Enhancing preparedness for tackling new epidemic threats
Authors: Alimuddin Zumla, Giuseppe Ippolito, Brian McCloskey, Matthew Bates, Rashid Ansumana, David Heymann, Richard Kock, Francine Ntoumi
Journal: The Lancet Respiratory Medicine (2017)

New and re-emerging infectious diseases cause much human suffering worldwide.1Mathis M Briand S Prentice T Emerging and re-emerging infectious threats in the 21st century.Wkly Epidemiol Rec. 2015; 90: 238-244PubMed Google Scholar Many of these diseases are zoonoses2World Health OrganizationZoonoses.http://www.who.int/zoonoses/diseases/en/Google Scholar with epidemic potential. All sub-Saharan African regions are highly biodiverse with large rural populations that are highly dependent on livestock agriculture. Movement of pathogens between animals and people increases as the domestic populations expand, creating novel ecotones and ecosystemic perturbation. With increasing food security demands, intensification of livestock and agriculture is required and further evolution and spill over of novel zoonoses to humans is inevitable. The emergence this century of previously unknown zoonotic respiratory tract infectious diseases with epidemic potential,3World Health OrganizationWHO publishes list of top emerging diseases likely to cause major epidemics.http://www.who.int/medicines/ebola-treatment/WHO-list-of-top-emerging-diseases/en/Google Scholar such as Avian influenza, Severe Acute Respiratory Syndrome (SARS), and Middle East Respiratory Syndrome (MERS), highlights an urgent need to change the current global status quo.4McCloskey B Dar O Zumla A Heymann DL Emerging infectious diseases and pandemic potential: status quo and reducing risk of global spread.Lancet Infect Dis. 2014; 14: 1001-1010Summary Full Text Full Text PDF PubMed Scopus (119) Google Scholar The 2015 west African Ebola virus epidemic5World Health OrganizationEbola virus disease outbreak.http://www.who.int/csr/disease/ebola/en/Google Scholar illustrated that once an infectious disease takes hold locally, the originating region and rest of the world is put at equal risk due to ease of international travel, global food systems, livestock trade, and inadequate capacities to identify and respond to outbreaks. Several lessons were learnt from the Ebola virus outbreak that could help guide development of more effective and appropriate response capacities. Much of the spread and devastating impact of Ebola virus in west Africa was rooted in the emerging environmental, socioeconomic, and socio-anthropological changes taking place in west Africa. The highly medicalised approach and ineffectiveness of the local and regional surveillance mechanisms delayed appropriate socioecological management of the epidemic.6Jacobsen KH Aguirre AA Bailey CL et al.Lessons from the Ebola outbreak: action items for emerging infectious disease preparedness and response.Ecohealth. 2016; 13: 200-212Crossref PubMed Scopus (65) Google Scholar, 7Walker NF Whitty CJ Tackling emerging infections: clinical and public health lessons from the West African Ebola virus disease outbreak, 2014–2015.Clin Med. 2015; 15: 565Crossref PubMed Scopus (3) Google Scholar Absent were effective active disease surveillance, early diagnosis using rapid diagnostic tests, rapid communication of data for health systems, and engagement and awareness of communities,6Jacobsen KH Aguirre AA Bailey CL et al.Lessons from the Ebola outbreak: action items for emerging infectious disease preparedness and response.Ecohealth. 2016; 13: 200-212Crossref PubMed Scopus (65) Google Scholar, 7Walker NF Whitty CJ Tackling emerging infections: clinical and public health lessons from the West African Ebola virus disease outbreak, 2014–2015.Clin Med. 2015; 15: 565Crossref PubMed Scopus (3) Google Scholar, 8Thiam S Delamou A Camara S et al.Challenges in controlling the Ebola outbreak in two prefectures in Guinea: why did communities continue to resist?.Pan Afr Med J. 2015; : 22PubMed Google Scholar to implement intervention measures to control spread. Behavioural factors also contributed to rapid outbreak spread. Improved understanding of eco-epidemiological, socio-cultural, anthropological, and political determinants that drive the emergence and spread of disease is crucial to preventing epidemics. Furthermore, the lack of local capacity and preparedness in affected west African countries to conduct comprehensive, multidisciplinary and well-coordinated research was also evident during the Ebola virus epidemic. Foreign aid workers and research groups aroused local anxieties among communities8Thiam S Delamou A Camara S et al.Challenges in controlling the Ebola outbreak in two prefectures in Guinea: why did communities continue to resist?.Pan Afr Med J. 2015; : 22PubMed Google Scholar due to ignorance of, or insensitivity to, cultural norms. Research studies to assess and determine optimal management protocols and trial new treatments and vaccines were slow to start,9Ippolito G Lanini S Brouqui P et al.Ebola: missed opportunities for Europe-Africa research.Lancet Infect Dis. 2015; 15: 1254-1255Summary Full Text Full Text PDF PubMed Scopus (13) Google Scholar and were dominated by foreign groups, with scant involvement of African scientists or local policy makers. Newer treatments in development and those with compassionate-use regulations were available but their use and evaluation to inform optimal evidence-based management, were slowed down by the absence of rapid ethical review processes for research in emergency situations. A more collaborative, inclusive, and strategic ONE HEALTH partnership between the human, environmental, and animal health sectors10Zumla A Dar O Kock R et al.Taking forward a 'One Health' approach for turning the tide against the Middle East respiratory syndrome coronavirus and other zoonotic pathogens with epidemic potential.Int J Infect Dis. 2016; 47: 5-9Summary Full Text Full Text PDF PubMed Scopus (72) Google Scholar is now essential to address recurrent and emergent zoonotic threats effectively and to improve national capabilities on disease preparedness, surveillance, and response for preventing another major epidemic in Africa. This partnership will also enable issues around the growing global threat of antimicrobial resistance to be tackled. Although antibiotic resistant bacteria have spread globally due to increased travel and population movement, the scale of the problem of antimicrobial resistance in Africa remains largely undefined. The WHO recommendations on antimicrobial resistance11WHO Antimicrobial resistancehttp://www.who.int/antimicrobial-resistance/en/Google Scholar points out the lack of surveillance data and highlights the need for coordination between human and animal surveillance systems. Based on a comprehensive inter-epidemic work programme, a ONE HEALTH partnership for emerging diseases and preparedness needs to develop and strengthen suitable sites and regional networks to enable resolution of administrative, regulatory, disciplinary, ethical, and cultural barriers; harmonise clinical case definitions and management guidelines; pre-approve adaptable protocols; and introduce mechanisms to rapidly exchange high quality data and samples. Such a partnership would ensure the readiness to immediately perform coordinated basic science research, to define the source of outbreak and transmission dynamics, and to conduct large-scale multisite clinical studies. It will enable establishment of regional high quality laboratories incorporating rapid diagnostics for multiple pathogens, and proactive surveillance systems providing latest real-time information.12Zumla A Goodfellow I Kasolo F et al.Zika virus outbreak and the case for building effective and sustainable rapid diagnostics laboratory capacity globally.Int J Infect Dis. 2016; 45: 92-94Summary Full Text Full Text PDF PubMed Scopus (17) Google Scholar Replication of the mobile laboratory model in all African regions will also enable to take forward the important agenda of establishing effective rapid response teams for outbreaks with support of national governments and public health services. New opportunities to take this ONE HEALTH concept forward comes from several promising developments. The newly established Africa Centers for Disease Control and Prevention (Africa CDC), through five regional centres will perform disease surveillance, investigation, and tracking of infection trends to help African Member States detect and respond to public health emergencies.13Nkengasong JN Maiyegun O Moeti M Establishing the Africa Centres for Disease Control and Prevention: responding to Africa's health threats.Lancet Glob Health. 2017; 5: e246-e247Summary Full Text Full Text PDF PubMed Scopus (48) Google Scholar Four research and capacity development networks of excellence exist across central, west, east, and southern Africa14EDCTP networks of excellencehttp://www.edctp.org/networks-excellence/Google Scholar with extensive experience of work on tuberculosis, HIV, malaria, and viral haemorrhagic fevers. With a critical mass of political support and resources of public health, veterinary, wildlife health, and clinical laboratories will ensure the timeliness and quality of surveillance, research, and response to zoonoses and the fractious issues of antimicrobial resistance in Africa. Benefits will not only accrue to public health but also food security and biodiversity conservation. Existing links with ongoing initiatives on emerging infections such as USAID Emerging Pandemic Threats Program,15USAID Emerging Pandemic Threats Programhttps://www.usaid.gov/news-information/fact-sheets/emerging-pandemic-threats-programGoogle Scholar WHO-Global Outbreak Alert and Response Network (GOARN),16Global Outbreak Alert and Response Networkhttp://www.who.int/ihr/alert_and_response/outbreak-network/en/Google Scholar Global Research Collaboration for Infectious Disease Preparedness (GLOPID-R), World Organisation for Animal Health, and other stakeholders could ensure implementation of findings into optimal health guidelines, standards, and policy recommendations. Importantly, the future of public health services in Africa will depend on empowering a whole generation of young African health-care workers, scientists, and technical staff to take leadership of emerging and re-emerging infections through high quality training and mentorship. The time is now for Africa to take bold steps (appendix) to develop its own capabilities and capacities to rapidly identify and respond quickly and effectively to potential outbreaks. The challenge is for African scientists, public health personnel, and national governments to take leadership of developing a new vision through a ONE HEALTH strategy for the emerging and re-emerging infectious diseases and antimicrobial resistance portfolio across the continent. All authors report an interest in emerging infections and are members of the PANDORA-ID-NET consortium. FN and AZ are members of the European & Developing Countries Clinical Trials Partnership-funded Central African Network on HIV/AIDS, tuberculosis and Malaria Network of Excellence-CANTAM-2. Download .pdf (.17 MB) Help with pdf files Supplementary appendix