The East African Community (EAC) mobile laboratory networks in Kenya, Burundi, Tanzania, Rwanda, Uganda, and South Sudan—from project implementation to outbreak response against Dengue, Ebola, COVID-19, and epidemic-prone diseases
Authors: Affara Muna , Lagu Hakim Idris , Achol Emmanuel , Karamagi Richard , Omari Neema , Ochido Grace , Kezakarayagwa Eric , Kabatesi Francine , Nkeshimana Anatole , Roba Abdi , Ndia Millicent Nyakio , Abudo Mamo U. , Kabanda Alice , Mpabuka Etienne , Mwikarago Emil Ivan , Kutjok Philip Ezekiel , Samson Donald Duku , Deng Lul Lojok , Moremi Nyambura , Kelly Maria Ezekiely , Mkama Peter Bernard Mtesigwa , Magesa Alex , Balinandi Stephen Karabyo , Pimundu Godfrey , Nabadda Susan Ndidde , Puradiredja Dewi Ismajani , Hinzmann Julia , Duraffour Sophie , Gabriel Martin , Ruge Gerd , Loag Wibke , Ayiko Rogers , Sonoiya Stanley Serser , May Juergen , Katende Michael J. , Gehre Florian 
Published: July 2021

Abstract
Background
East Africa is home to 170 million people and prone to frequent outbreaks of viral haemorrhagic fevers and various bacterial diseases. A major challenge is that epidemics mostly happen in remote areas, where infrastructure for Biosecurity Level (BSL) 3/4 laboratory capacity is not available. As samples have to be transported from the outbreak area to the National Public Health Laboratories (NPHL) in the capitals or even flown to international reference centres, diagnosis is significantly delayed and epidemics emerge.

Main text
The East African Community (EAC), an intergovernmental body of Burundi, Rwanda, Tanzania, Kenya, Uganda, and South Sudan, received 10 million € funding from the German Development Bank (KfW) to establish BSL3/4 capacity in the region. Between 2017 and 2020, the EAC in collaboration with the Bernhard-Nocht-Institute for Tropical Medicine (Germany) and the Partner Countries’ Ministries of Health and their respective NPHLs, established a regional network of nine mobile BSL3/4 laboratories. These rapidly deployable laboratories allowed the region to reduce sample turn-around-time (from days to an average of 8h) at the centre of the outbreak and rapidly respond to epidemics.
In the present article, the approach for implementing such a regional project is outlined and five major aspects (including recommendations) are described: (i) the overall project coordination activities through the EAC Secretariat and the Partner States, (ii) procurement of equipment, (iii) the established laboratory setup and diagnostic panels, (iv) regional training activities and capacity building of various stakeholders and (v) completed and ongoing field missions. The latter includes an EAC/WHO field simulation exercise that was conducted on the border between Tanzania and Kenya in June 2019, the support in molecular diagnosis during the Tanzanian Dengue outbreak in 2019, the participation in the Ugandan National Ebola response activities in Kisoro district along the Uganda/DRC border in Oct/Nov 2019 and the deployments of the laboratories to assist in SARS-CoV-2 diagnostics throughout the region since early 2020.

Conclusions
The established EAC mobile laboratory network allows accurate and timely diagnosis of BSL3/4 pathogens in all East African countries, important for individual patient management and to effectively contain the spread of epidemic-prone diseases.