobial Resistance (AMR) is increasing in frequency and severity

Majority are of animal origin (zoonotic), 75% of emerging zoonoses have wildlife origins

Increasing due to behaviors/practices involving people, animals, & environment (Nipah, SARS, Ebola)

Zoonotic Emerging Infectious Diseases are Increasing

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A “One Health” Approach to Global Health Security

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REAL TIME

SYSTEMS

2

3

4

1

ANTIMICROBIAL RESISTANCE (AMR)

LAB

SYSTEMS

SURVEILLANCE

WORKFORCE DEVELOPMENT/

HUMAN RESOURCE

USAID/INDIA’S GLOBAL HEALTH SECURITY RESPONSE

PREVENT, DETECT, RESPOND

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KEY ACTIVITY AREAS - AMR

Improve AMR surveillance in animal

& human health.

STATE ACTION PLANS

Strengthen Infection Prevention and Control (IPC)

IPC

STRENGTHENING

SURVEILLANCE

NAP for AMR

ADVOCACY

Support containing AMR using a One Health approach in select states

AMR Summit: One World, One Health, One Fight

Strategic expert consultations & synthesizing inputs for NAP-AMR

Reduce risk of animal diseases & excessive antibiotics use, reduced risk of zoonosis, development & spread of AMR

IMPROVE FARM MANAGEMENT

PRACTICES

Support surveillance and optimization of antimicrobial use

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KEY SUCCESSES

Forged a national network for fisheries and animals AMR (INFAAR) under the leadership of Indian Council of Agriculture Research (ICAR)

Expanded lab network for AMR surveillance in collaboration with the state governments and professional associations

Supported development of the National Guidelines for Infection Prevention and Control for health care facilities

Supported three states(Kerala, Madhya Pradesh, Delhi) to establish governance mechanisms for containment of AMR and develop state action plans for containment of AMR with a One Health approach

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KEY ACTIVITY AREAS – LAB SYSTEMS

STRENGTHENING PUBLIC SECTOR LABORATORIES

ENGAGING THE PRIVATE SECTOR LAB SERVICES

EXPANDING WHOLE GENOME SEQUENCING ABILITIES

BUILDING CAPACITIES- WORKFORCE, NEW TESTING & TECHNOLOGY

IMPROVING QUALITY

Improve Disease Detection and Response to Infectious Diseases

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KEY SUCCESSES

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Strengthening Public Sector Laboratories

Provided technical assistance for strengthening virology labs, including establishing Biosafety Level virology labs at a sub national level
Conducted supply chain gap analysis and action planning for test kits and lab consumables.
Supported Indian Council of Medical Research (ICMR) approvals for new labs
Commissioned new Reverse Transcription Polymerase Chain Reaction (RT-PCR) laboratories.

Genomic Sequencing

Expanded genomic sequencing capabilities in 5 states.
Supported State Gov of Telangana establish a WGS Lab Satellite.

Building Capacities

Train personnel working in laboratories on a variety of areas including RT-PCR testing, Whole Genome Sequencing, + hands-on district level training, and strengthening the collection and transportation of samples

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(WHO Polio) in collaboration with the Indian Council of Medical Research (ICMR) is working to establish an environmental surveillance system for SARS-CoV-2 and an early warning system for SARS-CoV-2 infections in the community and aid in the detection of circulating variants of concern. USG with the support of WHO enrolled eight labs under the Polio Laboratory Network for the environment surveillance pilot study - BJMC Ahmedabad, NIV Mumbai, NIV Bangalore, IOS Kolkata, SGPGI Lucknow, IPM Hyderabad, PGI Chandigarh, and AIIMS, Patna (Bihar).
USG virtually provided training to lab personnel through National Institute of Virology (NIV) on aspects such as sample collection, processing and testing of sewage water to perform testing for SARS-CoV2 from cities such as Amritsar, Ahmedabad, Bengaluru, Chandigarh, Hyderabad, Kolkata, Lucknow, and Mumbai. As of December 2021, nine laboratories were trained by National Institute of Virology on sample processing and for the labs where Environment Surveillance for SARS-CoV-2 has not yet been initiated, refresher training are to be conducted. Likewise, the training of personnel for collection of environmental samples have been completed in seven states - Chandigarh, Gujarat, Karnataka, Maharashtra, Telangana, Uttar Pradesh, and West Bengal.
RISE: commissioning new Reverse Transcription Polymerase Chain Reaction (RT-PCR) laboratories at 64 sub-district hospitals. Around 18 laboratories have received Indian Council of Medical Research (ICMR) approval and are operationalized. As of January 2022, around 463 laboratory personnel completed their online training on RT-PCR testing, while hands-on training on RT-PCR testing is being provided at the district level.
strengthen individual and institutional capabilities in the Whole Genome Sequencing (WGS). It is assisting five state governments to add WGS to existing facilities and strengthening the collection and transportation of samples used for genomic sequencing across eight states of Assam, Andhra Pradesh, Chhattisgarh, Goa, Gujarat, Jharkhand, Punjab, and Tamil Nadu. Through its partnership with Regional Medical Research Center (RMRC) Bhubaneswar and National Institute for Research in Tuberculosis (NIRT) Chennai, USG introduced Minion, an Oxford Nanopore sequencing device which is strengthening the genomic sequencing across select labs in the five states. In Hyderabad, Telangana, USG supported the state government in establishing a Whole Genome Sequencing Lab Satellite Center along with Center for Cellular and Molecular Biology (CCMB). Under this, CCMB is training a team of microbiologists from Siddhartha Medical College, Vijayawada.

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KEY SUCCESSES

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Improving Quality Systems

Disseminated guidance and SOPs to labs engaged in COVID-19 testing and training healthcare workers on sample collection safety, maintenance of sample, appropriate use, and interpretation of diagnostic tests.

Facilitated establishment, standardization and strengthening of three state AMR surveillance networks in Maharashtra, Kerala and in Delhi

Strengthened AMR testing in the veterinary sector by introducing protocols/ SOPs aligned with global guidelines

Engaging the Private Sector

Mapped RT-PCR machines in public and private sector to better engage them for scale-up of testing facilities.

Implementing ' One Stop TB/ DR-TB Diagnostic Solution Model" engaging a private sector lab for end-to-end operations.

Supported the next generation of genomic sequencing to increase COVID -19 sequencing capacity, by adopting next-generation technology, and engaging the private sector.

USG (NISHTHA) in collaboration with National Center for Disease Control (NCDC) and Integrated Disease Surveillance Program (IDSP) launched the Integrated Health Information Platform (IHIP) in six states - Madhya Pradesh, Arunachal Pradesh, Sikkim, Manipur, Mizoram, and Nagaland. IHIP is a platform designed to provide real-time data on disease surveillance, including outbreak detection and response; patient treatment and management for multiple health programmes; and other critical health management information. The aim is to improve public health surveillance and response, quality and coverage of care, and overall health system performance. USG is providing handheld support to the state and the district surveillance units towards making the portal operational; and strengthening disease surveillance in the country by establishing a decentralized state-based surveillance system for epidemic prone diseases. USG is developing citizen-centric models of surveillance using artificial intelligence/machine learning tools for media scanning and detecting early warning signals and is also working closely with the State Surveillance Unit and the Directorate Health Services (DHS), Pune, Maharashtra to provide technical assistance for the sentinel surveillance with Whole Genome Sequencing (WGS) of COVID-19.
MAIF developing an integrated early warning system to track various health and environment indicators/data sources such as wastewater, diagnostic data, air and water, and analyzes/translates to actionable insights for local authorities – in coordination with private players (providing surveillance solutions), corporates (managing townships, beneficiaries of surveillance, providing funding/CSR), government (providing public health linkages) and implementing partners (supporting on-ground surveillance activities).
(CAC) introduced Environmental Surveillance platform - Precision Health in India. This platform tests the community sewage and wastewater to detect pathogens which may be shed by the infected in the community. In collaboration with Tata Institute for Genetics and Society (TIGS) -National Center For Biological Sciences(NCBS)-Biome group initiative, which covers all the functional 28 sewer shed sites of Bangalore the number of operational sites has increased to 74. Three early warning signals reported to Bruhat Bengaluru Mahanagara Palike (BBMP) during November and December, 2021 even before the third wave was identified through clinical cases. The initiative conducted variant testing through Genome Sequencing. Around 45 samples were sent for Genome Sequencing, out of which 14 samples were detected with lineages and sub-lineages of different variants. An Omicron variant was detected in January 2022.

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SURVEILLANCE

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Eg IHIP at PHCs,

passenger screening

Media surveillance

ECOSYSTEM

AGENT

HOST

1

2

3

DISEASE

Eg Demonstrating integrated environmental surveillance; supporting the GOI

Eg Technical assistance, SOPs and guidelines, dashboards, capacity building , metropolitan surveillance research

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KEY SUCCESSES

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Improving Host Surveillance

Developed citizen-centric models of surveillance using AI/ML tools for media scanning and detecting early warning signals such as:

AI integrated automated media scanning and verification team covering 10 major languages in place at the Central Surveillance Unit of Integrated Disease Surveillance Program (IDSP).
‘Participatory Disease Surveillance Model’ in HWCs. The model leverages digital connectivity to directly engage the community using mobile apps and an IVR-based system to participate in disease surveillance exercise.

Android application to track and screen international passengers and their contacts for severe acute respiratory syndrome coronavirus-2 (SARS-COV2).

Strengthened the leadership of Indian Council of Agriculture Research (ICAR), by facilitating the establishment a network of laboratories from fisheries and livestock sectors to undertake surveillance of AMR, the Indian Network for Fisheries and Animal Antimicrobial Resistance (INFAAR).

- USG (Trace TB) developed a media scanning tool to collate information related to health and generate early warning signals. The project will soon be automating the existing media scanning cells of the Integrated Disease Surveillance Program (IDSP).

�USG (NISHTHA) developed an android application for tracking and screening of international passengers and their contacts for severe acute respiratory syndrome coronavirus-2 (SARS-COV2) variants arriving from high and low risk countries. The digital application also helps in recording the sample collection and test results for Reverse Transcription–Polymerase Chain Reaction (RT-PCR) which is sent for the Whole Genome Sequencing (WGS) surveillance, providing the real-time state and district-wise information of key indicators. The model is presently being implemented in Madhya Pradesh.

�USG (NISHTHA) is implementing the ‘Participatory Disease Surveillance Model’, in Madhya Pradesh with the catchment area of 30-40 HWCs in the 2 blocks of Guna and 2-3 slums of Bhopal. The model leverages digital connectivity to directly engage the community using mobile apps for smartphone users and an IVR-based system for basic phone users to participate in the disease surveillance exercise. The innovative model aims to decrease the surveillance reporting burden for the healthcare providers (ANM, Medical Officer, and laboratory technicians) and involves the Panchayati Raj Institutions (PRI) members to collect data.

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KEY SUCCESSES

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Improving Agent Surveillance:

Demonstrating integrated early warning system to track health and environment indicators/data sources such as wastewater.

Demonstrated an environmental surveillance platform that community sewage and wastewater to detect pathogens including new variants of concern

Strengthening the Surveillance Ecosystem

Provided technical assistance to State Surveillance Unit and Directorate Health Services to operationalize PM-ABHIM

Built sub national dashboards and analytics

Supported standardizing the basic laboratory protocols for the State of Chhattisgarh to strengthen virology labs

Technical support to ICMR to implement testing guidance and develop training material for health functionaries

Supporting research to guide decision makers on comprehensive surveillance systems for metropolitan cities

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- USG (Trace TB) developed a media scanning tool to collate information related to health and generate early warning signals. The project will soon be automating the existing media scanning cells of the Integrated Disease Surveillance Program (IDSP).

�USG (NISHTHA) developed an android application for tracking and screening of international passengers and their contacts for severe acute respiratory syndrome coronavirus-2 (SARS-COV2) variants arriving from high and low risk countries. The digital application also helps in recording the sample collection and test results for Reverse Transcription–Polymerase Chain Reaction (RT-PCR) which is sent for the Whole Genome Sequencing (WGS) surveillance, providing the real-time state and district-wise information of key indicators. The model is presently being implemented in Madhya Pradesh.

�USG (NISHTHA) is implementing the ‘Participatory Disease Surveillance Model’, in Madhya Pradesh with the catchment area of 30-40 HWCs in the 2 blocks of Guna and 2-3 slums of Bhopal. The model leverages digital connectivity to directly engage the community using mobile apps for smartphone users and an IVR-based system for basic phone users to participate in the disease surveillance exercise. The innovative model aims to decrease the surveillance reporting burden for the healthcare providers (ANM, Medical Officer, and laboratory technicians) and involves the Panchayati Raj Institutions (PRI) members to collect data.

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- USG (RISE) supports the Special Surveillance System (SSS) Portal, for state level predictive analytics which has helped with an improved case management, data automation for information management in the states; management of COVID-19 emergency operation centers; and contact tracing.

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WORKFORCE/HUMAN RESOURCE DEVELOPMENT

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Disease Surveillance

Emergency Support Training

Clinical & community-based approaches to better prepare workforce and communities to prevent and respond to emerging infections

Strengthen Infection prevention Control activities in healthcare facilities

Improving Critical COVID Care, Critical ICU training, establishing skill labs, O2 management support

Robust, responsive Technical Support Units (TSU) across implementation states to strengthen and capacitate health workers

Facility-readiness Assessment

Disease Preparedness (clinical/community)

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BUILDING CAPACITY OF WHOM

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Individuals

The patient and their family/ caregivers/ farmers

Peer groups, community leaders, frontline workers

Communities

Healthcare facilities

Supporting Services

Nurses aids, nurses, community health officers, doctors, specialists, administrators

Lab techs, IT coordinators, data entry, surveillance officers, helpline operators

and more

Local community CBOs, decision makers, other relevant ministries

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KEY SUCCESSES

Disease Surveillance Support

Training IHIP users on developing real time, case-based information, with integrated analytics for better disease surveillance.
Training data managers and district epidemiologists on Whole Genome Sequencing (WGS) and updating genome sequencing results on IHIP
Hands-on training of trainers on RT-PCR by ICMR-RMRC in partnership with London School of Tropical Medicine and Hygiene
Training on contact tracing and RT-PCR sampling of international passengers for district epidemiologist, district data manager and rapid response teams

Emergency Support Training

Technical training to government staff on oxygen ecosystem management, operation and troubleshooting of oxygen equipment in the facility, O2 Demand Aggregation system (ODAS), O2 Digital Tracking System (ODTS), to ascertain demand for medical O2 from all medical facilities and to track their transportation.

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IDDS

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KEY SUCCESSES

Facility-readiness assessment

Readiness assessment for facilities that included work forces; developed Learning Resource Package (ICMR-RMRC, NIRT & CCMB).

Clinical and community:

Deployed e-mentoring sessions and clinical case-based discussion along with Johns Hopkins University Center for Emergency Care and Clinical Global Health Education and disseminated SOPs, guidelines, best practice documents on management of critically ill COVID-19 patients, pediatric emergencies, infection prevention, basic life support.

Trained all levels of service providers on Presumptive (P), Laboratory (L) and Syndromic (S) Surveillance Forms.

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IDDS

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THANK YOU

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