2021GLOBAL MEETING OF PARTNERS

GOARN

Virtual meeting14–16 December 2021

Fourth meeting of the Global Outbreak and Alert Response Network (GOARN) partners

Fourth meeting of the Global Outbreak and Alert Response Network (GOARN) partners: virtual meeting, 14–16 December 2021

ISBN 978-92-4-004695-5 (electronic version)ISBN 978-92-4-004696-2 (print version)

© World Health Organization 2022

Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo).

Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO endorses any specific organization, products or services. The use of the WHO logo is not permitted. If you adapt the work, then you must license your work under the same or equivalent Creative Commons licence. If you create a translation of this work, you should add the following disclaimer along with the suggested citation: “This translation was not created by the World Health Organization (WHO). WHO is not responsible for the content or accuracy of this translation. The original English edition shall be the binding and authentic edition”.

Any mediation relating to disputes arising under the licence shall be conducted in accordance with the mediation rules of the World Intellectual Property Organization (http://www.wipo.int/amc/en/mediation/rules/).

Suggested citation. Fourth meeting of the Global Outbreak and Alert Response Network (GOARN) partners: virtual meeting, 14-16 December 2021. Geneva: World Health Organization; 2022. Licence: CC BY-NC-SA 3.0 IGO.

Cataloguing-in-Publication (CIP) data. CIP data are available at http://apps.who.int/iris.

Sales, rights and licensing. To purchase WHO publications, see http://apps.who.int/bookorders. To submit requests for commercial use and queries on rights and licensing, see https://www.who.int/copyright.

Third-party materials. If you wish to reuse material from this work that is attributed to a third party, such as tables, figures or images, it is your responsibility to determine whether permission is needed for that reuse and to obtain permission from the copyright holder. The risk of claims resulting from infringement of any third-party-owned component in the work rests solely with the user.

General disclaimers. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of WHO concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement.

The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by WHO in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters.

All reasonable precautions have been taken by WHO to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall WHO be liable for damages arising from its use.

This publication contains the collective views of an international group of experts and does not necessarily represent the decisions or the policies of WHO.

Design: Comstone

iii

CONTENTS

Abbreviations iv

Message from the Chair 1

1 Introduction 2About the Global Meeting of Partners 3

2 Opening remarks and keynote speeches 5

3 Key achievements of GOARN and upcoming opportunities for collaboration 8

4 Strengthening global collaboration for global alert and surveillance 13

5 Taking an integrated approach to outbreak analytics 16

6 Shaping a strong future for response: the GOARN Strategy 2022–2026 19

7 Emerging diseases and One Health 22

8 Capacity-building and training 26

9 Technical collaboration for stronger public health impact 31

10 The global health emergency workforce and GOARN 34

11 Output from the strategic conversation at GMP 2021 38

12 Governance 40

13 Closure of the meeting 41

Annexes 43Annex 1: GMP 2021 Agenda 46

Annex 2: List of Participants 48

Annex 3. Topical webinar 1. Shifting the community engagement paradigm 57

Annex 4. Topical webinar 2. ‘Go with GOARN’ – the realities of deploying experts for an international outbreak response 64

Annex 5. Topical webinar 3. Explore the Go.Data global roll-out opportunity 70

Annex 6. Topical webinar 4. Operational research 78

iv

BAG WHO Biosafety Advisory GroupBNI Bernard Nocht Institute for Tropical

Medicine, GermanyCBT Capacity-building and trainingCDC United States Centers for Disease

Control and PreventionDHIS2 District Health Information System 2ECDC European Centre for Disease

Prevention and ControlEIOS Epidemic Intelligence from

Open SourcesEMT Emergency medical teamFAO Food and Agriculture Organization of

the United NationsFETP Field epidemiology training

programme GISAID Global Initiative on Sharing All

Influenza DataGMP Global Meeting of PartnersGOARN Global Outbreak Alert and Response

NetworkGPW 13 WHO’s Thirteenth General

Programme of Work 2019−2023HERA European Health Emergency

preparedness and Response Authority

IANPHI International Association of National Public Health Institutes

ICRC International Committee of the Red Cross

IFRC International Federation of Red Cross and Red Crescent Societies

IHR International Health Regulations (2005)

ILO International Labour OrganizationIOA Integrated outbreak analytics

IOAC Independent Oversight and Advisory Committee for the WHO Health Emergencies Programme

IPC Infection prevention and controlIPPPR Independent Panel for Pandemic

Preparedness and ResponseISARIC International Severe Acute

Respiratory and emerging Infections Consortium

ITM Institute of Tropical Medicine, BelgiumLSHTM London School of Hygiene and

Tropical Medicine, United KingdomM&E Monitoring and evaluationMSF Médecins Sans FrontièresNCGM National Center for Global Health

and Medicine, JapanOHHLEP One Health High-Level Expert PanelOIE World Organisation for Animal HealthPHSM Public health and social measuresRCCE Risk communication and community

engagementRRML Rapid response mobile laboratorySAGO WHO Scientific Advisory Group on

the Origins of Novel PathogensSBS Saïd Business School, University of

Oxford, United KingdomSCOM GOARN Steering CommitteeTEPHINET Training Programs in Epidemiology and

Public Health Interventions NetworkUNEP United Nations Environment

ProgrammeUNHCR Office of the United Nations High

Commissioner for RefugeesUNICEF United Nations Children’s FundWaSH Water, sanitation and hygieneWHO World Health Organization

ABBREVIATIONS

1

MESSAGE FROM THE CHAIRI would like to thank everyone who participated in the December 2021 Global Meeting of Partners. It was certainly the most challenging of GMPs to create, given the restraints of travel

and the extreme demands on all of our time at what is now the end of the second year of the pandemic. With outstanding support from partner institutions, through

their leadership and focal points especially, the three-day meeting saw more than half the network actively engaged in the agenda. We covered the routine

updates and presented new tools and concepts. A constant thread was the future. How will Global Health Security emerge from the pandemic? With which new stakeholders and structures, particularly for health emergencies preparedness and response, will GOARN need to forge strong relationships? An important piece of work expected to be concluded in February 2022 is the

GOARN strategy for the next four years. Discussion was robust and will enrich the final product.

It is a critical time for GOARN and I urge all network institutional partners, through their focal points and other committed individuals, to engage in our activities. Opportunities will arise

for involvement as members of SCOM, in training, research, rapid response capacities, alert and surveillance, preparedness efforts and, of course, deployments.

I am sure you will find interesting components in this document and hope you enjoy looking through the key points of the GMP 2021 that follow.

Dale FisherChairperson, GOARN Steering Committee, 2018–2022

2

The Global Outbreak Alert and Response Network – also referred to as GOARN – is a global technical partnership established by the World Health Organization (WHO) as a key mechanism to engage the resources of technical agencies beyond the United Nations for rapid identification and confirmation of and response to public health emergencies of international concern.

In 2000, WHO took the initiative with key operational partners to set up GOARN as the framework to strengthen operational coordination and build outbreak response capacity. Since the Network’s inception, partners have provided technical support for international outbreak response to over 150 major outbreaks in more than 100 countries. These missions have involved over 3 500 deployments of experts and the mobilization of outbreak response teams and equipment, including mobile laboratories, information management tools and communication equipment, vehicles and response kits. In most cases, when countries have requested assistance from WHO, GOARN has provided coordination of the response from partners.

GOARN currently comprises over 260 technical institutions and networks (and their members) across the globe. These partners include medical and surveillance initiatives, regional technical networks, networks of laboratories, United Nations organizations such as the United Nations Children’s Fund (UNICEF) and the Office of the United Nations High Commissioner for Refugees (UNHCR), the International Federation of Red Cross and Red Crescent Societies (IFRC) and the International Committee of the Red Cross (ICRC), international humanitarian nongovernmental organizations (e.g. Médecins Sans Frontières (MSF) and the International Rescue Committee) and national public health institutions. All have the ability to pool their resources rapidly to assist affected countries seeking support. GOARN partners provide access to dependable technical capacities and response, as a lynchpin of the global system, and play an important role in development of the global response capacity.

1INTRODUCTION

3

About the Global Meeting of Partners

GOARN’s Global Meeting of Partners (GMP) provides a unique opportunity to discuss global priorities and challenges in emergency preparedness and epidemic alert and response, review the strategic direction of the Network, endorse important areas of work for operations and development, and contribute to concrete workplans and activities in the coming years. The meeting targets decision-makers and operation leads of GOARN partner agencies and key stakeholders, who can provide critical inputs and agree on participation in collaborative opportunities on behalf of their institutions.

The number of partners has increased significantly over the past 21 years, and the activities of the Network have increased. The primary objective of the GMP is to actively engage partners in the governance, development and operations of GOARN, and to seek endorsement of these from partners. There are a number of additional objectives, including to discuss the evolution of global systems for health security; to discuss and review governance issues required to better position GOARN to fulfil its alert and response mandate; and to provide partners with greater transparency in the operation of the Network’s Steering Committee.

Since the inception of GOARN, WHO has convened global meetings in 2004 (Atlanta), and 2009 and 2017 (Geneva). Additional regional meetings of partners have also provided major opportunities for networking, strengthening regional capacity and learning lessons from alert and response to major outbreaks in each part of the world.

The COVID-19 pandemic has exposed the strengths and gaps in global alert and response, including those of GOARN. Recent reviews and evaluations have suggested the need for a substantial rethink of global, regional and local capacities for emergency response, in order to generate greater resilience to forthcoming health challenges. They have also recommended significant strengthening of and investment in GOARN partners and the WHO/GOARN Operational Support Team.

This is a critical time for the Network to do right by populations at risk of life-threatening infectious diseases and to recalibrate its strategy for a more impactful future.

The aims of GMP 2021 were to enable participants to: l work together on current global priorities in health security and on major strategies and

implementation plans for GOARN support to countries and Network activities; l meet the GOARN Steering Committee, to guide and support the strategy for Network

development and implementation; l explore key areas of work for 2022–2026 and learn about the opportunities to establish

strong collaboration with institutions; l discuss and endorse the governance mechanisms that would shape the future of GOARN.

The Global Outbreak Alert and Response Network – also referred to as GOARN – is a global technical partnership established by the World Health Organization (WHO) as a key mechanism to engage the resources of technical agencies beyond the United Nations for rapid identification and confirmation of and response to public health emergencies of international concern.

In 2000, WHO took the initiative with key operational partners to set up GOARN as the framework to strengthen operational coordination and build outbreak response capacity. Since the Network’s inception, partners have provided technical support for international outbreak response to over 150 major outbreaks in more than 100 countries. These missions have involved over 3 500 deployments of experts and the mobilization of outbreak response teams and equipment, including mobile laboratories, information management tools and communication equipment, vehicles and response kits. In most cases, when countries have requested assistance from WHO, GOARN has provided coordination of the response from partners.

GOARN currently comprises over 260 technical institutions and networks (and their members) across the globe. These partners include medical and surveillance initiatives, regional technical networks, networks of laboratories, United Nations organizations such as the United Nations Children’s Fund (UNICEF) and the Office of the United Nations High Commissioner for Refugees (UNHCR), the International Federation of Red Cross and Red Crescent Societies (IFRC) and the International Committee of the Red Cross (ICRC), international humanitarian nongovernmental organizations (e.g. Médecins Sans Frontières (MSF) and the International Rescue Committee) and national public health institutions. All have the ability to pool their resources rapidly to assist affected countries seeking support. GOARN partners provide access to dependable technical capacities and response, as a lynchpin of the global system, and play an important role in development of the global response capacity.

1INTRODUCTION

4

The fourth GMP was held from 14 to 16 December 2021. In order to comply with restrictions related to the COVID-19 pandemic, the meeting was held virtually and was open by invitation to all GOARN partner focal points. Each day, the virtual meeting convened for four hours between 12:00 and 16:00 Central European Time (CET). Topical webinars were held at the end and start of each day, from 16:00 to 18:00 and from 09:00 to 11:00, focusing on four key areas of work for the Network.

5

The meeting was opened by Professor Dale Fisher, National University of Singapore, Chairperson of the GOARN Steering Committee (SCOM). He noted that, in the 21 years of GOARN’s existence, it had been responsible for 3 500 international deployments totalling more than 105 000 person/days in country, providing support to more than 100 countries in 150 operations or missions. The SCOM had recently held its thirtieth meeting. Since 2000, GOARN had grown to encompass 270 technical institutions and networks, reaching over 500 partners globally; the 260 attendees at GMP 2021 represented 140 partner institutions in 55 countries.

Dr. Tedros Ghebreyesus, WHO Director-General, said that GOARN’s work over more than two decades had involved responding to outbreaks of Ebola virus disease, severe acute respiratory syndrome (SARS), avian influenza, influenza A (H1N1), Middle East respiratory syndrome (MERS) and COVID-19. GMP 2021 was taking place at a critical juncture in the COVID-19 pandemic. The emergence of the Omicron SARS-CoV-2 variant underscored the importance of the work of GOARN as a platform for international collaboration between scientists and public health experts and institutions, for effective early warning, alert and coordinated response.

The COVID-19 pandemic had exposed serious shortcomings in the global health architecture in the form of complex and fragmented governance, inadequate financing, and insufficient systems and tools. Voluntary mechanisms had not solved those challenges. Bringing nations together to find common ground was the only way to make sustainable progress against common threats. And for that, stronger technical collaboration, coordination and networking were needed.

OPENING REMARKS AND KEYNOTE SPEECHES

2

Bringing nations together to find common ground was the only way to make sustainable progress against common threats.

6

Two weeks earlier, at a special session of the World Health Assembly, WHO Member States had agreed to work towards a new convention, agreement or other international instrument on pandemic prevention, preparedness and response. That overarching framework could foster greater international cooperation and provide a platform for strengthening global health security in four key areas:

l more coordinated and coherent global governance, with high-level political leadership anchored in WHO;

l stable and predictable financing for global health security; l better systems and tools to predict, prevent, detect and respond rapidly to outbreaks with

epidemic and pandemic potential; and l a strengthened, empowered and sustainably financed WHO, at the centre of the global

health architecture.

Some of the new systems and tools that the world needed for enhanced global health security were already being built: the WHO Hub for Pandemic and Epidemic Intelligence had recently been opened in Berlin, Germany, and the WHO Bio Hub System would provide a mechanism for countries to share novel biological materials. GOARN was critical to WHO’s work in building and supporting an expanded and professionalized cadre of emergency responders at national and global levels, as part of a global response workforce.

He called on GOARN to expand its membership, to increase its transparency and accountability, and to step up its capacity-building for research and surveillance, as well as its training of emergency and outbreak responders. He urged all governments and donors to substantially increase investment in public health institutions and networks and to support rapid response both nationally and internationally, including through GOARN.

Mr Jagan Chapagain, Secretary General of IFRC, paid tribute to GOARN: its network structure avoided the pitfalls of top-down, command-and-control approaches to epidemics. GOARN combined the perspectives of social scientists and specialists in community engagement with those traditionally seen as epidemic response experts. Over the previous two years of the COVID-19 pandemic, IFRC had also demonstrated the impact of acting locally: national societies’ epidemic preparedness and response capacity had been strengthened by developing and training networks of volunteers to support prevention, early detection and response to outbreaks through community-based surveillance, contact tracing, health and hygiene promotion, and other interventions. Local volunteers promoted trust; building trust required sustained presence and sustained investment.

GOARN combined the perspectives of social scientists and specialists in community engagement with those traditionally seen as epidemic response experts.

7

At the global level, IFRC would continue to advocate for sustained financing and a meaningful place at the table for its network of national societies. Attention should be focused on accompanying communities in their planning, in their leadership and in adding value as true partners in their own development. Preparedness and early warning systems were built at the community level, and that was where IFRC operated. He looked to global networks such as GOARN to advocate for the creation of systems, globally and locally, that systematically included and built on the perspectives and capacities of local communities and local responders.

Ms Henrietta Fore, Executive Director of UNICEF,1 said she was proud that her organization was a member of the GOARN partnership. UNICEF contributed to outbreak alert and response by supporting sectors such as immunization, water, sanitation and hygiene (WaSH), risk communication and community engagement (RCCE), community-based health, supply and logistics, health system strengthening, and integrated outbreak analytics (IOA). Its work also included cross-sectoral areas of nutrition, child protection and education. UNICEF had strengthened its investment in GOARN, contributing full-time staff to the GOARN Operational Support Team (OST), increasing participation in GOARN trainings and helping to lead the IOA hub. The final steps were being taken in creating a system that would allow UNICEF to host GOARN experts for response operations, providing new opportunities to collaborate with experts from diverse fields.

The COVID-19 pandemic illustrated the fact that, while children were not at greatest direct risk from the virus itself, they continued to suffer disproportionately from its socioeconomic consequences. Almost two years into the pandemic, a generation of children were enduring prolonged school closures and ongoing disruptions to health, protection and education services.

The response to the pandemic must be equitable, to guarantee that the most vulnerable were prioritized and received treatment and prevention services. Equity was not just a human rights imperative: it also increased the chances of preventing and controlling outbreaks and made good public health sense. Second, health and social workers needed to be prioritized in the response, to allow them to perform their invaluable work of saving lives and stopping outbreaks. Countries should also invest in community health systems that could withstand the effects of epidemics and bounce back from shocks. And they needed good epidemiological and information systems and effective vaccination setups. Those should be supported by a functioning public health system, health care capacity, WaSH infrastructure and trust from communities.

Lastly, while responding to immediate health threats, societies must also ensure continued access to health and social services. That would prevent and mitigate an indirect increase in morbidity and mortality from other diseases, as well as collateral harm to people through increased poverty, gender-based violence and reduced access to nutritious foods.

Global threats and crises had a way of pulling together diverse partners to solve shared problems. The world currently had a historic opportunity to end the COVID-19 pandemic and build a strong foundation for epidemic preparedness and response that would serve both present and future generations.

1. Prerecorded statement broadcast on the last day of the meeting.

8

Professor Dale Fisher, SCOM Chairperson, recalled that GOARN’s Strategy 2.0, adopted in 2014, focused on four areas of work (alert and risk assessment, training, rapid response, and research) and included three leadership objectives (governance, monitoring and evaluation, and advocacy).

Features of the area of work on alert and risk assessment included the GOARN knowledge platform; weekly operations calls (40 in 2021, a total of over 145 since inception in January 2017); and GOARN partners’ participation in the Epidemic Intelligence from Open Sources (EIOS) initiative. The capacity-building and training programme involved a 35-partner network in delivering four tiers of training: Tier 1 consisted of self-directed e-modules (36 programmes in seven languages); Tier 1.5 involved both virtual and face-to-face orientation courses (approximately 500 participants studying epidemiology, infection prevention and control (IPC) and case management); scenario trainings in Tier 2 had necessarily been “parked” during the COVID-19 pandemic, but 150 participants had been involved in six Tier 3 leadership training programmes. Work was also being done on an online serious gaming prototype, for which funding had been identified and a global work group formed.

In the area of work on rapid response capacity, activities were aimed at building on existing GOARN partnerships and operational capacities, focused on strengthening national preparedness. A workshop with operational partners had been held in June 2021, and a pilot project was under way in Armenia. With regard to operational research and tools, technical guidance and support had been provided for contact tracing and genome sequencing, the Go.Data tool for data collection for outbreak investigations and response in the field had been developed, and efforts had been made to strengthen RCCE. A new RCCE collective service (being implemented jointly with WHO, UNICEF and IFRC) delivered a common strategy, tools and guidance, as well as a coordination platform for all RCCE actors at global, regional and national levels. Other key projects covered rapid response mobile laboratories (RRMLs) and IOA.

KEY ACHIEVEMENTS OF GOARN AND UPCOMING OPPORTUNITIES FOR COLLABORATION

3

9

Following the third GMP in December 2017, he and Dr Gail Carson (International Severe Acute Respiratory and emerging Infections Consortium (ISARIC)) had been selected in June 2018 as Chairperson and Vice-Chairperson of SCOM, respectively, for a term of office of two years, later extended to four years. The new SCOM, constituted in December 2018, had been charged with overseeing implementation of a four-year strategy and workplan. A new Chairperson and Vice-Chairperson would accordingly be selected in June 2022, with a new SCOM to be selected later in that year. To ensure continuity and corporate memory, at least half of the existing SCOM members would see their terms renewed.

With regard to the governance of GOARN during the pandemic, the frequency of meetings of SCOM had been increased. Support had been provided to the two WHO–China joint missions on COVID-19. GOARN had participated in the special session of the World Health Assembly and in reviews by the Independent Oversight and Advisory Committee for the WHO Health Emergencies Programme (IOAC), the Independent Panel for Pandemic Preparedness and Response (IPPPR) and the Review Committee on the Functioning of the International Health Regulations (2005) during the COVID-19 Response. A contract governing deployment of UNICEF staff had been established, and investment had been made in implementing a policy on the prevention of sexual exploitation and abuse in GOARN. Novel efforts in communication had included a statement in the Lancet the previous year;2 a series of articles published by BMC to commemorate the 20th anniversary of GOARN;3 media commentary throughout the pandemic, including webinars and comics; and the dissemination of key information through the knowledge platform. Strategy development had continued through partner engagement, as had planning of GMP 2021.

With the support of the Public Health Agency of Canada (PHAC), GOARN had made efforts to strengthen its monitoring and evaluation (M&E) mechanisms: an M&E framework had been implemented and survey instruments were being developed to collect outcome data, with the ultimate aim of being able to measure the impact of GOARN’s work.

The design phase of the process for elaborating a new GOARN strategy covering the period 2022–2026 had been completed in May 2021, and the process itself had been endorsed by the Steering Committee in June. The methodology had been finalized in July; in-depth interviews with stakeholders had been held in August; a strategy paper had been agreed with the Steering Committee at its meeting in September; and a feedback survey had been conducted in October. A strategy workshop would be held during the second day of GMP 2021.

At the SCOM meeting the previous day, Dr Mike Ryan, Executive Director, WHO Health Emergencies Programme, had urged GOARN to speak up with a clear voice in the current COVID-19 pandemic. The Steering Committee had accordingly decided that an immediate output from GMP 2021 should be a declaration or statement from GOARN, setting out the Network’s concerns for health security and expressing its collective views on how outbreak preparedness and response should be managed. A group of members of the Steering Committee would prepare a draft statement.

2. Fisher DA, Carson G on behalf of the GOARN Steering Committee. Back to basics: the outbreak response pillars. Lancet. 2020; 396: 598 (https://doi.org/10.1016/S0140-6736(20)31760-8, accessed 19 December 2021).

3. See https://www.biomedcentral.com/collections/GlobalOutbreaksandResponses (accessed 19 December 2021).

Professor Dale Fisher, SCOM Chairperson, recalled that GOARN’s Strategy 2.0, adopted in 2014, focused on four areas of work (alert and risk assessment, training, rapid response, and research) and included three leadership objectives (governance, monitoring and evaluation, and advocacy).

Features of the area of work on alert and risk assessment included the GOARN knowledge platform; weekly operations calls (40 in 2021, a total of over 145 since inception in January 2017); and GOARN partners’ participation in the Epidemic Intelligence from Open Sources (EIOS) initiative. The capacity-building and training programme involved a 35-partner network in delivering four tiers of training: Tier 1 consisted of self-directed e-modules (36 programmes in seven languages); Tier 1.5 involved both virtual and face-to-face orientation courses (approximately 500 participants studying epidemiology, infection prevention and control (IPC) and case management); scenario trainings in Tier 2 had necessarily been “parked” during the COVID-19 pandemic, but 150 participants had been involved in six Tier 3 leadership training programmes. Work was also being done on an online serious gaming prototype, for which funding had been identified and a global work group formed.

In the area of work on rapid response capacity, activities were aimed at building on existing GOARN partnerships and operational capacities, focused on strengthening national preparedness. A workshop with operational partners had been held in June 2021, and a pilot project was under way in Armenia. With regard to operational research and tools, technical guidance and support had been provided for contact tracing and genome sequencing, the Go.Data tool for data collection for outbreak investigations and response in the field had been developed, and efforts had been made to strengthen RCCE. A new RCCE collective service (being implemented jointly with WHO, UNICEF and IFRC) delivered a common strategy, tools and guidance, as well as a coordination platform for all RCCE actors at global, regional and national levels. Other key projects covered rapid response mobile laboratories (RRMLs) and IOA.

KEY ACHIEVEMENTS OF GOARN AND UPCOMING OPPORTUNITIES FOR COLLABORATION

3

10

Mr Jean-Christophe Aze, GOARN/OST, described the major elements that had driven GOARN since the third GMP in 2017. The outbreaks of Ebola virus disease in 2017, 2018 and 2021, as well as the COVID-19 pandemic, had led all the major stakeholders to encourage GOARN to strengthen its operational development, not limiting its activities to deployments but also enhancing its networking for effective preparedness and response. During the COVID-19 pandemic, GOARN had deployed 210 experts from 50 partner institutions in 41 countries. The main areas of expertise had been covered, including laboratories; epidemiology and surveillance; data management; case management; and IPC.

The GOARN knowledge platform was regularly updated and ensured a consistent daily exchange of epidemiological information, in addition to weekly operational calls and ad hoc operational coordination meetings during acute events (notably at the start of the COVID-19 pandemic). The M&E framework was aligned with the countries’ priorities as set out in WHO’s Thirteenth General Programme of Work 2019−2023 (GPW 13). In the area of communication and advocacy, the SCOM Chairperson had made a major statement on behalf of GOARN at the special session of the World Health Assembly in November 2021.

GOARN had developed and implemented a comprehensive, three-tiered capacity-building and training programme that aimed to prepare individuals from all public health disciplines to work effectively in the field in response to disease outbreaks. Completion of online training modules was mandatory for deployment. The training network included over 25 institutional partners and a global faculty.

The RCCE Collective Service was established in June 2020 with four strategic priorities: to catalyse collaborative RCCE approaches; to generate, analyse and use evidence on community perspectives; to facilitate community-led responses by improving the quality and consistency of community engagement processes; and to reinforce local capacity to control epidemics and mitigate their impacts. GOARN is supporting the Collective Service through coordination, deployment and technical expertise to ensure that RCCE is well integrated into all pillars of COVID-19 response and strengthened as a capacity in the Network.

GOARN is supporting the Collective Service through coordination, deployment and technical expertise to ensure that RCCE is well integrated into all pillars of COVID-19 response.

11

GOARN has also supported the integration of social and behavioural sciences into epidemic responses. Since May 2018, a very robust social science network had been built up, donors had been consistently mobilized and engaged, and strong support had been given to operational and response partners.

The GOARN project on rapid response capacity aimed to improve response lead-times, optimize the coordination of national and international technical support, and provide operational support to national (rapid) response entities. In the June 2021 workshop, partners’ representatives had identified the operational elements that could shorten the delay between outbreak alert and effective joint field response and help build an agile and proven GOARN rapid response system in support of national alert and response capacity. In November 2021, discussions had been held with partners and the Ministry of Health on starting a pilot project in Armenia. Further pilot projects were envisaged in other WHO regions. GOARN’s rapid response capacity could be linked with WHO-certified emergency medical teams (EMTs) through coordination both at national level and within WHO itself. Deployment of an EMT within 72 hours would be the first step in deployment of a more efficient GOARN capacity. In addition, public health teams and EMT members from Australia and neighbouring countries in the Western Pacific and South-East Asia regions had received joint training in IPC.

The objective of the Go.Data project was to design, develop and deploy comprehensive software to be used globally by Member States, partners and WHO to support and facilitate outbreak investigation, including field data collection, contact tracing and visualization of chains of transmission. WHO and GOARN were supporting over 60 Go.Data projects worldwide through the organization of virtual and on-site trainings and briefings; development of plug-ins and scripts for interoperability and analytics; and provision to local responders of direct user support and technical support for epidemiology, analytics, interoperability and information technology.

WHO and GOARN were supporting over 60 Go.Data projects worldwide through the organization of virtual and on-site trainings and briefings.

The GOARN project on rapid response capacity aimed to improve response lead-times, optimize the coordination of national and international technical support, and provide operational support to national (rapid) response entities.

12

Led by the WHO Regional Office for Europe, a partner-driven initiative had reached agreement on minimum operational standards for RRMLs. The initiative was supported by a series of simulation exercises of increasing complexity: from tabletop exercises to operational base drills and field exercises, with a full-scale global field exercise planned for 2022, probably in Turkey.

The objective of the IOA project was to provide technical support to country stakeholders in order to set up local IOA cells or apply IOA methodology. That included the rapid deployment of skilled individuals to support the establishment and operation of an IOA cell; the provision of context- and country-specific technical training and support; and the creation of a platform for the exchange of knowledge and experience. Six organizations were represented in the core team of the IOA global network (Epicentre–MSF, the Institute of Tropical Medicine, Belgium (ITM), the London School of Hygiene and Tropical Medicine (LSHTM), UNICEF, the United States Centers for Disease Control and Prevention (CDC) and WHO). Three IOA cells had been set up during Ebola outbreaks, and one permanent IOA cell had been set up in the Democratic Republic of the Congo with interventions on cholera, plague, COVID-19 and Ebola outbreaks.

There had been a serious increase in GOARN-related activity in WHO regions: deployment of regional expertise; organization of training events (both for GOARN itself and for rapid response teams); implementation of Go.Data; promotion and integration of operational research and RCCE into outbreak responses; and encouragement of new partners to join GOARN.

Dr Gail Carson, Director of Network Development, ISARIC and Vice-Chairperson of the GOARN Steering Committee, reported that ISARIC had recently received funding from Wellcome and the United Kingdom Foreign, Commonwealth & Development Office to look at operational research across its four regional hubs, one of which was located in Manila, Philippines. It was good to see a GOARN partner and the GOARN focal point for the region working closely together at local level.

Dr Lina Moses, Tulane University, United States of America and Chairperson, GOARN/Research, said that GOARN had provided logistic support for the development of guidance on COVID-19, albeit mainly at global level. One of the challenges was to tap into the regional level, assessing the needs of GOARN partners across the globe for operational research and identifying appropriate capacity within the Network.

Dr Neil Squires, International Association of National Public Health Institutes (IANPHI), believed that all national public health institutes should include rapid outbreak response capability as a core set of skills and competencies. There was huge value in building up the national capability to respond to outbreaks. Interchange and peer-to-peer support between south–south and north–south organizations were critically important for that strengthened global network of peers who trusted, worked with and understood each other.

Interchange and peer-to-peer support between south–south and north–south organizations were critically important for that strengthened global network of peers who trusted, worked with and understood each other.

13

Dr Chikwe Ihekweazu, WHO Assistant Director-General for Health Emergency Intelligence, reported on the recent opening of the WHO Hub for Pandemic and Epidemic Intelligence, based in Berlin, Germany, of which he was the Director. Disease surveillance systems had evolved rapidly over the previous decade, but there were still gaps that need to be addressed: systems were still mostly limited to health data; surveillance data were increasingly fragmented, were frequently not shared and provided little insight into the context from which they were derived, which limited understanding of risks and the ability to take effective action. Stakeholders had varying capacities to analyse such data, which might be a further barrier to their use by policy- and decision-makers.

Numerous recent reports had included recommendations concerning the use of data, improvement of tools and capabilities, and enhancement of interconnectedness, but it was time to start tackling the very hard problems of bringing together the various sources of data. Some of those changes were already taking place in other spheres of endeavour, where data were being used to inform decisions on climate, business and financial services, for instance. While considerable work had been done on human behaviour and animal movements, it had not been carried out in a sufficiently interconnected way to influence public health decision-making.

The Hub had been set up to embrace complexity, deal with uncertainty and build learning systems. The aim was to foster a collaborative mindset, not just in the physical space that was being created in Berlin but also among the colleagues and institutions who would be brought in to work for defined periods of time on specific solutions, not in a typical outbreak response mode but rather to influence the development of new tools. One example of the type of tough question that the Hub hoped to address was how to achieve cohesion around defining methods for measuring excess mortality, as a way of monitoring the impact of the COVID-19 pandemic.

STRENGTHENING GLOBAL COLLABORATION FOR GLOBAL ALERT AND SURVEILLANCE

4

Disease surveillance systems had evolved rapidly over the previous decade, but there were still gaps that need to be addressed.

14

The Hub was not a new establishment, separate from WHO or its Health Emergencies (WHE) programme. All participants would be familiar with the cycle of managing health emergencies (prediction, prevention, preparedness, response, recovery). WHO intended to place a team at the heart of that cycle in order to improve not only the data but also the analytics and the resulting decision-making. The Hub was part of an evolving ecosystem that included not only a pandemic instrument or treaty but also global genomic surveillance and the new European Health Emergency preparedness and Response Authority (HERA).

A new division of Health Emergency Intelligence and Surveillance had been added to the two existing divisions of the WHE programme, on preparedness and response. Two departments in that new division, on Collaborative intelligence and Health intelligence systems, would form the Hub located in Berlin. The Hub would constitute a new collaborative environment where colleagues from partner organizations would be able to think about how to improve specific areas of interest or health intelligence in general.

The Hub aimed to attract the best talent and facilitate collaboration across disciplines, sectors and geographical areas, in order to foster the development of demand-driven innovations. The Hub would welcome 120 people – one third would be staff and the rest (fellows, secondees, etc.) would be drawn from external partners. The move into the new Hub office would take place in January 2022.

Responding to questions raised, Dr Chikwe Ihekweazu confirmed that national centres for disease control would be at the heart of what the Hub wanted to do, in terms of both feeding into it and also receiving from it. A strong country support team would accordingly be built up in Berlin. The GOARN model of developing a common set of tools with which to carry out outbreak response would applied in the public health intelligence space. The strategy would be to bring colleagues together so that they could develop a common approach and then go back to their countries or take those skills to other countries.

Another of the aims of the Hub would be to share knowledge of the tools developed by WHO, in the context of implementation of the International Health Regulations (2005) (IHR), for outbreak verification, grading and response. The EIOS project would also be transferred to the Hub in Berlin, to strengthen the interface between detection technology and systems.

The GOARN model of developing a common set of tools with which to carry out outbreak response would applied in the public health intelligence space.

15

Dr Jansz Paweska, National Institute for Communicable Diseases, South Africa, recognized the advantages of GOARN as a non-bureaucratic structure but called for institutions’ commitment to deliver specific tasks for the Hub to be more formalized, with due account taken of the contribution that the private sector could make in areas such as development and manufacture of testing equipment, vaccines and antibiotics.

Dr. Josep Jansa, European Centre for Disease Prevention and Control (ECDC), paid tribute to the dynamic sharing of information that was already taking place within WHO and underscored the need for regionalization in terms of epidemic intelligence.

Dr. Chikwe Ihekweazu agreed that the Hub would need to bring together data scientists, evolutionary biologists and behavioural scientists, as well as specialists in other disciplines, to drive forward the work in all areas of engagement, not only on diagnostics and vaccines. To that end, it would be necessary to identify specific institutions with specific skills that could be leveraged by the Hub. ECDC had been a major player in the whole public health intelligence space, including in event-based surveillance, and he hoped that it would be closely involved in the future work of the Hub.

16

Chairing the session, Dr Pascale Lissouba, Epicentre–MSF, introduced the other members of the core team of the IOA global network (from ITM, LSHTM, UNICEF, CDC and WHO).

Ms Simone Carter, UNICEF, described the history of the IOA initiative. It had emerged as an innovative approach to systematic and timely generation of integrated and actionable evidence during the 2018–2020 Ebola outbreak in the Democratic Republic of Congo. That work had been developed by a social sciences analytics cell (CASS) and an epidemiological cell (EPI) embedded within the national response.

In October 2019, GOARN/Research and UNICEF had been awarded a Wellcome Trust and United Kingdom Foreign, Commonwealth & Development Office grant to detail the IOA approach in the Democratic Republic of Congo and to model the approach for use in future outbreaks (such as plague and cholera). Subsequently, IOA was replicated several times in the Democratic Republic of Congo, as well as during the response to the 2021 Ebola outbreak in Guinea.

In July 2021, a core team representing key agencies involved in developing the approach was established as an agile mechanism for furthering the practice and uptake of IOA. All agencies represented in the core team were GOARN partners. GOARN became a natural platform for establishing an IOA network and advancing the IOA approach to promote multipartner collaboration and benefit from GOARN’s experience in bringing technical agencies together.

TAKING AN INTEGRATED APPROACH TO OUTBREAK ANALYTICS

5

GOARN became a natural platform for establishing an IOA network and advancing the IOA approach to promote multipartner collaboration and benefit from GOARN’s experience in bringing technical agencies together.

17

IOA could be defined as the use of transdisciplinary integrated data to better understand outbreak dynamics and impacts. The information analysed included programme data (not only on WaSH, IPC and immunization but also on cash transfers), surveillance data (number of cases, contact tracing), data on health service use and outcomes (including routine vaccination coverage), information on community perceptions and behaviours (obtained from household surveys and qualitative interviews) and data on health care workers. Other factors and contextual issues that influenced data (events, policies and chronology; price trends; population movements; gender and social norms, etc.) were also taken into account.

In a pre-recorded video statement, Mr Mathias Mossoko, Ministry of Health, Democratic Republic of Congo, described transdisciplinary data analysis in practice during the Ebola outbreaks in his country in 2018–2020 and 2021. Numerous partner organizations had worked together on IOA in those situations, aiming to reduce duplication and facilitate access, support evidence-based decision-making and enable the Ministry of Health to redefine priorities, adapt activities and implement new strategies.

IOA was about evidence use, not generation. Following the identification of a research question (arising from the epidemiological situation, requests from commissions/actors, existing data

or context), the IOA team would draw up terms of reference, specifying in particular how the data would be used. The terms of reference would be validated by the bodies or actors involved; data collection and analysis would be undertaken; and the findings would be presented on multiple occasions at local level to partners and all concerned parties. Implementation of the recommendations that they developed would subsequently be tracked by location over time.

In pre-recorded video statements, Ms Amani Charles, Risk Communication and Monitoring, Red Cross, Nord Kivu, Democratic Republic of Congo, described how IOA had served the Red Cross’s cholera response strategy. The research findings had been used to develop the right messages to communicate to the community. Mr Ghaffar Gomina, Ebola Response

Coordinator, UNICEF, Beni, Democratic Republic of Congo, explained how evidence generated by IOA had been used to better understand the risks of children contracting Ebola virus disease and to change strategies as a result. As an example of reinforcing capacity and skill sets in countries, Mr Jacques Millimouno Tamba, National Health Security Agency (ANSS), Guinea, described how IOA and a field epidemiology training programme (FETP) had improved the work of ANSS field teams.

Chairing the session, Dr Pascale Lissouba, Epicentre–MSF, introduced the other members of the core team of the IOA global network (from ITM, LSHTM, UNICEF, CDC and WHO).

Ms Simone Carter, UNICEF, described the history of the IOA initiative. It had emerged as an innovative approach to systematic and timely generation of integrated and actionable evidence during the 2018–2020 Ebola outbreak in the Democratic Republic of Congo. That work had been developed by a social sciences analytics cell (CASS) and an epidemiological cell (EPI) embedded within the national response.

In October 2019, GOARN/Research and UNICEF had been awarded a Wellcome Trust and United Kingdom Foreign, Commonwealth & Development Office grant to detail the IOA approach in the Democratic Republic of Congo and to model the approach for use in future outbreaks (such as plague and cholera). Subsequently, IOA was replicated several times in the Democratic Republic of Congo, as well as during the response to the 2021 Ebola outbreak in Guinea.

In July 2021, a core team representing key agencies involved in developing the approach was established as an agile mechanism for furthering the practice and uptake of IOA. All agencies represented in the core team were GOARN partners. GOARN became a natural platform for establishing an IOA network and advancing the IOA approach to promote multipartner collaboration and benefit from GOARN’s experience in bringing technical agencies together.

TAKING AN INTEGRATED APPROACH TO OUTBREAK ANALYTICS

5

IOA could be defined as the use of transdisciplinary integrated data to better understand outbreak dynamics and impacts.

18

IOA had to be flexible and adapted to the country, province and partners involved. Examples of IOA partnerships and approaches included:

l a short-term IOA cell set up for a large new or high-risk outbreak (such as Ebola), with a full-time focus, working via pillars/ commissions, with a rapid data turnaround (48 hours) and daily meetings;

l IOA for smaller outbreaks and public health emergencies (e.g. malnutrition), set up as collaborative partnerships under the Ministry of Health, employing IOA methods, focusing on underlying causes, no cell structure;

l IOA for improved rapid response teams in the Ministry of Health (surveillance of measles or meningitis), IOA cell based on District Health Information System 2 (DHIS2) data, used for early warning, integrated IOA teams deployed to areas of concern;

l topic-based IOA, supporting countries and partners to look at a public health or outbreak question using an IOA lens, collaboration between actors, one key question (e.g. COVID-19 vaccination).

Evaluation carried out by GOARN/Research and UNICEF had identified a number of reasons why IOA was successful. It featured inclusiveness in survey design, themes and study questions. It adopted a field- and service-based approach, addressing the questions and information required by stakeholders. Adaptive information-sharing techniques were used. Actions and recommendations were jointly developed with stakeholders, and there was no branding and no egos.

In a final pre-recorded video statement, Mr Mathias Mossoko gave an example of how global support could work in a field-based partnership; and Dr John Kombe, Ministry of Health, Democratic Republic of Congo, emphasized that a good IOA cell would be close to the outbreak and the teams tackling it, in order to understand the local context.

In conclusion, Ms Simone Carter noted that, at global level, the objectives of the IOA partnership under GOARN were to promote and strengthen a transdisciplinary understanding of outbreak dynamics for an improved, appropriate and more accountable response; to provide adapted context- and country-specific support to partners to conduct IOA; and to create a community of practice where IOA experiences could be shared, capitalized on and used to support partners in their adaptation or application in multiple outbreak contexts. GOARN partners could become more involved by providing human resources support (deployment of teams to support the Ministry of Health in the set-up of cells or to provide hands-on technical training); technical guidance and analytics support (remote analyses and review of tools and reports); workshops and training packages (sharing tools through multi-language webinars); and knowledge exchange (IOA working group, YouTube channel, IOA Field Exchange (publication)).

Responding to a question raised about how to scale up the IOA approach for use in a global pandemic, Ms. Simone Carter said that, in the previous two years, the IOA team had focused on the broader impacts of COVID-19, looking holistically at all the qualitative and quantitative data available in the DHIS2 system and making use of data primarily for advocacy purposes.

19

Dr Gail Carson, Vice-Chairperson of the GOARN Steering Committee, recalled that GOARN had been in existence for 20 years and needed to refresh itself through revisiting the strategy. In December 2019 and again in June 2021, the SCOM had acknowledged the need for a rigorous, consultative strategy process to establish what GOARN did and how it would work in the future.

Some working assumptions had been made at the start of that process: l GOARN was a global resource and a meta organization; l historically, GOARN had relied heavily on the commitment of individuals within partner

institutions, and those people (present and future) were critical; l GOARN was a network that provided a technical response to health emergencies at the

request of the countries/communities it served; l GOARN had engaged and continued to engage in readiness and preparedness activities

(operational research and tools such as Go.Data, capacity-building and training); l there was a need to evolve, as the working framework had changed considerably in the

previous 20 years.

A GOARN survey had been released in October 2021. Representatives of 73 partners had completed the survey, and and their responses had been analysed by a team based at Public Health England. The results would be included in a wider report and recommendations that would be issued in early 2022.

At the same time, the team at the University of Oxford’s Saïd Business School (SBS) had started working with SCOM to set up and run three workshops, with the aims of creating a set of scenarios for 2030 and understanding what a value-creating system might look like in each scenario. In November 2021, a GOARN/Research team led by Dr Lauren Sauer from the University of Nebraska Medical Center, United States of America, had interviewed more than 30 stakeholders. A thematic analysis of those interviews had already been completed; a further in-depth analysis would also be captured in the final report in 2022.

SHAPING A STRONG FUTURE FOR RESPONSE: THE GOARN STRATEGY 2022–2026

6

GOARN had been in existence for 20 years and needed to refresh itself through revisiting the strategy.

20

The SCOM Vice-Chairperson then outlined the strategic conversation that would be held during GMP 2021 the following day. Four scenarios would form the context for that conversation (Figure 1).

Figure 1 Scenarios for the strategic conversation at GMP 2021

A value-creating system had been defined for each scenario.

Table 1 Value-creating systems for the strategic conversation at GMP 2021

Scenario Value-creating system

A – Pay as you go In this VCS, the private sector is involved in addressing public health emergencies (of international importance). The orchestrators of the system are ministries of health, who coordinate a diversity of actors. GOARN is an international organization interpreting and scoping requests for assistance from individual countries, alongside other actors such as those in the private sector.

B – Global to local In this VCS, the learnings of the pandemic and the increased capacity of individual countries to respond to public health emergencies are evident. The locus of response has shifted from international bodies to in-country expertise; national ministries orchestrate response systems. GOARN is a network supporting countries on the ground – but not necessarily flying in ‘experts’.

21

Scenario Value-creating system

C – Political patchwork In this VCS, different responses are orchestrated by diverse actors who have emerged to address public health emergencies. Non-government local health care providers are intimately involved, drawing on international actors as needed. GOARN is a network providing a valuable conduit of expertise from academic institutions to health care providers.

D – Broad and bilateral In this VCS, national governments work largely bilaterally to support each other to address public health emergencies in their jurisdictions. GOARN is a network of health professionals that national governments, as orchestrators of systems, draw on.

In the strategic conversation, participants would be assigned to 10 groups, each of which would have a Steering Committee member as a facilitator and would be guided by a member of the SBS team. Each group would be requested to consider one of five questions from the perspective of two scenarios, initially as if they already were in 2030 and then for the period 2022–2026. Those five questions were:

1. Currently GOARN focuses on: l Alert and risk assessment l Rapid response l Research l Training l Preparedness

Which two of these are most important for GOARN to have continued in this scenario?Which should have stopped?What new services should have started?

2. For countries classed as vulnerable or in areas of conflict in this scenario, what new services should GOARN deliver?

3. What is the key value of being a member of GOARN in this scenario?

4. What organizational form and governance model should GOARN have implemented in this scenario?

5. What financial and human resources does GOARN need to operate in this scenario compared to today? Where would they come from?

The Vice-Chairperson would feed back the main conclusions of the group discussions at the plenary session on the last day of GMP 2021.

In early 2022, all the material generated would be pulled together and submitted to the SCOM, together with recommendations for a four-year strategy (2022–2026). There would then be a period of consultation with partner institutions, probably based on a regional approach, before validation and final approval of the new strategy.

22

Dr Marietjie Venter (Chairperson, WHO Scientific Advisory Group on the Origins of Novel Pathogens (SAGO)) presented the recently established advisory group and described how it fitted in to the rest of WHO and how it hoped to work with GOARN.

The overall role of SAGO was preparing for the next “disease X”. The current COVID-19 pandemic had re-emphasized the critical importance of One Health; human health, animal health and the state of ecosystems were inextricably linked. There were many emerging and re-emerging zoonoses with pandemic potential; 70–80% of emerging and re-emerging infectious diseases were known to be of zoonotic origin.

SAGO responded to the need for a global framework to investigate future emerging and re-emerging pathogens, using a holistic approach to study the emergence of high-threat zoonotic pathogens, including the animal/human interface, environmental safety, biosafety and biosecurity. It was a scientific advisory group with a global footprint and cross-cutting expertise, set up to advise WHO on technical and scientific considerations regarding origins of emerging and re-emerging pathogens.

The specific functions of SAGO were: l to advise WHO on the development of a global framework to define and guide studies into

the origins of emerging and re-emerging pathogens of epidemic and pandemic potential; l to advise WHO on prioritizing studies and field investigations, in accordance with the

framework described above;

EMERGING DISEASES AND ONE HEALTH

7

23

l in the context of SARS-CoV-2: à to provide independent evaluation of the scientific and technical knowledge in available findings from global studies into the origins of SARS-CoV-2; à to advise the WHO Secretariat regarding developing, monitoring and supporting the next series of studies into the origins of SARS-CoV-2, as outlined in the report on the Joint WHO–China Global Study of Origins of SARS-CoV-2: China Part, published on 30 March 2021, and with additional input from Member States and the scientific community, and advise on additional studies as needed;

l to provide additional advice and support, as requested, which may include participation in future WHO international missions to study the origins of SARS-CoV-2 or for other emerging pathogens, and briefing Member States in organized information sessions.

The 27 members of SAGO, selected and appointed by WHO, had expertise in a wide range of technical disciplines, with consideration given to geographical representation and gender balance. Members were appointed to serve for a period of two years and were eligible for reappointment. Two observers, from the United Nations Food and Agriculture Organization (FAO) and the World Organisation for Animal Health (OIE), also attended meetings of SAGO. The Co-Chairperson was Dr. Jean-Claude Manuguerra, Research Director of the Environment and Infectious Risks Unit, as well as head of the Emergency Biological Intervention Unit at the Institut Pasteur, France.

SAGO would meet frequently; its meetings were currently being convened virtually. Supporting materials would be provided by the secretariat ahead of each meeting. A quorum of two thirds of the members was required for a full meeting to go ahead. Working groups could be established to work on specific issues – no quorum requirement applied. SAGO had held its first meeting at the end of November 2021 and was working on defining the elements of its framework, which would include studies in the fields of human epidemiology and the animal/human interface, early investigation studies, environmental studies, anthropologic studies, phylogenetic studies, and biosafety/biosecurity studies.

SAGO was complementary to many other groups, such as the One Health High-Level Expert Panel (OHHLEP), GOARN, the WHO Biosafety Advisory Group (BAG), the Technical Advisory Group on Arbovirus, and the Global Initiative on Sharing All Influenza Data (GISAID). As a WHO advisory group, SAGO and its framework aimed to support GOARN’s operational implementation through joint missions using the expertise available in both groups.

Mr Peter Ben Embarek (Head, One Health Initiative, WHO headquarters) said that OHHLEP has been set up in response to Member States’ interest in having coordinated policy and technical advice on One Health. Tripartite FAO/OIE/WHO intersectoral collaboration had been formalized in 2010, focused on the animal/human interface, animal and human diseases, zoonoses, antimicrobial resistance (AMR) and emerging diseases. The United Nations Environment Programme (UNEP) had been added in 2021. The current COVID-19 pandemic had focused attention on the need to do more work on prevention and gain a better understanding of the emergence of those diseases. It was good to see a formalized link between GOARN and OHHLEP.

Dr Marietjie Venter (Chairperson, WHO Scientific Advisory Group on the Origins of Novel Pathogens (SAGO)) presented the recently established advisory group and described how it fitted in to the rest of WHO and how it hoped to work with GOARN.

The overall role of SAGO was preparing for the next “disease X”. The current COVID-19 pandemic had re-emphasized the critical importance of One Health; human health, animal health and the state of ecosystems were inextricably linked. There were many emerging and re-emerging zoonoses with pandemic potential; 70–80% of emerging and re-emerging infectious diseases were known to be of zoonotic origin.

SAGO responded to the need for a global framework to investigate future emerging and re-emerging pathogens, using a holistic approach to study the emergence of high-threat zoonotic pathogens, including the animal/human interface, environmental safety, biosafety and biosecurity. It was a scientific advisory group with a global footprint and cross-cutting expertise, set up to advise WHO on technical and scientific considerations regarding origins of emerging and re-emerging pathogens.

The specific functions of SAGO were: l to advise WHO on the development of a global framework to define and guide studies into

the origins of emerging and re-emerging pathogens of epidemic and pandemic potential; l to advise WHO on prioritizing studies and field investigations, in accordance with the

framework described above;

EMERGING DISEASES AND ONE HEALTH

7

24

Dr Wanda Markotter (OHHLEP Co-Chair) noted that the governments of France and Germany, meeting as the Alliance for Multilateralism at the Paris Peace Forum in November 2020, had proposed the establishment of a more independent, multidisciplinary panel on One Health. OHHLEP (formed of the tripartite organizations and UNEP) had held its first meeting in May 2021. The Panel consisted of 26 international experts, appointed for a two-year term, renewable.

OHHLEP had an advisory role in providing multidisciplinary, evidence-based scientific and policy guidance to the partners to address global, regional and national challenges raised by One Health. OHHLEP would focus initially on:

l policy-relevant scientific assessment of the emergence of health crises arising from the human/animal/ecosystem interface, and research gaps; and

l guidance on the development of a long-term strategic approach to reducing the risk of zoonotic pandemics, with an associated monitoring and early warning framework, and the synergies needed to institutionalize and implement the One Health approach, including in areas that drive pandemic risk.

To that end, OHHLEP would carry out the following functions: l provide advice on the analysis of scientific evidence on the links between human, animal

and ecosystem health, and contribute to foresight on emerging threats to health; l provide advice on better understanding the impacts of food systems and of ecological

and environmental factors that may be contributing to zoonotic disease emergence/ re-emergence and spillover events;

l contribute to setting the One Health research agenda and propose, advise on and review approaches and specific studies relevant to the development of a global approach to reduce the risk of zoonotic pandemics;

l provide advice by invitation on One Health policy response in relevant member countries; and

l provide recommendations on specific issues identified by the partners in the areas of highest concern for attention and action, and future directions, in One Health.

At their first meeting on 17–18 May 2021, Panel members had decided that the most effective way to carry out those functions was to establish four working groups, which would meet every two weeks and report outcomes to the full Panel. The areas covered by the working groups were:

l One Health implementation (development of the definition of One Health and looking at the theory of change in a broader, One Health environment);

l inventory of current knowledge in preventing emerging zoonoses; l surveillance, early detection and rapid data sharing in the prevention of emerging

zoonoses; and l factors causing spillover and subsequent spread of diseases.

OHHLEP had an advisory role in providing multidisciplinary, evidence-based scientific and policy guidance to the partners to address global, regional and national challenges raised by One Health.

25

Like SAGO, OHHLEP worked with many other groups. Again, it was important that those initiatives complemented each other and did not duplicate activities.

OHHLEP partners had recently elaborated a new definition of One Health: “One Health is an integrated, unifying approach that aims to sustainably balance and optimize the health of people, animals and ecosystems. It recognizes that the health of humans, domestic and wild animals, plants, and the wider environment (including ecosystems) is closely linked and interdependent. The approach mobilizes multiple sectors, disciplines and communities at varying levels of society to work together to foster well-being and tackle threats to health and ecosystems, while addressing the collective need for clean water, energy and air, safe and nutritious food, taking action on climate change, and contributing to sustainable development.” The principles underlying that definition included equity between sectors and disciplines; sociopolitical parity; socioecological equilibrium; stewardship; and transdisciplinarity.

Dr Maria van Kerkhove, COVID-19 Technical Lead, WHO headquarters, pointed out the distinct roles of the two bodies: SAGO was a technical advisory group with a very narrow focus, working with WHO to outline all the elements that needed to be studied, while OHHLEP had a massive mandate ranging from AMR to climate change and emerging diseases. SAGO was not the next mission team. If SAGO said more work needed to be done, WHO would organize that with the normal mechanisms, and of course it would look to GOARN and its partners for those types of missions, but each of those would have its own terms of reference and its own mandate.

Dr John Mackenzie, Co-Founder and Vice-Chair, One Health Platform Foundation, believed that both OHHLEP and SAGO could do great things and had tremendous futures in front of them.

SAGO was a technical advisory group with a very narrow focus, working with WHO to outline all the elements that needed to be studied.

One Health is an integrated, unifying approach that aims to sustainably balance and optimize the health of people, animals and ecosystems.

26

Professor Paul Effler, Medical Coordinator, Communicable Disease Control Directorate, Department of Health, Western Australia and SCOM Training Lead, led the session, which began with projection of a video outlining the scope and context of the GOARN Capacity-Building and Training (CBT) Programme. That three-tiered programme delivered essential skills and field adaptation training for outbreak responders at all levels of experience. It had been endorsed at the first Meeting of GOARN Training Partners, held in 2017.

Ms Renee Christensen, Capacity-Building and Training Lead, GOARN/OST, described the CBT Programme. Tier 1, Introduction to international outbreak response, aimed to provide baseline knowledge and preparedness for deployment. Details of the field deployment process, given in virtual and face-to-face interactive workshops, constituted Tier 1.5 of the programme. The purpose of Tier 2 (GOARN outbreak response scenario training) was to prepare partners to take part in international multidisciplinary outbreak response missions through on-site simulation and training. Tier 3 aimed to develop influential and trusted leaders for public health emergencies by strengthening individual and collective leadership and crisis management skills of highly experienced outbreak responders.

Figure 2: The GOARN capacity-building and training programme

CAPACITY-BUILDING AND TRAINING

8

27

In a period of more than five years, the CBT Programme had engaged a total of over 4 200 individual learners from 415 institutions across 113 countries, while more than 1 150 people had graduated from facilitated training workshops across the three tiers. In Tier 1, 12 different electronic courses were available in up to seven languages; more than 5 500 e-courses had been completed. Owing to recent cybersecurity incidents, access to the GOARN virtual training platform was currently limited to individuals verified by GOARN institutional focal points. Thirty institutions in three working groups were key partners for Tier 1.

Tier 1.5, a relatively new addition to the Programme, had been adapted for virtual delivery in 2020; it counted over 550 graduates from 60 institutions across 40 countries. A total of 16 virtual and face-to-face workshops had been delivered. Numerous partners had served as faculty or co-hosted workshops.

In the period up to March 2020, over 400 people from more than 90 institutions across 68 countries had benefited from 15 Tier 2 training courses, nine of which had been scenario-based. Total faculty had numbered 160 staff from 58 institutions across 29 countries. Owing to the COVID-19 pandemic, face-to-face Tier 2 training had had to be postponed, but it was hoped that it would resume in 2022. Partners were increasingly interested in co-funding those courses and financing the participation of their staff in them.

Tier 3 leadership training had been launched in a virtual format in mid-2021. It counted over 150 graduates from 72 institutions across 60 countries. A total of 46 individual virtual facilitated workshops and one global high-level leadership seminar had been delivered. It was hoped to roll out a larger, three-phased flagship training programme, comprising online, face-to-face and simulation exercises, in 2022. The Public Health Agency of Canada was the co-lead of the Tier 3 programme, while the Robert Koch Institute in Germany was the co-host and co-funder, and the Geneva Centre for Security Policy and Geneva Leadership Alliance were implementing partners.

GOARN Online Serious Gaming was a new initiative aimed at creating an online gaming prototype founded on innovative best practices for virtual learning. The prototype would be based on Tier 2 training and would address aspects of Tier 1 and Tier 2 for proof of concept. In the future, it was hoped that the fully fledged online game would also address Tier 3 training and could be used by partners for learning at their own institutions. The initiative had been awarded a grant by the International Health Grants Programme, Canada, and a working group had been formed, composed of training, gaming and simulation exercise experts.

Professor Paul Effler, Medical Coordinator, Communicable Disease Control Directorate, Department of Health, Western Australia and SCOM Training Lead, led the session, which began with projection of a video outlining the scope and context of the GOARN Capacity-Building and Training (CBT) Programme. That three-tiered programme delivered essential skills and field adaptation training for outbreak responders at all levels of experience. It had been endorsed at the first Meeting of GOARN Training Partners, held in 2017.

Ms Renee Christensen, Capacity-Building and Training Lead, GOARN/OST, described the CBT Programme. Tier 1, Introduction to international outbreak response, aimed to provide baseline knowledge and preparedness for deployment. Details of the field deployment process, given in virtual and face-to-face interactive workshops, constituted Tier 1.5 of the programme. The purpose of Tier 2 (GOARN outbreak response scenario training) was to prepare partners to take part in international multidisciplinary outbreak response missions through on-site simulation and training. Tier 3 aimed to develop influential and trusted leaders for public health emergencies by strengthening individual and collective leadership and crisis management skills of highly experienced outbreak responders.

Figure 2: The GOARN capacity-building and training programme

CAPACITY-BUILDING AND TRAINING

8

Partners were increasingly interested in co-funding those courses and financing the participation of their staff in them.

28

A panel of representatives of key partners collaborating in each tier of the CBT Programme was then asked to respond to the following questions:

l Why had they/their institution engaged with the Programme? l What advice could they give to other partners wanting to engage? l Where should the CBT Programme go next? What should it look like in five years’ time?

Professor Ali Khan, Dean, College of Public Health, University of Nebraska, USA, believed that the CBT Programme was the crown jewel of GOARN. The discussion at GMP 2021 constituted an invitation to all participants to join the work of the Programme, as many had already done. Through its teach/learn/teach/learn cycle, the Programme also built up the capacity of partners, as well as of trainees. It was very easy for an institution to become involved in the CBT Programme’s activities: he had been a member of some working groups and had helped to teach some of the courses, and the College of Public Health had a GOARN internship which enabled students to travel to Geneva to work and study. Partners were the source of new ideas. In five years, the CBT Programme could not be what it had been pre-COVID-19, nor could it be all COVID-19: other public health emergencies would arise. Better evaluation of leadership training was required. The world was moving into an immersive environment (the “GOARNverse”), as exemplified by the new gaming application; asynchronous or distributed learning would become increasingly important. What would not change, however, would be the value in coming together as a network, as partners, in order to optimize team-building.

Dr Norio Ohmagari, Director, Disease Control and Prevention Center, National Center for Global Health and Medicine (NCGM), Japan and Head, WHO Collaborating Centre for Prevention, Preparedness and Response to Emerging Infectious Diseases, said that it had been recognized several years earlier that Japan had not been made a sufficient response to emerging infectious diseases, in terms of human resources. In that context, a programme had been started in 2019 to improve the workforce for GOARN deployments and to increase the number of deployments from Japan. A Tier 1.5 on-site/online training had been organized every year; participation in the first two years had been limited to experts living in Japan, while from the third year onwards participation was open to people from other Member States in the WHO Western Pacific Region. A total of 116 experts had been trained to date; 75 of them were on a roster for GOARN deployment. Five experts on the roster had been deployed via GOARN or as WHO consultants in the previous two years. Deployees participated in an experience-sharing scheme.

In answer to the second question, he recommended that partner institutions should be involved in the process of preparing for GOARN training, in order to tailor training to their own countries’ needs in capacity-building for GOARN deployment. NCGM served as a hub for connecting Japanese experts with former GOARN deployees; that kind of coordination process facilitated the adaptation of experts who were being deployed. Smooth coordination had also been fostered by strengthened partnership and communication with WHO and its Regional Office for the Western Pacific.

29

With regard to the future vision for the Programme, he highlighted the importance of communication and connection among experts and GOARN partner institutions, especially at the regional level. Strengthening regionalization was essential for the smooth operation of GOARN in responding to international outbreaks.

Mr Lisandro Torre, Team Lead for Emergency Response, Learning and Network Collaboration, Training Programs in Epidemiology and Public Health Interventions Network (TEPHINET), said that in 2017 his Network had been given a mandate to prepare FETP alumni for emergency response. TEPHINET realized that a very good training programme already existed and was connected with GOARN for that purpose. The Tier 1.0 and Tier 1.5 training that TEPHINET had been delivering to its alumni had been invaluable. Over 140 FETP alumni had been trained.

His advice to other partners was to “just ask GOARN” and connect their networks and people to it, and then they would be training them to a very high standard that was useful in the field. In the next five years, he looked forward to further strengthening partnerships across all programmes and doing face-to-face trainings in other languages, possibly through networking and “train-the-trainer” programmes.

Dr Andreas Jansen, Head, Information Centre for International Health Protection, Robert Koch Institute, noted that the Institute had hosted the WHO Collaborating Centre for GOARN since 2019. From the outset, the Institute had been involved in training activities, since it wanted to make sure that people deployed, whether by GOARN or bilaterally, had the best skills to do the job in the field. As a network, GOARN lived by the activities of its partners; new institutions should not hesitate to address people personally within the Network and enter into a dialogue about their needs and ideas for innovation.

In the coming five years, there would continue to be a lack of national capacity and expertise, not only in field epidemiology and outbreak response but also in laboratory diagnosis, clinical management and IPC. Training should be expanded to those areas, and more emphasis should be placed on the fact that training for GOARN and international deployments would also be beneficial for national purposes, both within a country and in bilateral agreements. Further work should be done on establishing a GOARN fellowship at the WHO Hub for Pandemic and Epidemic Intelligence in Berlin.

30

Dr Ashley Greiner, Team Lead, Emergency Response Capacity Team, Division of Global Health Protection, US Centers for Disease Control and Prevention (CDC) said that the GOARN initiative offered a unique opportunity to hear, discuss and collaborate with multiple external partners across the world about training the global workforce. CDC had been able to share many of the lessons it had learned from using a standardized approach to workforce development, and in turn it had learned numerous lessons from the other partners in the Network that it had been able to apply to its own programme. The products developed with GOARN served as a framework for the way in which CDC approached capacity-building within the agency and in its support to ministries of health. The platform that GOARN offered had generated much innovation and more comprehensive approaches than would otherwise have existed, and it was a major reason why other institutions should get involved.

In the coming five years, GOARN might consider expanding the training needs captured, leveraging some of the other workforce development networks, promoting regional organizations and networks, and implementing “train-the-trainer” initiatives. Building on its Tier 2 training, GOARN might also looking at potential training that helped responders to translate their expertise into a field setting, without necessarily requiring simulation. There might also be an opportunity to shift from training GOARN responders to thinking about those who contributed to response management, or in other words to providing training on “operationalizing the training workforce”.

Dr Tony Stewart, Director of the MPhil (Applied Epidemiology) course at the Australian National University and former Chairperson, GOARN/SCOM, recommended that consideration should be given to the interface between outbreak response and EMTs and to the possibilities for joint trainings and joint deployments. Another theme of the discussion had been the need to build up national capacity and assist countries to meet their obligations under the IHR.

Ms Renee Christensen agreed that GOARN course participants should be informed of other highly recommended humanitarian trainings, such as those offered by Sphere. In answer to a question from a participant about how an institution could join the CBT Programme, she advised interested parties to contact her by email (goarn@who.int).

The products developed with GOARN served as a framework for the way in which CDC approached capacity-building within the agency and in its support to ministries of health.

31

Dr Lisa Carter, Technical Officer, GOARN/OST, moderated a panel discussion designed to show how GOARN, EMTs and partners were using their technical collaboration for outbreak preparedness and response, and what lessons could be learned to make improvements in the future.

Mr Oleg Storozhenko, Partnerships Officer, WHO Regional Office for Europe, recalled that the drive towards regionalization had been identified as a main priority in GOARN’s Strategy 2.0 in 2016. There were two WHO Collaborating Centres for GOARN in the Region, in Germany and the Russian Federation. Work was being done on developing a new GOARN initiative, a network of RRMLs. The project had initially been established by a core group of partners from Belgium, France, Germany, the Russian Federation and the United Kingdom, and could be expanded to global level in early 2022.

Based on a classification system for RRMLs developed by the initiative,4 work was being done on defining minimum standards for all five categories of RRMLs. Those standards were closely aligned with the conditions outlined by the Sphere project and the principles promoted by most international humanitarian and public health organizations. They covered quality management systems; laboratory information management systems and data exchange; biosafety and biosecurity; and operational support and logistics. They would form the basis for a forthcoming monitoring and evaluation system and would guide contextualized workforce development and training. Mechanisms were also being developed to ensure clearer and more transparent processes for deployment of RRMLs in the field, not only outside but also within host countries, in order to strengthen national capacities.

Another major objective was to strengthen the interoperability of mobile laboratories with other operational assets of WHO, such as EMTs. Consideration was being given to how to integrate coordination mechanisms into the work of emergency operation centres and other rapid response capacities, such as rapid response teams.

TECHNICAL COLLABORATION FOR STRONGER PUBLIC HEALTH IMPACT

9

4. Guidance for rapid response mobile laboratory (‎RRML)‎ classification. Copenhagen: WHO Regional Office for Europe; 2021 (https://apps.who.int/iris/bitstream/handle/10665/ 339845/9789289054928-eng.pdf, accessed 10 January 2022).

32

A programme of four simulation exercises had been drawn up in order to test standards in a safe environment. Two virtual exercises had been implemented in September and October 2021. Technical drills would be carried out in early 2022 to test quality management standards, and a global simulation exercise for mobile laboratories was to be held in Turkey at the end of May or beginning of June 2022. It was expected that the simulation exercise programme would result in a training programme that could be implemented by a WHO training centre.

Dr Stephan Günther, Head, Department of Virology and WHO Collaborating Centre for Arboviruses and Haemorrhagic Fever Reference and Research, Bernard Nocht Institute for Tropical Medicine (BNI), Hamburg, Germany, saw BNI as a hub that had enabled experts from different institutions to take part in more than 300 missions since the inception of the European Mobile Laboratory (EMLab) Consortium. BNI provided the training environment or the equipment, and sometimes placed teams in the field. The statutes of BNI provided for deployments to take place under GOARN, rather than through bilateral agreements.

GOARN’s mandate ensured that deployees were working to meet national and global objectives and enjoyed good logistic support in the country, not only from the WHO country office but also from GOARN. In addition to the security aspects, participating in a GOARN deployment meant being embedded in a coordinated response. There was no better way to strengthen networks than to act together in the field; BNI worked closely with institutions such as MSF, Public Health England and CDC.

Mr Flavio Salio, Network Leader, EMT Network, WHO headquarters, said that in the previous two years the EMT secretariat had received an increased number of requests for assistance in contexts other than the natural disasters for which the network had been set up. A total of 180 teams had been deployed globally, an increased number of which had been joint deployments with GOARN. EMT had also recently incorporated a readiness component, with emphasis on operational readiness at country level. The major difference in the previous two years had been the increased emphasis placed on the capacity-building and training component. Nonetheless, the guiding principles and core standards of EMT (notably solidarity and confidence-building) remained valid, even in responses to the COVID-19 pandemic. Work was being done with the initiatives responsible for RRMLs and rapid response teams, to identify synergies and explore the possibility of creating joint teams at country level in the near future. Joint training might also be further explored,

Mr Sam McKeever, Project Manager, TEPHINET, reiterated that in 2021 TEPHINET had provided Tier 1.0 and Tier 1.5 training to 140 FETP alumni representing 40 different nations. GOARN’s trainings, aimed at responders, not just epidemiologists, bridged the gap between epidemiological and laboratory information, transferring not only technical competences but also soft skills in areas such as leadership and conflict resolution. GOARN could advocate for balanced training in the different components of outbreak response work, rather than focusing solely on laboratory and epidemiological activities.

There was no better way to strengthen networks than to act together in the field.

33

Responding to further questions from the moderator, Mr. Oleg Storozhenko explained that the whole design of the RRML simulation exercise programme was aimed at setting a common “backbone” scenario of increasing complexity and developing an interface for engaging with different partners, firstly EMTs and emergency operation centres. The field exercise to test proposed coordination procedures and standards for biosafety and biosecurity for RRMLs had been organized by the Russian Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing (Rospotrebnadzor), and supported by WHE. In September 2020, WHO had deployed both an EMT and an RRML in response to fires that had broken out on the island of Lesbos, Greece.

Dr. Stephan Günther said that the nature of BNI’s support had changed since 2014. It no longer deployed complete laboratories with full teams of experts; instead, it met very specific requests for technical expertise to fill gaps in the laboratory response (by providing training in sequencing, for instance).

Mr. Sam McKeever confirmed that COVID-19 was changing TEPHINET’S strategy for how it delivered emergency response trainings to the FETP community. Trainings were moving online and more hybrid learning opportunities were being developed. FETP alumni should be ready to be deployed as responders in their home country and their region; that specific group of public health workers could be one of the first to get on the ground and effectively lead during a response.

Mr. Flavio Salio agreed on the need for further discussion of how to link GOARN’s rapid response capacities to EMTs at country level. Joint consideration should be given to defining ways for EMTs to support RRMLs. The EMT Network’s new strategic plan looked to strengthen surge planning and create a system that would allow a country to mobilize its workforce when needed. In view of the lack of standards applicable across all WHO regions, the EMT Network would also carefully consider the question of medical evacuation.

The whole design of the RRML simulation exercise programme was aimed at setting a common “backbone” scenario of increasing complexity and developing an interface for engaging with different partners, firstly EMTs and emergency operation centres.

FETP alumni should be ready to be deployed as responders in their home country and their region.

34

Dr Ibrahima Socé Fall, Assistant Director-General, Emergency Response, WHO headquarters, said that the global health emergency workforce (GHEW) was one pillar of the global framework for pandemic preparedness and response. Numerous recommendations had been issued on that topic, including by the IHR Review Committee and the Executive Board. In 2017, the newly elected Director-General of WHO had committed to creating a more reliable and coherent global workforce to respond to the health emergencies of the 21st century. There was currently an urgent need to integrate and coordinate a large number of siloed capacity-building initiatives across the entire disaster cycle.

The vision of the GHEW initiative was to have frontline responders in every country with the capacity to detect and respond to health emergencies in a timely manner, and for that national workforce to be linked to some capacity-building and supported by targeted international surge capacity when needed. The objectives of the initiative were therefore to strengthen national capacities to detect, prevent and respond to health emergencies through the creation of a standby workforce ready to be mobilized within their own countries and when required deployed to neighbouring countries in need, in the spirit of south–south cooperation. That required global coordination, and the Director-General was accordingly calling for a mechanism whereby WHO would be able to coordinate the network and enable the workforce to be deployed in a more predictable manner.

The GHEW initiative was designed to prioritize national ownership and mobilization of national responders, to support strategic deployment of international experts and teams, and to enable knowledge transfer and technical innovation. National responders were essential, so the focus on building capacity at national level was critical. Regional coordination would enable the workforce to be used in many countries, to respond not only to outbreaks but also to humanitarian crises. Global networks and initiatives (such as GOARN) were also needed to support Member States.

THE GLOBAL HEALTH EMERGENCY WORKFORCE AND GOARN

10

35

The added value of GHEW would include making a high-quality workforce available through capacity-building and certification and ensuring a diverse and inclusive workforce. The values embodied in the initiative were equity in access to learning opportunities; solidarity and shared capacity development, including south–south cooperation and bilateral and multilateral mechanisms; and protection of populations from any form of misconduct, including sexual exploitation and abuse.

There were numerous benefits to be obtained from being part of GHEW: free, certified trainings using a lifelong learning approach; recognition and membership of a national and international community working to save lives; leadership and management skills; access to a specialized network of experts and community of practice; the opportunity to gain national and international deployment experience; and professional development.

The expertise required by GHEW comprised not only technical skills but also competencies in leadership, health operations, supply chain management and strategic thinking. New profiles required to manage current and future emergencies would be identified in fields such as the social and behavioural sciences, data science, bioinformatics and genomics.

The GHEW ecosystem covered priority areas such as surveillance, clinical care, community engagement, coordination, rapid laboratory capacity and epidemic intelligence. The mechanisms operating in that ecosystem included national governments, academic institutions, rapid response teams, EMTs, innovative projects and GOARN.

Capacity-building efforts would have to be focused on Member States’ needs, build on and link to existing training and competencies, employ mixed methods and share experiences in communities of practice. The learning programme would adopt a three-pronged approach: education (formal training); exchange (social learning); and experience (learning by doing on the job).

The GHEW would make GOARN more global, more operational, more predictable and more responsive to Member States’ needs, and ensure that it had the global outreach that would be critical for the future.

Dr. Khassoum Diallo, Coordinator, Data, Evidence and Knowledge Management, Health Workforce Cluster, WHO headquarters, said that the GHEW initiative was timely for a number of reasons. First, the International Labour Organization (ILO) was currently revising the International Standard Classification of Occupations, and WHO was part of a technical working group looking closely at the public health emergency workforce. In addition, WHO was doing internal work to make sure that the Organization had a shared understanding of GHEW and health systems and avoided working in silos. WHO was jointly convening a global consultation in January 2022 to make sure that the global community spoke with one voice and acted together with regard to that key issue.

Dr Ibrahima Socé Fall, Assistant Director-General, Emergency Response, WHO headquarters, said that the global health emergency workforce (GHEW) was one pillar of the global framework for pandemic preparedness and response. Numerous recommendations had been issued on that topic, including by the IHR Review Committee and the Executive Board. In 2017, the newly elected Director-General of WHO had committed to creating a more reliable and coherent global workforce to respond to the health emergencies of the 21st century. There was currently an urgent need to integrate and coordinate a large number of siloed capacity-building initiatives across the entire disaster cycle.

The vision of the GHEW initiative was to have frontline responders in every country with the capacity to detect and respond to health emergencies in a timely manner, and for that national workforce to be linked to some capacity-building and supported by targeted international surge capacity when needed. The objectives of the initiative were therefore to strengthen national capacities to detect, prevent and respond to health emergencies through the creation of a standby workforce ready to be mobilized within their own countries and when required deployed to neighbouring countries in need, in the spirit of south–south cooperation. That required global coordination, and the Director-General was accordingly calling for a mechanism whereby WHO would be able to coordinate the network and enable the workforce to be deployed in a more predictable manner.

The GHEW initiative was designed to prioritize national ownership and mobilization of national responders, to support strategic deployment of international experts and teams, and to enable knowledge transfer and technical innovation. National responders were essential, so the focus on building capacity at national level was critical. Regional coordination would enable the workforce to be used in many countries, to respond not only to outbreaks but also to humanitarian crises. Global networks and initiatives (such as GOARN) were also needed to support Member States.

THE GLOBAL HEALTH EMERGENCY WORKFORCE AND GOARN

10The added value of GHEW would include making a high-quality workforce available through capacity-building and certification and ensuring a diverse and inclusive workforce.

36

Mr. Pat Drury, GOARN Project Manager, reiterated the vision, values and guiding principles of the GHEW initiative. He clarified that GOARN could support the initiative by strengthening national capacities to detect, prevent and respond to health emergencies; creating a standby rapid response workforce within each country; supporting the rapid deployment of international experts and teams as needed; and enabling knowledge transfer and innovation through technical networks. There was wide recognition of GOARN as a key component of global health security, of its global reach and of the diversity of its partners’ workforce. It played a vital role in supporting the coordination of alert and response work. The challenge was how to professionalize the strategic and technical support offered by GOARN, together with other initiatives, such as the Global Health Cluster and other clusters, EMTs, health operations networks, and standby partner arrangements.

GOARN could contribute to the development of a global, full-time, multidisciplinary and multiagency epidemic and pandemic alert and response corps in a number of ways. It should complete global and regional mapping of GOARN partners’ capacities against countries’ expertise requirements and needs. It should support surveillance and outbreak detection systems and epidemic intelligence through the WHO Berlin Hub and similar initiatives. Partnerships with countries should be strengthened through engagement with additional national public health institutions and local GOARN partners. Support to rapid response capacity and operations should be scaled up, including through the RCCE, IOA, RRML and Go.Data initiatives. GOARN’s training programme, and in particular Tier 2 field scenario training, should be expanded.

High-quality, rapid, cost-effective and efficient deployment of international support to support outbreak response was still GOARN’s core business; however, the mechanism for coordination of national and international public health institutes, centres for disease control, emergency operations centres and other GOARN partners might need to be adapted to support a fully functional and deployable corps based on pre-selected, pre-trained and pre-qualified experts.

Similarly, consideration should be given to improving the standard operating procedures for rapid deployment during a response, potentially including formal agreements (general or specific) with countries and other initiatives to facilitate global deployments. A review should also be made of the financing and support of both national and international rapid responses, including a critical analysis of baseline costs and incentives for international deployments.

Partnerships with countries should be strengthened through engagement with additional national public health institutions and local GOARN partners.

37

Ms. Nicoleta Dumitru, Technical Officer, Standby Partners, WHO headquarters, commended the interesting initiative and looked forward to joining the GHEW mechanism.

Dr. Joseph Jansa, ECDC, asked how local and national networks of GOARN partners could be managed and strengthened within the constraints of GOARN’s current funding. In response, Dr. Socé Fall advocated a phased approach, identifying priority countries for capacity-building efforts. That work would involve not only GOARN and WHO but all partners. The GHEW pillar needed to be fully integrated into the global discussion and global architecture of the pandemic prevention, preparedness and response agreement.

Mr. Pat Drury saw the current status of the GHEW initiative as one of building engagement and advocacy with the major stakeholders and donors. Initially, countries would need to invest in that capacity, then global donors could be brought in to finance a global system. The discussion and negotiations on a treaty in preparation for the World Health Assembly in 2022 provided an

opportunity to further advance that advocacy and work on financing mechanisms. Within GOARN, the question of financing would need to be looked at by the SCOM, bringing together a group of key stakeholders for that purpose.

Professor Ali Khan, University of Nebraska, USA, called for countries’ capacity-building efforts to be based on measurement of their preparedness to respond to an outbreak. Following a gap analysis, a set of clear training products could then defined for each of the domains identified. Mr. Pat Drury noted that a team at the Resolve to Save Lives initiative was working on a pilot project on a set of key indicators of preparedness.

In conclusion, Dr. Socé Fall agreed that it was important to consider the whole cycle of outbreak preparedness and response. A very dynamic set of metrics would be needed in order to measure preparedness in each country and define capacity and training needs accordingly.

High-quality, rapid, cost-effective and efficient deployment of international support to support outbreak response was still GOARN’s core business.

38

Dr. Gail Carson, SCOM Vice-Chairperson, recalled the five strategic questions across the set of four scenarios that had been considered by the 10 discussion groups.

Preliminary analysis of answers to the first question (“Which two areas of work are most important for GOARN to have continued, which should have stopped, and what new services should have started?”) revealed that participants were reluctant to drop any areas. However, drawing up a strategy was about making choices, and GOARN did not have the resources to do everything. If it wished to do high-quality work, it would have to prioritize. Participants had found it difficult to carry through a process of prioritization during the strategic conversation;

that aspect would accordingly need to be further worked on and presented to the SCOM and GOARN partners in early 2022. Nonetheless, participants had placed particular emphasis on training and capacity-building, as well as on GOARN going local, although the latter aspect required further elaboration, too.

When discussing the second question (“For countries classed as vulnerable or in areas of conflict in this scenario, what new services should GOARN deliver?”), participants had called for GOARN to be less bureaucratic and more flexible and agile, acting in particular as a guarantor of the basic elements of public health and not subscribing to the view of health as a commodity. In answer to the third question (“What is the key value of being a member of GOARN in this scenario?”), some participants had admitted that they did not know what GOARN did, what partners did or how to engage. It was suggested that GOARN needed to define why an institution should become a member of the Network. Nonetheless, GOARN was seen as offering an environment for shared learning and as an honest broker, which was particularly important in the “political patchwork” and “pay as you go” scenarios.

OUTPUT FROM THE STRATEGIC CONVERSATION AT GMP 2021

11

Participants had called for GOARN to be less bureaucratic and more flexible and agile, acting in particular as a guarantor of the basic elements of public health.

39

The fourth question (“What organizational form and governance model should GOARN have implemented in this scenario?”) had also proved difficult to answer; the Vice-Chairperson would call on the Saïd Business School for advice in that regard. In the “political patchwork” scenario, one participant had described GOARN as “valuable as a life boat to help countries that could struggle in the sea of nationalism” (notably in terms of equity of access to vaccines and therapeutics).

The fifth question (“What financial and human resources does GOARN need to operate in this scenario compared to today? Where would they come from?”) was clearly linked to the previous one on governance and how GOARN should organize itself, including a locally based component. Participants had urged GOARN to scale up its operations and had expressed optimism about the prospects of an increase in funds. More staff were undoubtedly needed in order to deliver on an international and local-based workplan. Participants had placed emphasis on the key role played by training and had suggested that leadership training might be used to ensure that future GOARN leaders rotated through partners before returning to their home countries.

A few common themes could therefore be discerned from all the discussion groups: the need for GOARN to be clear about its identity; partner and stakeholder mapping; funding; communications; training; strengthening the network; more collaboration with the global south; communities at the centre; and a flexible, agile and fast organization.

The Steering Committee would “digest” all those sources of information and data during a period of consultation in early 2022.

Dr. Gail Carson, SCOM Vice-Chairperson, recalled the five strategic questions across the set of four scenarios that had been considered by the 10 discussion groups.

Preliminary analysis of answers to the first question (“Which two areas of work are most important for GOARN to have continued, which should have stopped, and what new services should have started?”) revealed that participants were reluctant to drop any areas. However, drawing up a strategy was about making choices, and GOARN did not have the resources to do everything. If it wished to do high-quality work, it would have to prioritize. Participants had found it difficult to carry through a process of prioritization during the strategic conversation;

that aspect would accordingly need to be further worked on and presented to the SCOM and GOARN partners in early 2022. Nonetheless, participants had placed particular emphasis on training and capacity-building, as well as on GOARN going local, although the latter aspect required further elaboration, too.

When discussing the second question (“For countries classed as vulnerable or in areas of conflict in this scenario, what new services should GOARN deliver?”), participants had called for GOARN to be less bureaucratic and more flexible and agile, acting in particular as a guarantor of the basic elements of public health and not subscribing to the view of health as a commodity. In answer to the third question (“What is the key value of being a member of GOARN in this scenario?”), some participants had admitted that they did not know what GOARN did, what partners did or how to engage. It was suggested that GOARN needed to define why an institution should become a member of the Network. Nonetheless, GOARN was seen as offering an environment for shared learning and as an honest broker, which was particularly important in the “political patchwork” and “pay as you go” scenarios.

OUTPUT FROM THE STRATEGIC CONVERSATION AT GMP 2021

11

Participants had urged GOARN to scale up its operations and had expressed optimism about the prospects of an increase in funds.

40

Dr. Lina Moses, Lead, GOARN/Research, reported that several members of the SCOM had been working on drawing up a GOARN declaration or statement focused on a recommitment to public health and equity in the distribution of medical countermeasures to the COVID-19 pandemic. The statement would reiterate a number of principles that had been repeatedly emphasized during GMP 2021: actions must be community-centred, equitable, interdisciplinary and science- and evidence-based. Several points in the call to action that would be included in the declaration were still being worked on. It was planned to release the statement in early 2022, to maximize uptake by media outlets.

Professor Dale Fisher, SCOM Chairperson, noted that GOARN was close to finalizing its strategy for 2022–26. At the next meeting of the Steering Committee, in the first half of 2022, he and Dr. Gail Carson would stand down as SCOM Chairperson and Vice-Chairperson, respectively, and the Steering Committee would select a new leadership. After that, the SCOM leadership and some other independent parties would look at partners’ expressions of interest to join the new Steering Committee. GOARN would strive for diversity of disciplines and regions and looked for a strong Steering Committee, which would be charged with implementing the new strategy.

GOVERNANCE12

41

Professor Dale Fisher, SCOM Chairperson, summarized the achievements of GMP 2021. GOARN partners had secured collective recognition of GOARN’s added value; strategized possible global health futures; explored new opportunities for partnerships; networked among each other and made new professional connections; discovered ways of getting more involved in GOARN’s areas of work and missions; and shared experiences and gathered feedback.

Dr. Mike Ryan, Executive Director, WHO Health Emergencies Programme, said that GOARN was an inspirational network that had managed to last for 20 years with almost no governance, which testified to the advantages of unstructured collaboration and participatory power. As he had said to the Steering Committee earlier in the week, the debates currently going on at global level on a pandemic preparedness treaty or instrument involved politicians and people attending G7 and G20 meetings, and faceless committees and panels of self-declared experts. Over the previous 20 years, there had been a failure of investment in public health, health emergency preparedness and disaster risk reduction. What was needed now was for the real experts, the people who had worked on the frontline of epidemic preparedness and response and of health emergency management for the previous two decades, to stand up at national and global levels and be heard, and to influence the global debate on where to invest money in pandemic preparedness and response.

GOARN was a collaboration more than 250 institutions and networks that existed in their own right. It had a strong and unique voice on the global stage. Through its strategy, GOARN had a unified voice and could be part of that global conversation. WHO would do everything from its side to create the platforms for GOARN to have that voice. It must use it, or it would lose it.

GOARN needed to focus on building national capacity. Global health security existed when strong national public health institutions were connected and able to detect and respond to disease outbreaks. Connecting those national systems in an unbreakable chain of global security was the job of GOARN and WHO. Their primary task was to support acceleration of the development of national capacities and to make sure that capacities were transferable.

CLOSURE OF THE MEETING

13

42

The vast majority of response scenarios were where national governments retained their sovereignty within their own territory and their responsibility for the health protection of their citizens. In order to ensure national accountability, countries should be able to choose the resources deployed and to control their quality. To drive professional responses in the field, the global community needed to offer pre-qualified resources, people who were actually interoperable. GOARN was well placed to put national public health institutions at the centre and to work to create the kind of training and professional proficiency standards that would guarantee and underwrite the quality and professionalism and proficiency of those individuals.

GOARN was one of the most respected and admired networks, and it had never been challenged in its existence. If it was to evolve, there needed to be a higher level of commitment to its core operational support, and other major institutions would be expected to make the same commitment. He was pleased that UNICEF and others had deployed personnel from GOARN and partners, and that other agencies had been involved in areas of work such as IOA and RCCE. Some of the better coordination within the United Nations system had come from the trust that had been built up through the GOARN process.

There were some real champions of the One Health approach within GOARN; many partners were also drivers of the One Health agenda. But it was important to be very practical and to ensure that One Health was truly articulated in the lives of ordinary communities of people. One possible positive aspect of the pandemic was the fundamental recognition at the highest level of governments that there was a concept of One Health, there was an animal/human interface, and that the planet, the ecosystem and human systems were deeply intertwined and connected. GOARN should be pushing for practical realization of what One Health meant.

In conclusion, he thanked Professor Dale Fisher and Dr. Gail Carson for their leadership, commended the work of the OST team and paid tribute to Mr. Pat Drury as the living embodiment of the principles, practice and ethos of GOARN. The Network needed to step forward and see where the next 20 years would take it. Never had there been a better opportunity for it to act, to influence and to evolve than there was at present.

Annexes Annex 1 GMP 2021 Agenda Annex 2 List of participants Annex 3 Topical webinar 1. Shifting the community engagement paradigm Annex 4 Topical webinar 2. ‘Go with GOARN’ – the realities of deploying experts

for an international outbreak response Annex 5 Topical webinar 3. Explore the Go.Data global roll-out opportunity Annex 6 Topical webinar 4. Operational research

43

44

45

46

ANNEX 1: GMP 2021 AGENDA

GOARN GLOBAL MEETING OF PARTNERS 2021Virtual meeting

14-16 December 2021

DAY 1. TUESDAY, 14 DECEMBER 2021Time Session Title Presenters

12:00 – 13:00 Opening Remarks and Keynote Speeches D. FisherT. GhebreyesusJ. Chapagain H. Fore

13:00 – 14:00 Key achievements of GOARN and upcoming opportunities for collaboration

JC. Aze

14:00 – 14:15 Break

14:15 – 15:00 Strengthening Global Collaboration for Global Alert and Surveillance D.FisherC. Ihekweazu

15:00 – 15:30 Taking an integrated approach to outbreak analytics P. LissoubaS. Carter

15:30 – 16:00 Shaping a strong future for response: GOARN Strategy 2022-2026 G. Carson

16:00 – 18:00 Topical Webinar 1: Shifting the community engagement paradigm L.HilmiE. SyN. EmirogluJ. De BourghI.SohG.Makangila

DAY 2. WEDNESDAY, 15 DECEMBER 2021Time Session Title Presenters

09:00 – 11:00 Topical Webinar 2: ‘Go with GOARN’ – the realities of deploying experts for an international outbreak response

S.SalmonK. Von HarbouJ.ShepardB. MartinP. ZimmermanM. HenkensB. Gannon

12:00 – 13:30 GOARN Strategy Workshop G. CarsonR. Ramirez

13:30 – 13:45 Break

47

ANNEX 1: GMP 2021 AGENDA

GOARN GLOBAL MEETING OF PARTNERS 2021Virtual meeting

14-16 December 2021

13:45 – 15:00 GOARN Strategy Workshop (continued) G. Carson

15:00– 16:00 Emerging Diseases and One Health P. Ben EmberakM. VenterJC. Manuguerra T. MettenleiterW. Markotter

16:00 – 18:00 Topical Webinar 3: Explore the Go.Data global roll out opportunity A.SallM. PanicO.Morgan

DAY 3. THURSDAY, 16 DECEMBER 2021Time Session Title Presenters

09:00 – 11:00 Topical Webinar 4: Operational research V. del RioN. GobatS.SwaminathanT. TshokeyT. HousenB. SmaghiA. OlayinkaL. Moses

12:00 – 13:00 Capacity Building and Training P. EfflerA. KhanN. OhmagariL. TorreA.JansenA.Griener

13:00 – 14:00 Technical Collaboration for stronger public health impact L.CarterS. GuntherO.StorozhenkoF. SalivoS. McKeever

14:00 – 14:15 Break

14:15 – 15:00 10. Global Workforce and GOARN S.Fall P. Drury

15:00 – 15:30 11. Output from the GMP Strategy Lab and Governance next steps D. FisherG. CarsonL. Moses

15:30 – 16:00 12. Closing and Next Steps for 2022-23 D. FisherM. Ryan

48

ANNEX 2: LIST OF PARTICIPANTS

GOARN GLOBAL MEETING OF PARTNERS 2021Virtual meeting

14-16 December 2021

AUSTRALASIAN COLLEGE FOR INFECTION PREVENTION AND CONTROL (ACIPC)Dr Peta-Anne ZimmermanBoard Director

BERNHARD-NOCHT INSTITUTE FOR TROPICAL MEDICINE (BNITM)Prof Dr Stephen GuntherVirologist

COLLEGE OF PUBLIC HEALTHNEBRASKA UNIVERSITYProfessor Ali S. KhanDean COMMUNITY READINESS AND RESILIENCEWORLD HEALTH ORGANIZATIONDr Nina GobatTechnical Officer

CORE GROUP Dr Lisa HilmiExecutive Director

COUNTRY READINESS STRENGTHENING WORLD HEALTH ORGANIZATIONMr Flavio SalioNetwork Leader

COUNTRY READINESS STRENGTHENINGWORLD HEALTH ORGANIZATIONDr Nedret EmirogluDirector

DIVISION OF HEALTH EMERGENCIES AND COMMUNICABLE DISEASESWHO REGIONAL OFFICE FOR EUROPE(EURO)Dr Oleg StorozhenkoPartnership Officer

EMERGENCY RESPONSEHEALTH EMERGENCIES PROGRAMMEWORLD HEALTH ORGANIZATIONDr Ibrahima-Soce FallAssistant Director-General

FIELD EPIDEMIOLOGY TRAINING PROGRAM(FETP) PAPUA NEW GUINEAMrs Bernnedine SmaghiProgramme Convener

HEALTH EMERGENCIES PROGRAMMEWHO REGIONAL OFFICE FOR THE WESTERN PACIFIC (WPRO)Dr Sharon Salmon GOARN, Technical Officer

EMERGENCY RESPONSE AND RECOVERY BRANCH UNITED STATES CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC) Dr Ashley GreinerMedical Officer / Lead

EMERGENCY SUB-OFFICE -COX’S BAZAR BANGLADESHWORLD HEALTH ORGANIZATION Dr Kai HarbouHead

EPICENTRE FRANCEDr Pascale LissoubaEpidemiologist

GLOBAL OUTBREAK ALERT AND RESPONSE NETWORK (GOARN)HEALTH EMERGENCIES PROGRAMMEWORLD HEALTH ORGANIZATIONMr Pat DruryManager

GLOBAL OUTBREAK ALERT AND RESPONSE NETWORK (GOARN)HEALTH EMERGENCIES PROGRAMMEWORLD HEALTH ORGANIZATIONMr Jean Christophe AzeTechnical Officer

HEALTH EMERGENCY INFORMATION AND RISK ASSESSMENTWORLD HEALTH ORGANIZATIONDr Oliver MorganDirector

HEALTH EMERGENCIES PROGRAMMEWHO REGIONAL OFFICE FOR SOUTH-EAST ASIA (SEARO)Dr Victor del Rio VilasGOARN, Technical officer

HEALTH EMERGENCIES PROGRAMMEWORLD HEALTH ORGANIZATIONDr Mike RyanExecutive Director

INSTITUT PASTEUR (IP) FRANCEDr Jean-Claude ManuguerraResearch and Director/Head

INSTITUT PASTEUR (IP) SENEGALDr Amadou SallCEO

INTEGRATED OUTBREAK ANALYTICS-IOAUNITED NATIONS CHILDREN’S FUND (UNICEF)Ms Simone CarterLead

INTERNATIONAL FEDERATION OF RED CROSS AND RED CRESCENT SOCIETIESDr Jagan ChapagainSecretary General

INTERNATIONAL SEVERE ACUTE RESPIRATORY AND EMERGING INFECTION CONSORTIUMDr Gail CarsonDirector

SPEAKERS

49

JIGME DORJI WANGCHUCK NATIONAL REFERRAL HOSPITAL (JDWNRH)BHUTANDr TshokeyClinical Microbiologist

MÉDECINS SANS FRONTIÈRES INTERNATIONAL OFFICE Dr Myriam Henkens International Medical Coordinator

NATIONAL CENTRE FOR EPIDEMIOLOGY AND POPULATION HEALTH, RESEARCH AUSTRALIAN NATIONAL UNIVERSITYDr Tambri HousenSenior Research Fellow

NATIONAL CENTER FOR GLOBAL HEALTH AND MEDICINE (NCGM) JAPANDr Norio OhmagariDirector

NATIONAL CRITICAL CARE AND TRAUMARESPONSE CENTRE, AUSTRALIAMs Bronte MartinSenior Director

NATIONAL UNIVERSITY OF SINGAPORESINGAPOREProfessor Dale Fisher Group Director

NIGERIA CENTRE FOR DISEASE CONTROL (NCDC)Prof Adebola OlayinkaResearch Officer

OFFICE OF THE CHIEF SCIENTISTWORLD HEALTH ORGANIZATIONDr Soumya SwaminathanExecutive Director

OFFICE OF THE HEALTH EMERGENCIES PREPAREDNESS AND RESPONSEWORLD HEALTH ORGANIZATIONDr Chikwe IhekweazuAssistant Director-General

ONE HEALTH HIGH-LEVEL EXPERT PANEL Dr Thomas MettenleiterCo- Chair

ONE HEALTH INITIATIVEHEALTHIER POPULATIONS WORLD HEALTH ORGANIZATIONDr Peter Karim Ben EmbarekHead

PATHWEST LABORATORY MEDICINE WADr Paul EfflerMedical AdvisorPUBLIC HEALTH AGENCY OF CANADA(PHAC)Ms Mirna PanicManager

ROBERT KOCH INSTITUTE GERMANYDr Andreas JansenHead

SCENARIOS PROGRAMME AT THE SAЇD BUSINESS SCHOOL OXFORD UNIVERSITYDr Rafael RamirezDirector

SCENARIOS PROGRAMME AT THE SAЇD BUSINESS SCHOOL OXFORD UNIVERSITYDr Trudi LangSenior Fellow

THE INDEPENDENT PANEL FOR PANDEMIC PREPAREDNESS AND RESPONSE (IPPPR)Mr Elhadj As Sy

TRINIDAD & TOBAGO RED CROSS SOCIETYPORT OF SPAIN TRINIDAD Ms Jill De BourgPresident

TRAINING PROGRAMS IN EPIDEMIOLOGY AND PUBLIC HEALTH INTERVENTIONS NETWORK (TEPHINET) Sam MackeeverTechnical officer

TRAINING PROGRAMS IN EPIDEMIOLOGY AND PUBLIC HEALTH INTERVENTIONS NETWORK (TEPHINET) Mr Lissandro TorreProject Management

TULANE SCHOOL OF PUBLIC HEALTH AND TROPICAL MEDICINEProf Lina MosesAssociate Professor

UK HEALTH SECURITY AGENCY (FORMERLY PHE)Prof Benedict GannonSenior Microbiologist

UNITED NATIONS CHILDREN’S FUND (UNICEF)UNITED STATES OF AMERICADr Henrietta H. ForeExecutive Director

UNIVERSITY OF LONDONMr Ian SohMedical Student

UNIVERSITY OF PRETORIAProf Wanda MarkotterVirologist

WORLD HEALTH ORGANIZATIONDr Tedros GhebreyesusDirector-General

YALE UNIVERSITY SCHOOL OF MEDICINEDr James ShepherdAssociate Professor

ZOONOTIC ARBOVIRUS AND RESPIRATORY VIRUS RESEARCH PROGRAMMEUNIVERSITY OF PRETORIADr Marietjie VenterProfessor

ANNEX 2: LIST OF PARTICIPANTS continued

50

INSTITUTION AND ORGANIZATION

ANNEX 2: LIST OF PARTICIPANTS continued

AFRICA CENTERS FOR DISEASE CONTROL AND PREVENTION, ETHIOPIADr Benjamin DjoudalbayeHead

AFRICAN FIELD EPIDEMIOLOGY NETWORKDr Ditu KazambuEpidemiologist

AMERICAN UNIVERSITY OF BEIRUT MEDICAL CENTER, LEBANONNada Kara ZahreddineManager

AMERICAN UNIVERSITY OF BEIRUT MEDICAL CENTER, LEBANONProf Souha KanjProfessor

AMREF HEALTH AFRICA, KENYADr Jane Carter

APEC EMERGING INFECTIONS NETWORK (EINET), USADr Randal SchoeppVirologist

ARM NETWORK (AUSTRALIAN RESPONSE MAE NETWORK), AUSTRALIAProf Raina MacintyreProfessor

ASSOCIATION OF PUBLIC HEALTH LABORATORIES (APHL), USAMr Ralph TimperiSenior Advisor

ASSOCIATION POUR LE DÉVELOPPEMENT DE L’ÉPIDÉMIOLOGIE DE TERRAIN (EPITER),ITALYASMA SAIDOUNIEpidemiologist

AUSTRALASIAN COLLEGE FOR INFECTION PREVENTION AND CONTROL (ACIPC), FORMERLY AICA, AUSTRALIADr Peta-Anne ZimmermanClinician

BUREAU OF EPIDEMIOLOGY, SURVEILLANCE AND RESPONSE UNIT, MINISTRY OF HEALTH, THAILANDWanna HanshaowarakulSenior Adviser

CANADIAN INSTITUTES OF HEALTH RESEARCH (CIHR) - INSTITUTE OF INFECTION AND IMMUNITY (III),CANADADr Charu KaushicScientific DirectorCENTER FOR EMERGING VIRAL DISEASES, HUG, SWITZERLANDDr Frederique Jacquerioz Doctor

CENTER FOR INFECTION AND IMMUNITY, MAILMAN SCHOOL OF PUBLIC HEALTH OF COLUMBIA UNIVERSITY, USAMr Kenneth WiskiserDirector

CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC), USADr Dana PittsLead- Communications

CENTER FOR INFECTIOUS DISEASES, NARA MEDICAL UNIVERSITY, JAPAN Kei KasaharaDirector

CENTRAL DEPARTMENT OF MICROBIOLOGY, TRIBHUVAN UNIVERSITY, NEPAL Prof Prakash GhimireProfessor

CENTRE NATIONAL DE TRANSFUSION SANGUINE (CNTS), BURKINA FASODr Koumpingnin NebieAssistant Professor

CENTRE NATIONAL DE TRANSFUSION SANGUINE (CNTS), BURKINA FASO Salam SawadogoAssistant professor

CHAN ZUCKERBERG BIOHUBDr Cristina TatoDirector

CENTERS FOR DISEASE CONTROL AND PREVENTION, (USA CDC)Dr Ray R. ArthurDeputy Incident Manager/Lead

CHINESE CENTERS FOR DISEASE CONTROL AND PREVENTION, (CHINA CDC)Dr Yanping ZhangResearcher/Deputy Director

CHINESE CENTER FOR DISEASE CONTROL AND PREVENTION, (CHINA CDC)Dr Ning FengSenior Doctor

CHINESE CENTER FOR DISEASE CONTROL AND PREVENTION, (CHINA CDC)Nijuan XiangChief

CHINESE CENTER FOR DISEASE CONTROL AND PREVENTION, (CHINA CDC)Lianmei JinChief

CHINESE CENTER FOR DISEASE CONTROL AND PREVENTION, (CHINA CDC)Prof Lei ZhouProfessor

CLINICAL RESEARCH UNIT, HOSPITAL FOR TROPICAL DISEASES, VIET NAMRogier Van DoormResearcher

COLLABORATIVE FOR THE ADVANCEMENT OF INFECTION PREVENTION AND CONTROL (CAIPC), AUSTRALIAMr Matt MasonLead

COLLEGE OF PUBLIC HEALTH, MEDICAL AND VETERINARY SCIENCES, JAMES COOK UNIVERSITY, AUSTRALIAMaxine WhittakerPhysician

EASTERN MEDITERRANEAN PUBLIC HEALTH NETWORK, JORDANDr Mohannad Al-NsourExecutive Director

51

MINISTRY OF HEALTH OMANDr Seif AI-AbriDirector General

EPIDEMIOLOGY BUREAU DEPARTMENT OF HEALTH, PHILIPPINESMa. Nemia SucalditoChief

EPIET ALUMNI NETWORK (EAN), SPAINDr Iro EvlampidouGeneral Doctor

ERASMUS MC NETHERLANDS (THE)Dr Richard MolenkampMicrobiologist/Virologist

EUROPEAN CENTRE FOR DISEASE PREVENTION AND CONTROL, SWEDENDr Josep JansaHead

EUROPEAN CENTRE FOR DISEASE PREVENTION AND CONTROL (ECDC), SWEDENDr Maria Carmen Varela SantosEpidemiologist / Head

BERNHARD NOCHT INSTITUTE FOR TROPICAL MEDICINE EUROPEAN MOBILE LABORATORY (EMLAB), GERMANYDr Sophie DuraffourTeam lead

BERNHARD NOCHT INSTITUTE FOR TROPICAL MEDICINE EUROPEAN MOBILE LABORATORY (EMLAB), GERMANYDr Emily NelsonResearcher

BERNHARD NOCHT INSTITUTE FOR TROPICAL MEDICINE EUROPEAN MOBILE LABORATORY (EMLAB), GERMANYDr Giuditta Annaibaldis

EUROPEAN VIRUS ARCHIVE GOES GLOBAL (EVAG), FRANCEDr Jean-Loius Romette

FACULTY OF HEALTH SCIENCES, CURTIN UNIVERSITY OF TECHNOLOGY AUSTRALIAProf John MackenzieVirologist

FACULTY OF MEDICINE, CHULALONGKORN UNIVERSITY THAILANDDr Supaporn WacharapluesadeSenior Researcher

FACULTY OF MEDICINE, CHULALONGKORN UNIVERSITY, THAILANDProf Thiravat HemachudhaProfessor

FACULTY OF MEDICINE, CHULALONGKORN UNIVERSITY, THAILANDOpass PutcharoenPhysician

FACULTY OF PUBLIC HEALTH - LEBANESE UNIVERSITY, LEBANONProf Nabil HaddadProfessor

FEDERAL UNIVERSITY OF RIO DE JANEIRO, BRAZILDr Marta Cavalcanti

DEPARTMENT OF INTERNATIONAL DEVELOPMENT, UNITED KINGDOMDr Clementine FuChief Scientific Adviser

GLOBAL VIRUS NETWORK USAMr Christian BrechotPresident

GLOPID-R, FRANCEDr Hans Hagen

GUANGDONG PROVINCIAL CENTER FOR DISEASE CONTROL AND PREVENTION,CHINADr Haiming LuoDirector

INTERNATIONAL CENTER FOR DIARRHOEAL DISEASE RESEARCH,BANGLADESH (ICDDR,B)Dr Lubaba SharinAssociate Scientist

INSTITUT FUER VIROLOGIE, PHILIPPS-UNIVERSITÄT MARBURG, GERMANYDr Thomas StreckerPrincipal investigator

INSTITUT PASTEUR (IP), ALGERIAAissam HachidDirector

INSTITUT PASTEUR (IP), ALGERIAFawzi DerrapDirector

INSTITUT PASTEUR (IP), COTE D’IVOIREDr Mariam Mama Djima Pharmacist / Epidemiologitst

INSTITUT PASTEUR (IP), INTERNATIONALFRANCEDr Christophe BatejatVirologist

INSTITUT PASTEUR (IP), MOROCCOMohammad AbidHead

INSTITUTE DE RECHERCHE POUR LE DEVELOPEMENT (IRD), FRANCEDr Benjamin RocheResearch Director

INSTITUTE OF EPIDEMIOLOGY, DISEASE CONTROL AND RESEARCH (IEDCR), BANGLADESHDr ASM AlamgirHead

INSTITUTE OF MICROBIOLOGY AND IMMUNOLOGY, FACULTY OF MEDICINE, UNIVERSITY OF LJUBLJANA, SLOVENIAProf Tatjana AVŠIČ-ŽUPANCHead

INSTITUTE OF MICROBIOLOGY AND IMMUNOLOGY, FACULTY OF MEDICINE, UNIVERSITY OF LJUBLJANA, SLOVENIAMisa KorvaResearcher

INSTITUTE OF TROPICAL MEDICINE NAGASAKI UNIVERSITY, JAPANDr Kouchi MoritaDirector

INSTITUTO NACIONAL DE SAÚDE DR. RICARDO JORGE, PORTUGALJorge Machado

INTERNATIONAL ASSOCIATION OF NATIONAL PUBLIC HEALTH INSTITUTIONS (IANPHI)Dr Neil Squires

ANNEX 2: LIST OF PARTICIPANTS continued

52

ANNEX 2: LIST OF PARTICIPANTS continued

INTERNATIONAL FEDERATION OF RED CROSS AND RED CRESCENT SOCIETIES (IFRC), SWITZERLAND Dr Panu SaaristoDirector a.i.

INTERNATIONAL FEDERATION OF RED CROSS AND RED CRESCENT SOCIETIES (IFRC), SWITZERLANDMs Silvia MagnoniRCCE Collective Coordinator

INTERNATIONAL FEDERATION OF RED CROSS AND RED CRESCENT SOCIETIES (IFRC), SWITZERLAND Ms Ombretta BaggioSenior Adviser

INTERNATIONAL ORGANIZATION FOR MIGRATION SWITZERLAND Alice WimmerTechnical Officer

INTERNATIONAL ORGANIZATION FOR MIGRATION SWITZERLANDHaley WestSenior Programme Officer

INTERNATIONAL RESCUE COMMITTEE (IRC) USADr Marydale OppertPublic Health Advisor

ISARIC - INTERNATIONAL SEVERE ACUTE RESPIRATORY AND EMERGING INFECTION CONSORTIUM UNITED KINGDOMMs Sarah MooreProgramme Manager

ISARIC - INTERNATIONAL SEVERE ACUTE RESPIRATORY AND EMERGING INFECTION CONSORTIUM USADr Melina Michelen

ISARIC - INTERNATIONAL SEVERE ACUTE RESPIRATORY AND EMERGING INFECTION CONSORTIUM, UNITED KINGDOMDr Gail CarsonDirector

ISTITUTO SUPERIORE DI SANITA (ISS), ITALYDr Flavia RiccardoSenior Researcher

JAPAN INTERNATIONAL COOPERATION AGENCY (JICA), JAPANMaki NagaiNurse

JAPANESE RED CROSS WAKAYAMA MEDICAL CENTER, JAPANDr Nobuhiro KomiyaPhysician

JOHANNITER-UNFALL-HILFE E.V. HEADQUARTERS BERLIN, GERMANYDr Oliver HoffmannAdvisor

JOHNS HOPKINS UNIVERSITY, USADr Paul SpiegelDirector

JOHNS HOPKINS UNIVERSITY, USAMs Lucia MullenSenior Analyst

JOHNS HOPKINS UNIVERSITY, USAMs Kathryn BertramSr. SBC Advisor

JORDAN FOOD AND DRUG ADMINISTRATION, JORDANMs Sarab AlabbadiSpecialist

JW LEE CENTER FOR GLOBAL MEDICINE, SEOUL NATIONAL UNIVERSITY COLLEGE OF MEDICINE, REPUBLIC OF KOREA (THE)Ms Jien Park

JW LEE CENTER FOR GLOBAL MEDICINE, SEOUL NATIONAL UNIVERSITY COLLEGE OF MEDICINE, REPUBLIC OF KOREA (THE)Professor Myoung-don OHProfessor

JW LEE CENTER FOR GLOBAL MEDICINE, SEOUL NATIONAL UNIVERSITY COLLEGE OF MEDICINE, REPUBLIC OF KOREA (THE)Dr Sang-Won ParkPhysician

KENYA MEDICAL RESEARCH INSTITUTE (KEMRI), KENYAMr Joel LutomiahResearcher

KOREA CENTRES FOR DISEASE CONTROL AND PREVENTION (KCDC), REPUBLIC OF KOREA (THE)Dr Bryan KimEpidemiologist

LABORATORY P4 INSERM JEAN MERIEUX, FRANCEDr Stéphane MelyHead- Department of Vitro Experimentation

LABORATORY P4 INSERM JEAN MERIEUX, FRANCE Dr Delphine PannetierHead- Scientific coordination and diagnostics

LONDON SCHOOL OF HYGIENE AND TROPICAL MEDICINE (LSHTM), UNITED KINGDOMDr Jimmy WhitworthProfessor

MÉDECINS SANS FRONTIÈRES, LUXEMBOURG Prof Amrish BaidjoeDirector

MÉDECINS SANS FRONTIÈRES, BELGIUMDr Myriam HenkensMedical Coordinator

MEDECINS SANS FRONTIERES, BELGIUMDr Daniela Garone

MEDICAL UNIVERSITY OF VIENNA, CENTER FOR PUBLIC HEALTH, AUSTRIAProf Ruth KutalekAssociate Professor

MEKONG BASIN DISEASE SURVEILLANCE (MBDS), THAILANDMr Moe Ko OOHead

MERIEUX FONDATION, FRANCEMr Richard VauxCoordinator

53

ANNEX 2: LIST OF PARTICIPANTS continued

MINISTRY OF HEALTH SUDAN, NATIONAL PUBLIC HEALTH LABORATORY (NPHL), SUDANDr Mutasim Mustafa Mohamed

EPIDEMIOLOGICAL SURVEILLANCE PROGRAM MINISTRY OF PUBLIC HEALTH, LEBANONDr Nada GhosnHead

MWATER, USADr Annie FeigheryTechnical Officer

NATIONAL CENTER FOR GLOBAL HEALTH AND MEDICINE, ,JapanDr Masahiro Ishikane

NATIONAL CENTER FOR GLOBAL HEALTH AND MEDICINE, JAPANDr Mugen UjieDirector

NATIONAL CENTRE FOR EPIDEMIOLOGY AND POPULATION HEALTH (NCEPH), THE AUSTRALIAN NATIONAL UNIVERSITY (ANU), AUSTRALIA Dr Florian VogtSenior Research Fellow

NATIONAL CENTRE FOR EPIDEMIOLOGY AND POPULATION HEALTH (NCEPH), THE AUSTRALIAN NATIONAL UNIVERSITY (ANU)Dr Meru SheelEpidemiologist & Researcher

NATIONAL CENTRE FOR EPIDEMIOLOGY AND POPULATION HEALTH (NCEPH), THE AUSTRALIAN NATIONAL UNIVERSITY (ANU)Professor Tony StewartIncoming Director of Australia’s FETP

NATIONAL CENTRE FOR INFECTIOUS DISEASES (NCID), SINGAPOREDr Shawn VasooAssistant Professor

NATIONAL CENTRE FOR INFECTIOUS DISEASES (NCID), SINGAPOREDr Margaret SoonDirector of Nursing

NATIONAL CENTRE FOR INFECTIOUS DISEASES (NCID), SINGAPORE Prof Mathhias TohProfessor

NATIONAL CENTRE FOR INFECTIOUS DISEASES (NCID), SINGAPORE Dr Christine GaoDeputy Director

NATIONAL CENTRE FOR INFECTIOUS DISEASES (NCID)SINGAPOREDr Darius Beh

NATIONAL CRITICAL CARE AND TRAUMA RESPONSE CENTRE (NCCTRC)AUSTRALIADr Bronte MartinSenior Director

NATIONAL INSTITUTE FOR COMMUNICABLE DISEASES (NICD), SOUTH AFRICADr Janusz PaweskaHead

NATIONAL INSTITUTE FOR INFECTIOUS DISEASES LAZZARO SPALLANZANI (INMI), ITALYProf Antonino Di CaroProfessor

NATIONAL INSTITUTE OF HEALTH - NIH, PAKISTANDr Mumtaz Ali Khan Field Epidemiologist

NATIONAL INSTITUTE OF HEALTH DR RICARDO JORGE (NIH PORTUGAL)Dr Isabel Lopes de CarvalhoResearcher

NATIONAL INSTITUTE OF HEALTH DR RICARDO JORGE (NIH PORTUGAL) Dr Maria Sofia NuncioResearcher

NATIONAL INSTITUTE OF HEALTH DR RICARDO JORGE (NIH PORTUGAL)Dr Rita CordeiroScientist

NATIONAL INSTITUTE OF INFECTIOUS DISEASES (NIID), JAPANDr Meng Ling MoiVirologist

NATIONAL INSTITUTE OF PUBLIC HEALTH - NATIONAL INSTITUTE OF HYGIENE, POLANDMr Janusz JaniecTechnical officer

NATIONAL UNIVERSITY OF SINGAPORE Prof Dale FisherSenior Consultant / SCOM Chairman

NATIONAL UNIVERSITY OF SINGAPORE (NUS), SINGAPOREProf Paul Ananth TambyahDeputy Director

NEW ENGLAND COMPLEX SYSTEMS INSTITUTE (NECSI), USAProf Yaneer Bar-YamProfessor

NIGERIA CENTRE FOR DISEASE CONTROL (NCDC)Dr Olaolu AderinlaDeputy Director

NORWEGIAN NATIONAL UNIT FOR CBRNE MEDICINE AT OSLO UNIVERSITY HOSPITALDr Arne Broch BrantsæterActing Director and ID physician

ONE HEALTH COMMISSION (OHC)USADr Cheryl Stroud

ONE HEALTH EUROPEAN JOINT PROGRAMME (ONE HEALTH EJP)FRANCEDr Ludovico-Pasquale Sepe

ONE HEALTH EUROPEAN JOINT PROGRAMME (ONE HEALTH EJP)STATENS SERUM INSTITUT, DENMARKMr Pikka Jokelainen

OUR LADY OF SNOW MEDICAL JURIDICAL CORPORATION ST. MARYS HOSPITALDr Motoi AdachiPediatrician and Epidemiologist

OXFORD UNIVERSITY CLINICAL RESEARCH UNIT, VIET NAMDr Le Van Tan

PACIFIC DISASTER CENTER (PDC), USAMr Joel MyhreSenior Specialist

54

PATHWEST LABORATORY MEDICINE WA, AUSTRALIAProf Paul EfflerMedical Advisor

PROEPI, BRAZILDr Jonas BrantProfessor

PROEPI, BRAZILDr Erika Rossetto

PROEPI, BRAZILDr Sara Ferraz

PROMED, USADr Marjorie PollackDeputy Editor

PROMED, USADr Lawrence MadoffEditor

PUBLIC HEALTH AGENCY OF CANADA (PHAC)Mr Ram KamineniDirector

PUBLIC HEALTH AGENCY OF CANADA (PHAC)Boniface KaboreManager

PUBLIC HEALTH AGENCY OF CANADA (PHAC)Cavan Van UlftPolicy Analyst

UK HEALTH SECURITY AGENCYMs Tina EndericksHeadGlobal Health Security in the newly formed UK Health Security Agency (previously Public Health England)

R EPIDEMICS CONSORTIUM,FRANCEProf Thibaut JombartAssociate Professor

RESEAU DES EXPERTS SANITAIRES DES EAUX (RESEAUX), RÉUNION ISLANDMr Dominique MaisonEngineer

RESOLVE TO SAVE LIVES, AUSTRALIAMs Amanda McClellandSenior Vice President

RURAL HEALTH TRAINING CENTRE (RHTC), NEW DELHI, INDIADr Chanra Shekher Aggarwal

RIVM, NATIONAL INSTITUTE FOR PUBLIC HEALTH AND THE ENVIRONMENT, NETHERLANDS (THE)Chantal ReuskenPrincipal expert

RIVM, NATIONAL INSTITUTE FOR PUBLIC HEALTH AND THE ENVIRONMENT, NETHERLANDS (THE)Dr Anoek BackxMicrobiologist

ROBERT KOCH INSTITUT (RKI), GERMANYDr Basel KaroCoordinator

ROBERT KOCH INSTITUT (RKI), GERMANYDr Andreas JansenHead

SAMARITAN’S PURSE INTERNATIONAL, USAMs Cindy AlbertsonTechnical Officer

Santé publique, FRANCEMs Alexandra MaillesEpidemiologist

SANTÉ PUBLIQUE, FRANCEDir. Anne-Catherine VISODirector

SAVE THE CHILDREN INTERNATIONALUNITED KINGDOMMs Ayesha KadirLead

SCHOOL OF POPULATION HEALTH, UNSW MEDICINE. AUSTRALIAProf Mary-Louise MclawsProfessor

SINGAPORE GENERAL HOSPITALMoi lin LingTechnical Officer

SWISS TROPICAL AND PUBLIC HEALTH INSTITUTE, SWITZERLANDDr Daniel ParisHead

TAN TOCK SENG HOSPITAL, SINGAPOREMs Angela ChowEpidemiologist

TAN TOCK SENG HOSPITAL, SINGAPOREDr Poh-Lian LimDirector

THE KORET SCHOOL OF VETERINARY MEDICINE, ISRAELDr Nir RudolerCoordinator

TOSHIMA HOSPITAL, JAPANMr Takuya AdachiPhysician

TRAINING PROGRAMMES IN EPIDEMIOLOGY AND PUBLIC HEALTH INTERVENTIONS NETWORK (TEPHINET), USASam MackeeverTechnical officer

TRAINING PROGRAMMES IN EPIDEMIOLOGY AND PUBLIC HEALTH INTERVENTIONS NETWORK (TEPHINET), USAMr Lisandro TorreTeam Lead

TRAINING PROGRAMMES IN EPIDEMIOLOGY AND PUBLIC HEALTH INTERVENTIONS NETWORK (TEPHINET), USAMs Tina RezvaniAssociate Director Communications

TULANE SCHOOL OF PUBLIC HEALTH AND TROPICAL MEDICINE, USAProf Lina MosesAssociate Professor

TULANE SCHOOL OF PUBLIC HEALTH AND TROPICAL MEDICINE, USADr Jeni StolowSocial & Behavioral Scientist

ANNEX 2: LIST OF PARTICIPANTS continued

55

ANNEX 2: LIST OF PARTICIPANTS continued

UK PUBLIC HEALTH RAPID SUPPORT TEAM (UK-PHRST)Prof Benedict GannonSenior Microbiologist

UK PUBLIC HEALTH RAPID SUPPORT TEAM (UK-PHRST)MS Susan IsmaeelProgramme Manager

PUBLIC HEALTH EMERGENCIES GLOBAL PREPAREDNESS AND RESPONSE UNITED NATIONS CHILDRENS FUND (UNICEF), USADr Carlos NavarroLead

UNITED NATIONS CHILDRENS FUND (UNICEF), SWITZERLANDMr Jerome PfaffmannSenior Adviser

INTEGRATED OUTBREAK ANALYTICS-IOAUNITED NATIONS CHILDRENS FUND (UNICEF), USAMs Simone CarterManager

UNITED NATIONS CHILDRENS FUND (UNICEF), UNITED KINGDOMMs Rudy SiddiquiEpidemiologist

UNITED NATIONS CHILDRENS FUND (UNICEF), USAMs Akila SimonTechnical Officer

UNITED NATIONS CHILDRENS FUND (UNICEF), USADr Raoul KamadjeuHealth Specialist / Epidemiologist

UNITED NATIONS CHILDRENS FUND (UNICEF), KENYAMs Ida-Marie AmedaRegional Specialist

UNITED NATIONS CHILDRENS FUND (UNICEF), KENYADr Rachel JamesInteragency Coordinator

UNITED NATIONS CHILDRENS FUND (UNICEF), JORDANDr Anirban ChatterjeeTechnical Lead

UNITED NATIONS CHILDRENS FUND (UNICEF), JORDANDr Abu Obeida EltayebHealth Specialist

UNIVERSITY OF GENEVA, FACULTY OF MEDICINE (HUG), SWITZERLANDDr Pauline Vetter Physician

UNIVERSITY OF NEBRASKA MEDICAL CENTER, USAProf Ali KhanDean

UNIVERSITY OF NEBRASKA MEDICAL CENTER, USA Dr Sharon Medcalf Director

UNIVERSITY OF NEBRASKA MEDICAL CENTERUSA Prof Laurent SauerAssociate Professor

UNIVERSITY OF NEBRASKA MEDICAL CENTER, USADr Steven YehProfessor / Director

UNIVERSITY OF NEBRASKA MEDICAL CENTER, USADr Jocelyn HersteinResearch Assistant Professor

UNIVERSITY OF TEXAS MEDICAL BRANCH (UTMB), USADr Dennis BenteVirologist

WESTMEAD HOSPITAL, AUSTRALIADr Dominic DwyerDirector/Virologist

WHO REGIONAL OFFICE FOR THE AMERICAS (PAHO)Dr Sylvain AldighieriDeputy Director

WHO REGIONAL OFFICE FOR EUROPE(EURO)Dr Oleg StorozhenkoTechnical Officer

WHO REGIONAL OFFICER FOR THE EASTERN MEDITERRANEAN(EMRO)Dr Evans BulivaTechnical Officer

WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA (SEARO)Mr Arutro PesiganDeputy Representative

WHO REGIONAL OFFICE FOR SOUTH-EAST ASIA (SEARO)Dr Victor Del rio vilasTechnical officer

WHO REGIONAL OFFICE FOR THE WESTERN PACIFIC (WPRO)Dr Sharon SalmonIncident Manager

WORLD ORGANISATION FOR ANIMAL HEALTH (OIE) FRANCEMariana MarranaTechnical Officer

56

ANNEX 2: LIST OF PARTICIPANTS continued

Mr Jean-Christophe AzeTechnical Officer Emergency ResponseWHO HEALTH EMERGENCIES PROGRAMME

Mr Armand BejtullahuTechnical Officer Emergency ResponseWHO HEALTH EMERGENCIES PROGRAMME

Dr Lisa CarterTechnical Officer Emergency ResponseWHO HEALTH EMERGENCIES PROGRAMME

Mr Ramon CayabyabOffice Assistant Emergency Response WHO HEALTH EMERGENCIES PROGRAMME

Ms Renee ChristensenTechnical Officer Emergency ResponseWHO HEALTH EMERGENCIES PROGRAMME

Mr Lucas Loic DerooData Management officer Emergency ResponseWHO HEALTH EMERGENCIES PROGRAMME

Mr Pat DruryManager Emergency ResponseWHO HEALTH EMERGENCIES PROGRAMME

Ms Sara HollisEpidemiologistEmergency ResponseWHO HEALTH EMERGENCIES PROGRAMME

Mr Gianluca Loi Technical Officer Emergency ResponseWHO HEALTH EMERGENCIES PROGRAMME

Ms Silvia MorrealeTechnical Officer Emergency ResponseWHO HEALTH EMERGENCIES PROGRAMME

Ms Sameera SuriTechnical Officer Emergency ResponseWHO HEALTH EMERGENCIES PROGRAMME

Ms Khristeen Umali Administrative Assistant Emergency ResponseWHO HEALTH EMERGENCIES PROGRAMME

Ms Cristina ValenciaTechnical Officer Emergency ResponseWHO HEALTH EMERGENCIES PROGRAMME

Ms Tamar ZalkTechnical Officer Emergency ResponseWHO HEALTH EMERGENCIES PROGRAMME

GOARN SECRETARIAT

RAPPORTEUR

Mr Charles Robson

57

ANNEX 3. TOPICAL WEBINAR 1. SHIFTING THE COMMUNITY ENGAGEMENT PARADIGM

Summary

The COVID-19 pandemic has made it clear that communities must be at the heart of any response, making them empowered actors and decision-makers in public health and other humanitarian emergencies. In a world fraught with persistent inequity and crisis, the engagement of communities is a critical component to ensure rapid, effective and equitable local solutions. We must invest in community systems and in collective and coordinated approaches that put communities at the centre of their own response and resilience. We need a fundamental shift in the community engagement paradigm now, before another emergency strikes. A stronger community focus must be built within the architecture of pandemic preparedness, readiness and response, creating inclusive mechanisms for engagement of all communities, particularly those most vulnerable and marginalized, in decision-making and planning. More fundamentally, there is an opportunity to rethink the ways in which communities are engaged, recognizing the citizen as an active and empowered stakeholder in public health outcomes and redefining the critical role of global collaboration in filling the gaps.

Chair Lisa Hilmi, Executive Director, CORE Group (LH)Resource person Silvia Magnoni, Global Coordinator, RCCE Collective Service (SM)Moderator Melinda Frost, Technical Lead, RCCE, Infodemics Management Pillar –

COVID-19 Response, WHO (MF)Final intervention Carlos Navarro Colorado, Steering Committee Chair, RCCE Collective

Service (CN) Rapporteur Ginger A. Johnson, Social Science Research Specialist, RCCE Collective

Service (GJ)

58

Three key messages

l We need more than community engagement, we need community-driven responses. Communities need to be engaged and empowered from the very beginning and throughout an emergency response.

l Building trust and establishing long-term relationships are key (if you’re trying to start this process for the first time in the middle of a crisis, you’re already behind).

l Behaviour change requires long-term engagement, it is not a process that occurs quickly and we need to continue to remind governments, national authorities, partners, etc. of this. Funding processes must understand the need for, and be responsive to, community engagement needs.

Speakers Ian Soh, MVVTV (IS); Nedret Emiroglu, WHO (NE); Elhadj As Sy, Global Preparedness Monitoring Board (GPMB) (EAS); Jill De Bourg, Trinidad & Tobago Red Cross Society (JDB); Gibstar Makangila, Circle of Hope (GM).

Panel 1: Where we are with community engagement and preparedness today? What are the main opportunities and challenges? What needs to change systemically?

Guiding questions l What does community engagement mean today? How is the paradigm shifting? l Risk communication and community engagement (RCCE) remains a blind spot, with

fragmented investments in preparedness and response and ad hoc reactive support during epidemics. What needs to happen to bring RCCE at the core of pandemic response and preparedness?

l What is one thing you wish the world would immediately do, from a community engagement perspective, to mitigate the impact of the current pandemic and be better prepared for the next one?

l What does it take to ensure that communities become empowered health decision-makers? How are respondents accountable to communities and people they are meant to serve?

LH: Most recently, the World Health Assembly has met to look at conventions, agreements and collaboration as part of the COVID response effort. What do you think about this?

EAS: In some of these higher-level discussions that you mention, we hear about community engagement and the need for this, but are they engaged from the start of a response? ‘Right from the start’ means before a pandemic, during a pandemic, throughout the entire process of recovery. Communities and their leaders are always there experiencing the crisis, so they should be there in all phases of the response. But the need for this is not always validated, and it is very important to make sure that this changes. Communities are the first to see the problem, they are the first to see the changes experienced as a result, and they are the first to feel the burdens. This recognition of their experiences must be translated into action. This recognition should start with trust and

59

with long-term partnerships. This does not mean we need to be romantic about community engagement and community feedback and shift the burden of the response onto their shoulders. It is about supporting them and supporting their needs. Shifting the paradigm means the early inclusion and incorporation of community participation and insights right from the start.

NE: Any outbreak starts and ends with communities. These principles of community engagement were part of the Declaration of Alma-Ata (1978) and we are even now rediscovering some of them. However, community engagement is not a strong enough term; what we are talking about is the need for a community-driven response. This is WHO’s approach and we learned this through some of the difficult lessons of Ebola (West Africa) and the current pandemic. Some of the strategic approaches currently taken by WHO include strengthening systems at global, regional and country levels. Anything that happens at the community level must be supported by all of the higher levels of the response. WHO is engaged in the work of the RCCE Collective Service and is also involving more partners in this work throughout the entire response cycle (preparedness, response, recovery). We also have good examples of working with civil society in the COVID response for vaccines, on issues related to public health and social measures (PHSM), and engaging with youth and women is also a very important part of this process. At WHO, we want to give accurate and empowering information and ensure sustainable national systems and structures for health service delivery. And the focus is always on protecting the most vulnerable, prioritizing their needs.

JDB: Public health emergencies are our past and our present and we will face them again in future. One key lesson is the importance of meaningful engagement. Working with community-based organizations and reaching those with mental health challenges and other vulnerable groups is key to our response effort here. The current COVID-19 pandemic has reversed many of the gains we had made. The Latin American and Caribbean region has been one of the hardest hit by this pandemic. The virus has shown us the weaknesses in our public health systems and the importance of responding to a pandemic in a coordinated way. It has shown the terrible impact of what happens when people do not trust us, do not trust the safety measures which we are supporting (e.g. mask-wearing). Additional data collection with communities since the pandemic began has revealed who, where, and how individuals trust messaging (e.g. political leaders have often rated low on trust). Community trust has to be earned, and this requires seeking community feedback, and understanding community knowledge, attitudes and practices that influence their decisions. This work calls for additional investments. It is not a quick, overnight process. This pandemic and its challenges demand a different way of doing business. This may be disruptive to how we normally operate. My three recommendations are: 1) invest more in the work of community actors (put them at the centre of the response); 2) create a culture of data collection and evidence-based decision-making; and 3) agree that community engagement is a central feature of any response and this requires clear coordination to make funding for this work more stable and predictable.

60

Audience member (question for NE): During the West African Ebola outbreak, the UN system was obviously disconnected from the community at the start of the outbreak. What does this demonstrate about our effectiveness?

l We need to support our country teams. I don’t think working through the UN is enough. We must bring in all partners, community influencers, local organizations, local health care providers, civil society members. This is the only way to mobilize what needs to happen at the community level. And this requires funding, which is also dependent on the governance system of the country itself (for instance, it is easier to do in decentralized countries).

Audience member (question for EAS): How can we better gain the trust of communities? l One effective way is to deliver on the promises we make, before, during and after a

pandemic. You will often hear communities say something like “Now you are coming to us with your Ebola” or “You are coming to us with your COVID, but where were you when I needed ...?”. We need to engage with communities all the time to deliver on promises made in response to their stated needs, not just what we tell them it is important to focus on. It is almost impossible to build trust during a crisis; this work must begin before a crisis occurs (preparedness).

Audience member (question for JDB): Can you take lessons learned from your region, which has used community feedback extensively, and share with a region (such as the European Region) that has not necessarily used these methods to the extent that you have?

l As EAS mentioned, it is about building relationships over time and not just during an emergency. Also, a lot of times, we think in silos, we have to go beyond this and think how we can work more collaboratively and work better with communities.

Panel 2: Real-life perspectives of communities and how they want to see the shift happening

Guiding questions l How do communities want to see change happening in the way they are engaged and

involved in preparedness and response programmes? l How do they feel about the current approaches to accountability to affected communities? l What stories/experiences can be highlighted as good examples of community engagement?

IS: Meaningful youth engagement is a powerful term and a very complex one. Why do we need to engage with young people? With COVID, we have seen many things happening where there was a dissonance between young people and leaders of the world. For example, where youth were seen as not cooperating with PHSM. But we young people do recognize that something needs to be done; we want to be meaningfully engaged with, we want to be listened to, we want to be heard and recognized as the leaders of tomorrow. You mentioned trust, but I would

61

add communication, how you communicate with us is equally important. Young people can be involved in communicating key messages as well as amplifying them. Meaningful engagement is what is needed, and communication that is not top-down but respectful.

GM: From the onset, for the past two years or more, Circle of Hope has wanted to change the community engagement paradigm. We want to work for community engagement using a decentralized model. We want to work where people are, where they socialize and where they work. This is the work we do with communities. Any emergency response has its barriers. It is important that we understand these barriers before we can address them. Here are some of the common barriers we have experienced. Community barriers: there is the barrier of time (do people have enough time to do what we are asking), there is the cost of services (can people afford to pay for the things which are being recommended), there is the barrier of stigma (how will a person be perceived?). Organizational barriers: there is a barrier when response organizations go with the idea that they know what is best for people without listening to their needs (we need more intellectual humility in our organizations), there is the barrier of competition between response organizations who appear to be competing with each other for resources and responsibilities. I can give one example of how we have overcome some of these identified barriers. In the city of Lusaka, all NGOs in this area involved in promoting vaccination worked on a decentralized model of working with communities. Our most successful strategies now have come from the communities. For example, trust can only be earned if community influencers who are resident in those areas have bought into what we have tried to bring to them. Communities of faith are important to this process. All over the world, you have these communities of faith and here we have leveraged the potential of these communities to work with them as partners. We have moved away from mass communication and more into one-on-one forms of communication.

I also want to talk to you about how intricate community knowledge is and how it should be embedded in any response operation. Using local leaders and local community health workers is crucial. And finally, access to households is key. If I visit, I’m a stranger. But if you use local people, you are invited in and you are a more trusted source of information. These successful strategies which have come directly from affected communities have led to an incredible increase in case finding and contact tracing. In closing, I want to say that we need to place a premium on community engagement from its first inception, and to involve communities in the full cycle of the response. We also need to invite communities to assess us, to assess our work, and be responsive to the suggestions and criticisms we may receive.

IS: The problem we recognized during COVID was a gap between young people and leaders of the world. Despite all the guidance produced by respected institutions, all the information that was available, people were having a hard time understanding it. Was this because youth were defiant? Or because they were outside of the system in which these messages were created? We recognized this gap and knew that we had to put information across to young people in a way that was visible

62

to them (accessible using the communication channels they used) and understandable to them (translating guidelines in a way that they would respond to). For example, maybe an infographic (which response organizations like to use) is not the best way to communicate messages. Maybe it’s something that is more catchy or exciting or used more by youth (e.g. a TikTok video, comedy/comic strips).5 I hope that we can all connect and continue to reach out to those groups and young leaders who may not be taking action now and try to bring them onboard.

GM: We need to view community influencers as first responders, and all our response efforts must be community-devised and -driven. We need to empathize with communities, our compassion for them needs to lead our actions for them. We must also have passion for our own work to continue to find new and better ways of engagement. And, as has been mentioned many times before already, trust is key and it must be earned. This should be what drives any response.

Audience member (question for IS): I like your perspective on how we can do better to engage youth. I want to ask about the next pandemic we may face, what are your recommendations to continue to draw on the power of youth, knowing that generations change and we always have a new group of young people we need to engage with?

l (response from IS): If you want to get more young people on board, you need to help shape their perspective on what their place is in the world. For future outbreaks, we need to know who to engage with, to build up to this, to help more young people understand their place and how they can contribute.

l (response from GM): One of the things we have learned over years is to allocate adequate resources to local influencers. We need to re-engineer our budgets to reflect this need. Our budgets are skewed towards managers and higher-level officials, but we need to also resource our community influencers.

l Audience member: One of the issues that I’ve run into through my own community engagement work is retention. If communities do get involved and you are able to gain their trust, many still drop out of this work due to COVID fatigue. It’s a job, as GM mentioned, to be the first responders for their communities. Response fatigue does become an issue. How do you retain interest and involvement?

l (response from JDB): This is a real issue; communities do become overwhelmed, so how do we build engagement and support each other collectively through this process? It is a learning process, and we need to remember that we must be in constant contact with our community members to gauge how they are feeling.

Audience member: I think we are in agreement that community engagement is needed, so why is it that governments or agencies continue to use a top-down approach? Why do so many continue to use an approach that is not engaging communities? Is it due to a lack of trust? Lack of resources? Belief that communities don’t have the skills to manage themselves? Why do you think we keep seeing a top-down emergency response?

5. See https://www.youtube.com/ watch?v=GWpIrqcgpT4&list= UUQPss_g3Iak_a0PmvrGvH8w

63

l (response from EAS): Behaviour change is a long and difficult process, and this is a fundamental fact that response agencies and governments must understand. We must continue to challenge our governments and institutions on this aspect. There have been some positive changes and movements in the right direction and we need to build on this. As GM said, we must also build responsive budgeting mechanisms, so that we can properly fund this work.

l (response from NE): This is a complex issue. How can we do a better job of making sure that governments and leaders invest in community-driven responses? I do agree that the power of communities has often been underemphasized. The key question is how do we create resilient communities and make these structures sustainable? WHO is giving more priority to community-based interventions, and to building and maintaining sustainable systems. There are many answers to this question, but we must all work better together for coordination around this work.

Concluding remarks

LH: Some of the key points discussed by panellists have included the importance of ensuring community participation from the inception, the need for this work to be well financed, and the crucial importance of trust for this process.

CN: The conversation today has given us a timely reminder of your experiences with community engagement and how this makes for an effective response that is, importantly, responsive to community needs. Community engagement also ensures an equitable response, with priorities defined by those who are most affected by the consequences of a crisis.

When we put together the Collective Service, we started from the realization that the field of RCCE remained a blind spot for responders, for donors and even for our own organizations. We felt the field was fragmented and disconnected. Weeks into the COVID-19 pandemic, we realized this was going to continue to be a big challenge, but also an opportunity: an opportunity for us to do this work together, to scale up our efforts together, to bring our assets and visions together so that we could have a collective plan for the RCCE response to the pandemic.

We have four priorities in this work: coordination, guidance, data/evidence and capacity-building. We are now thinking how we can bring this experience of the Collective Service to the next level, to move beyond outbreaks into other humanitarian crises. Every pandemic and crisis leaves its legacy. We hope that the Collective Service will be one of the positive legacies of this pandemic. I think we all agree here that community engagement is everyone’s business. Regardless of what field you work in, community engagement should be a part of your work. I invite all of you to be a part of this collective work going forward.

64

ANNEX 4. TOPICAL WEBINAR 2. ‘GO WITH GOARN’ – THE REALITIES OF DEPLOYING EXPERTS FOR AN INTERNATIONAL OUTBREAK RESPONSE

Chair Peta-Anne Zimmerman, Australasian College for Infection Prevention and Control Lead Sharon Salmon, Technical Officer, GOARN, WHO Regional Office for the Western PacificRapporteur Gianluca Loi, Operational Support Team, GOARN, WHO headquarters

Objectives l To share information on innovative remote GOARN deployments during COVID-19 l To engage current and new partners to contribute to the pool of experts to support

international outbreak response l To discuss areas to improve and strengthen GOARN deployments for international

outbreak response

Outcomes l Participants aware of remote deployment modalities and opportunities to support

international outbreak response l Shared deployment challenges and solutions l Recommendations to strengthen GOARN deployment modalities

Speakers Kai von Harbou, WHO Cox’s Bazar Sub-Office James Shepherd, GOARN secretariat Bronte Martin, National Critical Care Trauma Response Centre, Australia

Panellists Ben Gannon, UK Public Health Rapid Support Team Myriam Henkens, Médecins Sans Frontières

65

Opening remarks Peta-Anne Zimmerman highlighted the fact that no organization has the capacity to deal with COVID-19 or any other major infectious disease threat individually. She emphasized the impact of the pandemic in changing the way we work and of GOARN’s engagement with partners to support Member States.

She briefly presented the agenda of the webinar, which would be divided into three parts: (1) a presentation of GOARN global and regional operations; (2) a presentation from operational partners describing innovative approaches to providing technical assistance; and (3) a panel discussion with partners on the possible future of deployments with GOARN.

Presentation of GOARN operationsSharon Salmon gave an overview of GOARN’s global operations in the previous 21 years (more than 3 400 deployments in over 152 missions) and the current status of operations and deployments. With regard to those related to the COVID-19 pandemic, 192 deployments (in 41 countries) had been completed in the previous two years, with more currently in process. These deployments had been made possible thanks to partnerships with several institutions worldwide, including the US Centers for Disease Control and Prevention, the UK Public Health Rapid Response Team, the Robert Koch Institute and the European Mobile Laboratory.

She also provided a snapshot of deployments in the Western Pacific Region since the beginning of the pandemic: 58 deployments had taken place (30% of total GOARN deployments) in 10 of the 37 Member States in the Region, in partnership with 24 organizations.

Lastly, she described the GOARN process for managing events and operations, including responding to requests for assistance from Member States; the application process; types of positions available; the current process for remote assistance and the impact of the COVID-19 pandemic in GOARN deployments; the selection process; the standard package, including general terms and conditions (“one-dollar contracts”, i.e. no remuneration, but travel and living allowance covered by WHO); and, finally, the post-mission completion reporting requirements.

Presentations by guest speakersKai von Harbou gave an overview of the main areas of expertise of people deployed through GOARN (remotely and in person). In view of the challenges currently being faced and the travel restrictions imposed, reliance was mainly placed on the human resources available at the national level. This required the team at Cox’s Bazar to find innovative ways to build case management capacity, which had been one of the pillars of the response.

66

He highlighted the role of the GOARN team and the leadership it had provided in the Surge Case Management Working Group, namely support to health sector partners in the coordinated establishment of a dedicated treatment capacity, and the provision of technical advice to partners on the full spectrum of aspects related to setting up severe acute respiratory infection (SARI) isolation and treatment centres (ITCs). GOARN experts had also provided support in improving and standardizing clinical care practices and training newly recruited health care workers in clinical case management. Since the majority of experts were deployed remotely, mechanisms put in place had included remote technical discussions, peer-to-peer knowledge exchange and real-time individualized support for decision-making.

Lastly, he informed participants that the GOARN team was currently in the process of integrating COVID-19 capacity into the health system in a sustainable and cost-effective way, in order to prepare for a future surge in cases.

James Shepherd briefly described the circumstances that had led him to support the Cox’s Bazar team remotely and the challenges he had faced, notably owing to the time difference. He highlighted the challenges that also arose from working with a multitude of partners and in developing a network of care with the mission of “ensuring high-quality care, regardless of whether to refugee or host, at all sites across the network”.

The focus of the team’s mission had included: (1) operations to set up a care network that involved a large number of people; (2) development of a dashboard to support real-time information-sharing; and (3) clinical case management – a rarer activity for GOARN – that had proved to be extremely important given the specificities of COVID-19. Remote working arrangements had been instrumental in fostering a collaborative approach among clinicians to establish a new standard of care. Several of the methods utilized by the team had been extremely successful: online meetings, real-time support through WhatsApp; the globally recognized and easily adopted case conference format; and guidelines and data reviews. The success of the team’s work had been underpinned by the willingness of global experts to support the response, given the limited disruption caused by remote deployments.

From her experience of working with the Cox’s Bazar team, Bronte Martin highlighted the sustainability of online deployment, despite some challenges related to the time difference and connectivity. The fact that teams were already working in safe online environments, together with the flexibility and concerted efforts of all those involved, were important aspects of the success of the team’s work. One of the best practices that she highlighted was the combination of an acute health care network and a public health response, which allowed for more predictability and better resource management and decision-making.

67

Other positive aspects included the knowledge-sharing that arose from development of the COVID network; the organization of a series of webinars that leveraged participants’ networks on the ground to support health facilities’ emergency preparedness and response; partnerships with UNHCR and ICRC; and implementation of a multidisciplinary service delivery and workforce model.

Lastly, she underlined the benefits of being part of GOARN and the advantages that had led her organization to join the Network. They included shared contemporaneous clinical and operational practice; an international network of global experts; impacts beyond COVID-19; outcomes on the quality of patient care; reciprocal technical partnership networks; and training. Given their current success, she advised that remote deployments should be considered for providing access to those types of services worldwide.

Panel discussion1. What is one barrier and one facilitator to international expert deployment as a result of

the COVID-19 pandemic?

Bronte Martin identified the time difference and difficulties in physical deployments due to the restrictions imposed by the pandemic as the main barriers for her team. Conversely, the possibility of leveraging the network was identified as a facilitator: it was only when her organization had joined GOARN that they had access to the one-dollar contract and were able to deploy individuals from partner groups for longer periods.

Ben Gannon shared those views and pointed to access to staff as a major barrier. Conversely, the existence of a team dedicated to outbreak response was a facilitator. While providing remote support in an outbreak response was often challenging, the remote work done during the COVID-19 pandemic showed that it could be effective.

Myriam Henkens emphasized the challenges related to the availability, procurement and delivery of supplies caused by the pandemic. MSF’s membership of GOARN had allowed her organization to work with United Nations agencies to overcome those bottlenecks.

2. How has COVID-19 changed your institution’s approach to supporting international outbreak response?

Ben Gannon stressed the tremendous impact that the pandemic was having on people’s ways of working, as well as on interactions and response activities at global level. That underscored the importance of coordination, which in turn demonstrated how networks such as GOARN could act as facilitators. Flexibility and adaptability had been key during the period.

68

Myriam Henkens highlighted two main consequences: travel restrictions had made it impossible to increase capacity in certain situations and had resulted in extended deployments in certain cases. MSF had faced challenges in adjusting to working remotely, in particular across different time zones, given its limited experience, but had leveraged technology to continue its operations.

Bronte Martin noted that, in addition to working remotely, Australian Medical Assistance Teams (AUSMAT) had had to take their normal capability (for supporting acute care in sudden onset disasters of short duration) and shift their focus to longer durations, with integrated public health and acute care teams – a modality that AUSMAT would continue to implement. The pandemic had also led to adaptation in terms a stronger focus on capacity-building. Existing networks, including those related to EMTs and GOARN, were extremely important because they ensured a certain familiarity with those new modalities in the region.

3. What more can we do to build national response capacity?

Myriam Henkens reinforced the idea that no single partner had the capacity to respond to an outbreak alone and therefore it was crucial to work as a network. Key aspects of the rapid response mechanism included leveraging national capacity, resources and existing relationships on the ground; the ability to be pragmatic, agile, reactive and adapt the mechanism to the context in question; stakeholder collaboration at various levels, including with national authorities and UN agencies; and knowledge- and data-sharing between the different partners. Given the importance of coordination, especially in the early stages of an outbreak, it was key to select the most capable partner as a leader and to clarify collaboration with other mechanisms, such as EMTs and health clusters. GOARN partners and members were particularly well placed to take the lead (as was being done in the pilot project on rapid response capacity in Armenia). Emergency response was a mindset, rather than a simple plan for better results.

Bronte Martin highlighted the importance of building national capacity in outbreak situations to ensure sustainability in the long term. In such situations, the concurrent challenges and needs at national level often led to challenges in deploying international partners. AUSMAT focused on providing early support in terms of capacity- and agility-building and promotion of effective decision-making by national actors, to ensure that they had the ability to manage the responses themselves.

Ben Gannon emphasized the importance of south–south interaction and the need to build capacity and preparedness closer to the outbreak. GOARN’s existing capacity development function should be further built up, given the lack of sustainability of the current system. Although a series of operations and initiatives were currently being implemented to strengthen partner coordination, under the leadership of WHO, he believed they could be further improved. Lastly, it was important to expand the GOARN network of partners.

69

4. What is the most important gain that your institution receives from being a part of GOARN?

Bronte Martin highlighted the immense learning gained by her team from the GOARN network and its global community of practice.

Ben Gannon identified coordination, networking and communities of practice as the main benefits of membership of GOARN. He also highlighted the importance of reciprocal learning and the invaluable gains, in terms of capacity-building and network development, made by those deployed through GOARN.

Myriam Henkens added that being a part of the network had allowed MSF to be included in the supply community and the diagnostics consortium, as well as in discussions on establishing the COVAX Humanitarian Buffer to ensure access to COVID-19 vaccines for high-risk populations in humanitarian settings. Finally, she noted that GOARN could be a starting point to develop a series of additional activities around outbreak response. It offered multiple resources that could be used by the different members to expand their activities, depending on their specificities and role in the Network.

Key takeaways/the way forwardBased on the presentations and discussions, Sharon Salmon identified four priority areas moving forward:

1. deployment modalities – explore how to develop remote deployments (since these play an important role in GOARNs support and outreach to the Member States) and how to strengthen and integrate processes to engage partners;

2. integration and augmentation of EMTs to ensure capacity to respond simultaneously to natural disasters and long-term outbreaks;

3. expansion of GOARN and how to increase the utilization and contribution of its partners; and

4. capacity development and building response mechanisms, in partnership with local authorities, to be able to strengthen outbreak response measures at the national level and ensure swift response in future outbreaks.

70

ANNEX 5. TOPICAL WEBINAR 3. EXPLORE THE GO.DATA GLOBAL ROLL-OUT OPPORTUNITY

Lead Armand Bejtullahu, Technical Officer, GOARN Operational Support Team, WHO headquarters

Speakers Cheikh Loucoubar, Head, Department of Epidemiology, Clinical Research and Data Science, Institut Pasteur, Dakar, Senegal

Oliver Morgan, Director, Health Emergency Information and Risk Assessment, WHO Emergencies Programme, WHO headquarters

Dušan Milovanović, WHO Open Source Programme Office, WHO Berlin Hub Mirna Panic, Manager, Training and Development Unit, Public Health Agency of Canada

Rapporteur Lawrence Hinkle, WHO headquarters

Objective l To clarify the current Go.Data strategy for 2022–23 and seek GOARN partner engagement

Outcome l Greater engagement of GOARN partners in the global roll-out of Go.Data

IntroductionArmand Bejtullahu said that the purpose of the webinar was to discuss the global roll-out of Go.Data and how to collaborate with GOARN partner institutions in global Go.Data implementation.

l Reasons for implementing Go.Data à enhance timeliness of information à enhance quality of information à improve access to case and contact data à automate and improve data visualization, analysis and reporting à reduce number of disconnected data sets

l Go.Data is collaborative, versatile, innovative l Go.Data implementation activities

à training activities, interoperability, analytics, epidemiology, country support, enhancements, user and IT support

71

l Strategy for 2022–2023 àGo.Data pre-positioned and embedded in the national/institutional infrastructure, including training programmes, and used in subsequent outbreaks àGo.Data as an established tool with a proven track record used for outbreak response in countries and institutions àBroad Go.Data expert user community engaged in global implementation àGo.Data as an open-source project, managed through a governance structure coordinated by WHO and supported by partners

Enhancing engagement of GOARN partners in global Go.Data roll-out activitiesCheikh Loucoubar gave an overview of Go.Data training activities recently carried out at the Institut Pasteur-Dakar (IPD), the analytical aspects that IPD was working on, and the next steps in its collaboration with WHO.

l IPD is establishing long-term support of Go.Data activities as part of its role as one of the key partners for outbreak response in Senegal and the region.

l The objective of IPD, as a GOARN partner, is to create a pool of expert users who will be able to:

à train a broader community of users to implement Go.Data àdevelop analytic support resources

l A training was held in 2020, at the start of the COVID-19 pandemic. A further two-week training course took place at IPD from 22 November to 3 December 2021.

àCourse participants were 10 permanent staff from IPD with expertise in epidemiology, laboratory, analytics, and IT àOne week to train the trainers � Experts trained in all activities to support a multidisciplinary response team that

can rapidly adapt and respond to acute events � Experts trained in all modules of Go.Data implementation and data management

configuration for countries (IT infrastructure support, reference data configuration, disease-specific data dictionaries)

� One week to share knowledge of resources for Go.Data analytics and interoperability — Rationale: beyond training super-users in configuration and roll-out, there are many requests for support in the area of data management, analysis and interpretation

— Aimed to ensure that super-users can give targeted analytics and interoperability support to francophone countries

— Key principles include open-sourcing solutions, building local capacity, and standardizing approaches and templates – discussed existing code solutions and way to optimize them (e.g. R scripts), connecting platforms such as DHIS2 and Teranga, and collaborating on GitHub.

72

l Next steps: àTrain a larger Go.Data community of users who will actively support their countries and institutions for acute events response àFurther develop analytics and interoperability resources for Go.Data users to improve quality à Involve other GOARN partners in the African Region for Go.Data implementation.

l Thoughts from Argentina (Tamara Mancero, WHO/PAHO) àUrgent need to implement a software for contact tracing àArgentina a huge country with many information systems, but no national system for contact tracing àAll institutions from the public and private sector were welcome to use Go.Data, but wanted to do it in a coordinated way: � Needed any contacts and cases picked up through private sector contact tracing to

be linked to national Ministry of Health � Algorithm showed good integration of Go.Data to the Ministry of Health

àAll directors of epidemiology at regional level met to present on what they are doing: � Have already developed Go.Data forms for hantavirus and measles

àArgentina well pleased with use and performance of Go.Data so far.

Open-sourcing Go.DataOliver Morgan said that the collaboration between WHO and Go.Data in the context of the new WHO Hub for Pandemic and Epidemic Intelligence, based in Berlin, was aimed at taking WHO and partners in a new, refreshing direction of much more dynamic collaboration, using the outcomes and successes from the different projects that they had worked on together to build momentum for yet further and future projects. Open source offered the opportunity to use the business case for one project to build an approach that was useful for multiple different applications.

Dušan Milovanović presented the Open Source Program Office (OSPO) at the WHO Berlin Hub. l Needs – sharing and collaboration:

àEIOS – grassroots initiative � Centralism and consolidating code base � Open-source machine learning (ML) models and algorithms � Suspected that needs are similar throughout WHO

àGo.Data example � Developed using open-source software components � Open Go.Data application programming interface (API) for interoperability � Global community of Go.Data users sharing analysis

73

l Innovation paradigm: àOpen innovation � Share innovative ideas externally � Assimilate external innovative ideas internally

àProprietary innovation � Every aspect of innovative ideas is a closely guarded secret � An organization is unlikely to have any interest in sharing or helping others to

learn from its successes and mistakes àThe open-source paradigm is an extension of the open innovation paradigm � Misunderstanding – “free” does not mean that open source software cannot be

commercialized

l Open-source software – inbound drivers and risks: àDrivers for using open-source software components � Re-using rather than re-inventing � Accelerate time-to-delivery � Potentially large community of contributors

àRisks of using open-source software components � Security vulnerabilities � License risk � Operational risk (e.g. technical debt) � Legal risks

l Open-source software – outbound drivers and risks: àDrivers for providing open-source software components � Re-using improvements done by the community of contributors � Accelerate time-to-delivery � Increase speed of innovation � Access to more competence and knowledge for free

àRisks of providing open-source software components � Unsustainable delivery model � Hidden integration and operational costs � Unable to get support for right priorities � Liabilities and/or branding loss

74

l Organic roadmap – software development capability maturity model: àHousekeeping � Simple organization, architecture, team structure autonomy, self-servicing tooling,

leverage the cloud àEfficient software development life cycle (SDLC) � Simple integration and deployment models, automated testing, documentation is

code, shorten time to production à Inner source (open source within WHO) � Break down silos, strategize, encourage cross-team projects, boost developer

engagement àCommunity-building � Leverage WHO mandate, clear contribution guidelines, publish project roadmap,

spread the word àCommunity management � Reward and recognize contributors � Engage community to drive continued innovation

àFirst three components supported by Information and Application Management under Chief Technology Officer; last two components supported by WHO Hub for Pandemic and Epidemic Intelligence and WHO Health Emergencies Programme.

l Solution: WHO Open Source Program Office (OSPO): àLegal support � Develop open source software policies and guidance on inbound open source

licenses, contributor license agreement to third-party projects, legal structure around managing open-source projects run by WHO

àProcurement � Policy for: using open source packages (inbound), sharing software source code

and data externally, contributions to non-WHO open-source projects, accepting funding for open-source software and open data

àTechnical � Programmatic (using and providing open source software) � Technology (build and maintain tools, security policy)

àCapacity-building � Develop trainings, educate developers about open source software etiquette

àCommunications � External value demonstration, advocacy, internal demonstration of OSPO progress.

It was hoped that OSPO would become operational in the near future. GitHub’s Tech for Social Good had been assisting WHO through a pro-bono agreement.

75

Inclusion of Go.Data in field epidemiology training programmesMirna Panic discussed possible pathways to integrate technical software training, such as Go.Data, in field epidemiology training programmes and other applied public health training opportunities.

l The Training and Development Unit at the Public Health Agency of Canada (PHAC) – what we do:

àDesign, develop, coordinate and deliver applied public health and emergency management training àCreate learning paths and curriculums, and design and deliver courses à Support internal stakeholders in developing, designing and delivering their own specialized training à Support requests for assistance by delivering specialized training to internal and external stakeholders àCollaborate with domestic and international content experts/training groups, to create common training standards and material.

l The Canadian Field Epidemiology Training Program (CFEP): à In CFEP, fellows gain experience and build competencies in applied epidemiology, emergency management and transversal skills through a combination of mentored on-the-job learning, training and the completion of professional experience.

l Technical software in the Field Epidemiology Training Programme (FETP) curriculum: àConsider multiple factors when selecting technical software to include in curriculum: use in the Canadian landscape, need for international FETP training standards and cohesion, usability in the field, etc. à Include software training in two main ways: � Standalone: technical training focusing on building proficiency in a software tool

using exercises and case studies in applied epidemiology � Integrated: software training and practice is integrated in applied epidemiological

training (e.g. fundamentals of outbreak investigations) àAs of now, designing training to leverage existing resources and in-house learning products or courses.

l CFEP and Go.Data: àCFEP field epidemiologists were deployed to support the 2014–2016 Ebola response (with other PHAC personnel) àPiloted Go.Data during this response àTook part in the working group aiming to further refine the software features and analytic requirements àPiloted Go.Data in training in 2019 – part of the foundational three-week course for field epidemiologists, in collaboration with GOARN team.

76

l Experience piloting learning pre-COVID: àThroughout the week of module 2, participants applied their learning in a case study focusing on a fictional tuberculosis outbreak àThe GOARN learning team used fictional case study data to develop a Go.Data training dataset and training interface àThe Go.Data session was a combination of live demonstrations and practice àThe pilot was successful and, following the official launch of the software, the intent was to further develop and integrate the Go.Data sessions into the case study by drawing on lessons learned from the pilot.

l Moving to the virtual environment: àHave had to change instructional methods to accommodate this new learning modality. As a result, CFEP courses have been re-designed àThe 3-week foundational course remains but focuses exclusively on conceptual learning � Still combines in-classroom time (case studies, collaborative exercises, expert

panels) and pre/post classroom self-directed work (online modules, videos, exercises)

� Software learning (Go.Data, EpiInfo, and Pajek) is completely asynchronous and condensed

� For Go.Data training, learners are referred in particular to the WHO online training modules and the Go.Data community of practice.

Questions & answers from the Zoom chat function l Basil Kaburi: May I clarify if Go.Data is already interoperable with DHIS2? If not, how

soon do you anticipate this will happen. àGo.Data–DHIS2 interoperability app was released earlier this year and is mapped for standard DHIS2 COVID-19 Tracker metadata package. There is a v2 of the app that will be released in the coming months that is extendable to other metadata configurations (beyond Tracker, other disease programs). You can find more information on our GitHub: https://worldhealthorganization.github.io/godata/integration/ àThe plan in 2022 is to make this application extendable as middleware to other platforms and aligned to standards like FHIR/HL7.

l Mirwais Amiri: Thank you for the interesting presentation. You mentioned that you use both R and Python languages for Go.Data programming. If so, which areas of the Go.Data platform are they mainly used for?

àAt present, we have R and Python packages to extract data dynamically from API. Also, R/Python scripts to flatten, clean and transform the data for analysis. Additional R markdown reports for static HTML dashboards and shinyapp templates also. So, to answer your question, they are connecting to API, mostly GET requests or POST requests for extracting and modifying data in bulk from API.

77

l Carlos Navarro: Does Go.Data focus on epidemiological data only (cases, contacts, etc.) or can it integrate other sources of data like social science or the Integrated Outbreak Analytics (IOA) type of studies that were presented yesterday?

àThe main “core” variables are case/contact/exposure event creation across dimensions of demographic/location/epidemiological variables. Having said that, there is a flexible questionnaire so that you can add onto this whichever other data points you want to collect. If it’s not the right place to ask it during an outbreak investigation, this data could flow into a data repository of IOA, being another source of information that the larger IOA engine is analysing. This is where structured format proves useful (either exporting data for later use/joining to other datasets, or automatic joining with API). àGo.Data’s focus is on case and contact data, but we definitely want to see how data stored in Go.Data can integrate with other data sets. Perhaps something to collaborate on with IOA?

l Mahbubur Rahman: How would you compare Epi Info and Go.Data for data collection in the field, especially for a localized outbreak investigation? And can you link these two?

àBoth tools can collect structured data on cases and during outbreak investigation; Go.Data features facilitate contact tracing operations (generating contact tracing follow-up lists; tracking follow-up statuses over time, managing workload across teams) as well as visualizing relational data. à If EpiInfo data can be exported via.csv or.xslx, then it can be imported into Go.Data, and vice versa.

78

ANNEX 6. TOPICAL WEBINAR 4. OPERATIONAL RESEARCH

Co-Chairs Gail Carson, Vice-Chairperson, GOARN Steering Committee Nina Gobat, Technical Officer, WHO headquarters

Lead Victor Del Rio Vilas, Technical Officer, GOARN, WHO Regional Office for South-East Asia (WHO/SEARO)

Rapporteur Lina Moses, Director, MPH Programs, Tulane University School of Public Health and Tropical Medicine and GOARN Research Lead

Objectives l To highlight the purpose of and need for operational research l To hear practical examples from local and national teams l To signpost what people can do to get involved with operational research

Speakers Soumya Swaminathan, Chief Scientist, WHO Tshokey Tshokey, Ministry of Health, Bhutan Bernnedine Smaghi, Field Epidemiology Training Programme, National

Department of Health, Papua New Guinea Tambri Housen, University of Newcastle, United Kingdom Adebola Olayinka, Infection Control Focal Point, WHO Country Office, Nigeria Mukhtar Bullale, Health, Water and Sanitation Officer, Somalia

IntroductionGail Carson opened the webinar and Nina Gobat presented its three objectives.

Purpose of and need for operational researchSoumiya Swaminathan said that operational research is essential in health emergencies and integral to any health programme. Health systems should be constantly learning, innovating and adapting, in order to become more efficient. Development of diagnostics, vaccines and drugs is only half the battle in the prevention and control of epidemics; so much depends on how and where these tools are used.

79

Operational research can be defined as “the scientific approach to the solution of problems in the management of complex systems” or simply “the science of better”. Operational research provides the bridge between the controlled environment of basic biomedical research and the very chaotic and complex one of health emergencies. One of WHO’s six core functions is to shape the research agenda and stimulate the generation, translation and dissemination of valuable knowledge. The time is really right to integrate operational research into effective outbreak response. GOARN, with its diverse partner institutions, has the potential to move this forward. The research community must come together now with the response community, because there are questions about how to define and measure a quality public health action and response.

A decision quality framework has six components: 1) What we are deciding? 2) What choices do we have? 3) What do we need to know? 4) What consequences do we care about? 5) Are we thinking logically? and 6) Will we really take action? Such a framework can be refined and developed in operational research, in order to “build back better” and develop resilient systems.

Building capacity in operational research at the country level is very important. The Special Programme for Research and Training in Tropical Diseases (TDR) runs a structured operational research course called SORT-IT. As many as 85% of SORT-IT graduates have said they have been involved in operational research during the COVID-19 pandemic, even though their training was in a different disease.

Data analysis and interpretation is an integral part of operational research. There is a huge need for data; unfortunately, a lot of the data is coming from a few countries, and it is not appropriate to extrapolate. Because the health situation is so contextual, data has to be generated locally to inform policy-makers and improve local action.

When people talk about research, many often think about quantitative data, but qualitative data is often more important. Elements of behavioural and social science research are needed, particularly when a major public health response programme is to be implemented.

There must be a plan for how GOARN engages with the WHO Science Division and with other organizations around the world. A number of WHO collaborating centres, for example, have very good expertise in research. The question is how we can build a community where the people going out to do emergency and outbreak response are “tuned in” to research and can motivate their peers in the country to undertake operational research and to really use data effectively to guide responses.

80

Country perspectivesBhutanTshokey Tshokey said that Bhutan has only limited research experience but is committed to taking operational research to new heights. There is no dedicated research body or research funds. However, there has been increased interest in the past five years. Most research is operational and observational but not yet very successful in changing policy and helping decision-makers.

There is a growing pool of officials trained in medical and health research through postgraduate training or the TDR SORT-IT training programme. A local training program, B-SMART, which is modelled on SORT-IT, has trained several public health officials, medical doctors and nurses. There is growing awareness of operational research among administrators and policy-makers.

As an example of operational research in progress, a study is being carried out to monitor the utilization and efficiency of road ambulances for emergency medical services. Ambulances have been allocated and deployed to all health centres in the country, but performance and utilization have not been monitored previously. Coordination and collaboration has been a challenge owing to a lack of collection of field data.

The way forward is to create awareness among administrators and policy-makers; allocate a budget and form a core expertise group; undertake skills development (trained faculty teach operational research to their students); work towards a research endowment fund; create awareness of regional and international grants; and increase institutional linkages.

Papua New GuineaBernnedine Smaghi said that, during the COVID-19 pandemic, there has been a realization that operational research plays a vital role in informing the response in Papua New Guinea. Two major studies illustrate this. The first was a study into the barriers and enablers experienced by health care workers in swabbing for COVID-19. This was needed to understand the reasons for very low testing coverage. Through collaborative efforts by stakeholders, problems were identified with human resources, transport and logistics for specimen collection, and health care and community attitudes. The second study, on vaccine hesitancy, highlighted the fact that health care workers are the most trusted sources of health information. The public wants to hear directly from health care workers. This helps with development of risk communication.

Operational research during this emergency generated evidence-based data. It provided opportunities to strengthen collaboration and coordination at all levels and to make effective decisions. Lastly, it yielded an understanding of the gap in human resources and the need for additional, targeted training and support with resources.

81

Translatng research findings into policy and practice is a major challenge. A full written report was disseminated to decision-makers at all levels, from national to provincial, and oral presentations were also made. Another challenge is that responders do not use evidence-based information for decision-making. Frontline workers do not implement response plans if they are not supported with resources. Staff may not be able to adapt findings to practice.

In view of the low uptake of routine vaccination during the pandemic and concern about a future outbreak of vaccine-preventable disease, the next step is to carry out further OR in the form of an exploratory mixed-methods study to be conducted by the Papua New Guinea Institute of Medical Research.

Translating findings into actionIn response to a question from Nina Gobat about getting decision-makers to act on recommendations, Tambri Housen noted the value of communicating research findings in Papua New Guinea through weekly distribution of a regularly updated infographic to WhatsApp groups and national forums. Interventions also targeted health care workers.

Tshokey Tshokey said that findings obtained through day-to-day work can be utilized to a certain extent, but beyond that, funds are needed in order to deliver research. At the moment, much research is project-driven and time-bound. It must be emphasized that when funders provide support, those organizations should focus on output and impact.

Webinar poll (1) 1. Does your institution currently support OR?

Yes No Don’t know

24 7 4

2. How would you rate your understanding of OR?

Minimal Basic Adequate Superior

5 9 17 4

82

Country perspectives (cont’d)NigeriaAdebola Olayinka said that Nigeria was currently experiencing outbreaks of COVID-19, Lassa fever, cholera, cerebrospinal meningitis, yellow fever and measles. These present many opportunities for research.

Following the 2018 outbreak of Lassa fever, a research pillar was established in the technical working group and also in the Emergency Operations Centre. This has subsequently been replicated in other disease technical working groups. During outbreaks, the research pillar identifies areas and challenges where operational research would be helpful. It is designed to quickly put together research proposals, carry out reviews and obtain ethical approval for implementation before the end of the outbreak. Funding challenges have made implementation difficult.

During the 2019 Lassa fever outbreak, research suggested by the research pillar helped the country to develop diagnostic strategies that would provide a differential diagnosis for cases that had tested negative for both Lassa fever and malaria. This also built up national capacity for sequencing that has proved useful in the COVID-19 pandemic. Another OR project has been launched to identify gaps in infection prevention and control that facilitate human-to-human transmission of Lassa fever in health care settings.

Challenges in the COVID 19 response include poor compliance with non-pharmaceutical preventive measures and vaccine hesitancy. To address these problems, weekly polls are conducted by the risk communication pillar and adjustments are made to communication measures, in order to improve community engagement and compliance. One goal of research in this area has been to measure public perceptions and knowledge of the COVID-19 situation in Nigeria. Research focused on feelings, attitudes, who people trust, beliefs, and experiences during lockdown. Information, education and communication (IEC) materials developed by the Nigeria Centre for Disease Control (CDC) were evaluated. Another research goal was to understand facilitators and barriers to compliance with COVID-19 preventive measures by looking at changes in public risk perception and behaviour through the phases of the pandemic.

Lessons learned: l Outbreak response activities highlight the gaps to be addressed by operational research. l There is a need for capacity to develop rapid proposals. l Rapid response teams do not work for implementation of research. They need to work in

tandem with research teams. l Finding resources for research is challenging. l Working with ethics committee to do rapid reviews is challenging. l Communicating research outputs to inform response or policy is challenging. It is less

challenging when it concerns operational adaptations within the Nigeria CDC, but more challenging for policy outside of the institution.

83

SomaliaMukhtar Bullale said that, in Somalia’s response to the COVID-19 pandemic, accelerated risk communication and community engagement (RCCE) has dispelled rumours and misinformation and led to increased vaccination uptake. Data-driven approaches in RCCE are based on global evidence. Door-to-door awareness-raising has been done. Routine use is made of the media (television, radio, social media platforms). A health promotion and training campaign has been developed and rolled out to over 10 million people. More than 1800 community health workers (CHWs) have been trained and redeployed to deliver risk communication messages to communities.

Challenges include providing correct information through media and medical experts. Community surveillance activities are being carried out in only 71 of 118 COVID-19 priority districts. Considerable amounts of funds are required to sustain the CHW effort. Owing to a lack of coverage with CHWs in security-restricted areas, it is difficult to monitor the quality of implementation of the community-based strategy.

Nonetheless, there has been improved monitoring of local transmission, rates of suspected COVID-19 infection have fallen in subsequent vaccination rounds, and a study conducted in sites for internally displaced persons found that participants showed improved understanding of COVID-19.

Lessons learned: l There is a need to continue strengthening coordination, especially at subnational level,

and to deliver COVID-19 communication and awareness initiatives. l Data-driven evidence with coordinated efforts is critical to success. l More involvement of partners and private sector actors is required: the Government

needs to engage the private sector with a view to offering vaccination in private hospitals.

Timely implementationIn response to a question from Nina Gobat about how to do research in a timely way, Adebola Olayinka said that it was necessary to look at previous outbreaks, take pre-emptive action and start protocols early. Mukhtar Bullale confirmed that knowledge of the trends in infection obtained through surveillance made it possible to plan future interventions.

84

Webinar poll (2)3. What challenges do you experience when trying to do OR?

Competing demands on time 9

OR is a low priority for institution 3

Lack of expertise to identify research questions and design studies 3

Limited funding 3

Lack of information management systems to compile date 3

4. What resources does your institution have that can support OR?

Information/data management expertise 6

Data analytics expertise 5

Ethics review infrastructure 3

Dissemination support (writing publications, developing recommendations) 3

Study design expertise 2

Funding 2

WHO regional perspectiveVictor Del Rio emphasized the importance of taking account of organizational issues, such as governance or the political economy, when coming up with innovations in existing processes or operational research proposals. There is a crucial difference between data, on the one hand, and the translation of that data into knowledge, on the other. The first step in operational research is to provide a mechanism for data capture, curation and prompt analysis. Proper documentation and monitoring and evaluation (M&E) systems must be in place to gather data, while building up expertise in data analytics and information management in order to foster learning within an organization and the generation of policy advice.

85

Operational research related activities being carried out by WHO/SEARO: l The SORT-IT approach is being adapted for use in public health emergencies across the

Region. l Work is being done with international faculty to develop and execute research proposals. l The Regional Office is working with two teams for the next six months to improve

procurement and the supply chain in a number of countries. l The Office is also working with Population Council (India) to assess how vulnerability can

impact mobility or access to vaccination. l The Operational Research for Public Health Emergencies (ORPHES) winter school started

on 10 January 2022, targeting colleagues from the South-East Asia and Western Pacific regions.

l Efforts to strengthen the laboratory network in Nepal include identifying benchmarks and improving the movement of samples across different laboratories.

l A working group has been established, to focus on documentation and M&E and subsequently to come up with suggestions for operational research.

The current focus in the South-East Asia Region is to expand the number of GOARN partners in 2022 and to increase the number of disciplines in which the Regional Office engages through its partners. More decision scientists, decision managers, bioengineers and biostatisticians are needed. To achieve this, the Regional Office is planning targeted outreach to countries and partners and is creating a community of practice with operational research and public health practitioners. It is also looking at the value of harnessing operational research in the area of alerts to disease outbreaks.

GOARN perspectiveLina Moses outlined the values underlying GOARN Research. Research should be an integral component of alert and response activities, with dedicated personnel and resources. Research should focus on the needs of countries and communities at grass-roots level. Research findings need to be operationalized immediately to inform response. Research should not interfere with but enhance response activities.

The services that GOARN Research intends to deliver include: l carrying out operational research to improve GOARN network functionality and support

attainment of strategic goals l building collaboration among member partners, improving communication, and advocacy l supporting research administration, documentation, ethics protocol approval, logistics,

analytics, publications during outbreaks l curating evidence to inform technical guidance and operations l developing research protocols and tools (data collection instruments, assessments) that

countries and communities can quickly adapt to their context and research priorities l conducting research needs assessment and prioritization for health emergencies that

GOARN does not frequently respond to (measles, plague, cholera).

86

The challenges faced when carrying out operational research include the need to invert the funding model so that it focuses on the environment in which research is carried out, rather than on research questions. As already mentioned, operational research findings must be rapidly turned into practice, particularly in health emergencies. Findings may not be generalizable and scalable; operational research is problem- rather than discovery-based. There can be a culture clash between responders and researchers: there is sometimes distrust between them surrounding data sharing and sample collection, and misalignment of priorities and outputs. Lastly, building capacity during a crisis may be difficult. Within GOARN itself, there is limited knowledge of the capacity for operational research; limited resources for research coordination and facilitation; and limited access to information about regional, country and community-level needs.

Partners are invited to participate in three core activities that comprise the plan for 2022: l conduct a research assets assessment (identify the best people within each GOARN

partner to gather this information) l strengthen information dissemination and engagement modalities l ensure more effective dissemination of requests for assistance.

GOARN Operational Support TeamGlobal Outbreak Alert and Response Network (GOARN)World Health Organization20 Avenue Appia1211 Geneva 27goarn@who.intExtranet.who.int/goarn

ISBN 978-92-4-004695-5