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Ann Marie Kimball, MD, MPH, Director, APEC EINet University of Washington

A Grand Challenge to Information Systems: Success in Infectious Disease Control in the Asia Pacific. Ann Marie Kimball, MD, MPH, Director, APEC EINet University of Washington. Outline. Challenge, Overall Goal- “Working” Virtual Public Health community across the Asia Pacific

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Ann Marie Kimball, MD, MPH, Director, APEC EINet University of Washington

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  1. A Grand Challenge to Information Systems: Success in Infectious Disease Control in the Asia Pacific Ann Marie Kimball, MD, MPH, Director, APEC EINet University of Washington

  2. Outline • Challenge, Overall Goal- “Working” Virtual Public Health community across the Asia Pacific • Rationale- Increasing integration through trade, finance, travel creating increased risk of pandemics • Methods-EINet and beyond • What next? The grand challenge of situation awareness, prediction, control and success

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

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

  5. APEC EINet Newsbrief

  6. Two coincident challenges:1) Pandemic Preparedness,2) Implementation of the International Health Regulations • The new International Health Regulations approved by the WHA 2005, Require countries to control outbreaks within their borders • Assessments by 2008, plans by 2009

  7. Yes No Is the event unexpected? Is the event unexpected? Yes No Yes No Could it (or has it) spread internationally? Risk for international sanctions? No Yes Reassess when more information available Yes No Notify the event under the International Health Regulations 1) THE INTERNATIONAL HEALTH REGULATIONS; A WHOLE NEW PARADIGM Is the event serious?

  8. Challenge 2) Influenza, a global threat • Avian influenza H5N1 virus has manifested itself globally • Asia Pacific community has been hit hardest. • Economic, agricultural, and public health impacts. • Potential to turn into a pandemic influenza and become a substantially greater global threat.

  9. What is next with Avian Influenza? • Active Surveillance in place ,sub-regional exercises in pandemic preparedness, APEC, ASEAN,WHO • High human mortality, poor transmission • 200 deaths in 328 cases worldwide (173 deaths in 265 cases in Asia) • “Threshold” for pandemic is not known.

  10. Trade, Travel Direct Contagion Disease Transmission and Interruption: The Race between Traffic, Transmission and Control Mechanisms TRANSNATIONAL TRAFFIC Levels of Prevention: Levels of Microbial Traffic

  11. Trade, Travel Direct Contagion THE NEW IMPERATIVE FOR GLOBAL POPULATION SAFETY Mechanisms Remedies TRANSNATIONAL PUBLIC HEALTH PRACTICE TRANSNATIONAL TRAFFIC Levels of Prevention: Levels of Microbial Traffic

  12. The Preparedness Imperative: • Preparedness against the threat of pandemic influenza • Little transnational exchange of preparedness plans. • Communication is one key for improving preparedness and response • Collaboration between public and private sectors highly variable in APEC economies • Capacity for “on the ground investigation” is very uneven.

  13. Why videoconferencing? • Facilitates “high level” but informal discussions (non-representational) • Real-time communication with multiple sites (can simulate face-to face meeting--more cues than teleconferencing). • Virtual medium is unaffected by travel advisories or restrictions (potential for use during actual pandemic). • Tested systems—e.g. Access Grid (was used during SARS outbreak in Taiwan).

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

  15. Virtual Symposium • To discuss pandemic influenza preparedness and response in the Asia Pacific Region. • Thoroughly “vetted” agenda, previewed slides • Technology testing • Interactive with experienced facilitator

  16. Methods: the EINet link • EINet linked public health to technology counterparts for each participating economy • E.g. In Australia, Australia’s Academic and Research Network (AARNet) worked with the Dept. of Health and Ageing • Build on preexisting relationships among and with advanced networks and research institutions • Request technology partners to host public health

  17. PLAY VIDEO First Virtual Symposium 2006

  18. Results: Successful “Beta” Virtual Symposium • 10 APEC economies presented their epidemiologic situation and pandemic planning • 210 minute real-time virtual meeting. • Few technical difficulties. • Consensus on follow-up discussions.

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

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

  21. Limitations • Access to technology: • Those economies without Access Grid (i.e., Chile and Peru) were unable to participate. • Viet Nam was hosted in Thailand, but such a model is not sustainable • We need a working plan for Indonesian participation this round. • Currently planning on technical outreach to these economies to allow for future participation.

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

  23. Caveat • Technology is a moving target • Access Grid was the appropriate technology to use at the time, combined with polycom for second symposium • Access Grid demands significant technical support, unreliable for extended symposium • Promising technologies are much needed • Easier to set up • Have the same functionality as Access Grid • Can work on dialup lines and advanced networks

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

  25. Conclusions: “High Level” • Partnership of public health and advanced network communities holds promise in planning pandemic preparedness and response in the Asia Pacific region. • Deployment and utilization of common videoconferencing technology should be considered for pandemic influenza preparedness.

  26. Conclusions: The local and national “working” level • The importance of human networks reigns supreme: EINET and APAN collaborations have “positioned” our ability to contribute • UW entering collaboration with PRC/CDC, US CDC for Field epidemiology training • Working with Thailand, MBDS in same domain • Ongoing team member is senior adviser to Japan FETP.

  27. Ability to compile micro to macro information , visualize and analyze Explore “prediction” with non traditional information sources, modeling. e.g, travel routes and volumes, trade flows, linked to genomics Standard platforms for lab/reporting which includes geospatial Generalized field epidemiology competence with continuing education Persistent communications Full text library access Some “Grand Challenge” elements for Communicable Disease Control

  28. Acknowledgments • Funding: APEC, IBM, and the Global Health and Securities Initiative (NTI). • Participants: All participating public health institutions and advanced networks. • Technical support: Pacific Northwest Gigapop and UWTV.

  29. Participating Economies from the Public Health sector: 2nd Virtual Symposium • Brunei Department of Health • Peru Ministry of Health, National Institutes of Health • Australia Dept of Health and Ageing • Public Health Agency of Canada • People’s Republic of China: Ministry of Health • Ministry of Health Japan • Korea Center for Disease Control and Prevention • Malaysia Ministry of Health • Ministry of Health Papua New Guinea • Indonesian Ministry of Health • Philippines Dept of Health • Singapore Ministry of Health • Chinese Taipei: Taiwan Center for Disease Control • Thailand Ministry of Public Health • USA: Georgia State Department of Health; US Centers for Disease Control and Prevention • Viet Nam Institute of Hygiene and Epidemiology

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

  31. For more informationabout EINet apecein@u.washington.edu http://depts.washington.edu/einet

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