The world has a sophisticated infectious disease, epidemiological and technological intersection. Multiple funding sources remove the risk of total epidemiological collapse. And, the epidemiological reporting mechanisms are familiar to one another worldwide.
There is enough structure to advance emergencies in infectious disease beyond medicine’s paternalistic culture. While the remainder of paternalism in medicine will take collaborative, significant energy to transform, we are fortunate that infectious disease emergencies are already energized.
Medicine’s inability to learn from the H1N1 geopolitical disagreements around definitions of outbreak, epidemic and pandemic spilled over into full failure of the COVID pandemic call. Delayed infectious disease definitions matter. From the start, failure in identification diminished confidence in medical science.
We should set a confident tone and better trajectory for future infectious disease emergencies, and remove the opaqueness of over-reliance on medical doctor paternalism. If medicine truly knows what’s best for the rest of us, medicine will create a transparent, real-time system of infectious disease emergency data, contingent upon one another’s place and space.
*Define with clarity. Remove the opaqueness of infectious disease emergencies in definition. It is not enough to describe the situation, such as a situation that has the ability to lead to more deaths. Do not hide from definition failures [1], rather, be honest and clear. Create an algorithm, incorporate numeric values and incorporate the virulence of the strain. Have infection control and prevention at the table, for clear dissemination of better, objective definitions[2]. Be clear, reasoned and receptive to country input. Be honest and firm that clearer definitions may require heightened response earlier, and ask countries how definitions can be respectful to practical response.
*Describe the outbreak declaration decision-making process, in publicly available and easy to read reports. Detail
A.The hierarchy and flow of epidemiological monitoring worldwide. Include the WHO territories, the Epidemic Intelligence from Open Surces (EIOS) [6], the Program for Monitoring Emergning Diseases (ProMED), the Mapping the RIsk of Internationa; Infectious Disease SPread (MRIIDS) [7] and other information sources.
B. The movement toward objective algorithms to alert us of outbreaks, epidemics and pandemics.
C. The methods of manual submission of the data into the technology for the algorithms.
D. The oversight, management, enforcement and consequences tied to manual data submission. Current manual, mathematical and technological formulas currently used by worldwide epidemiological groups should be analyzed for reliance and missing elements.
Analyze and observe country acceptance.
*Decide how current groups and information sources will be refined. It may or may not do our world any good to continue to re-invent the wheel with new groups. The Global Preparedness Monitoring Board (GPMB) is a good example of a 2017 addition [8] to decades of preparedness in world governance and international surveillance. How does this funding sharpen needed real-time, objective decision making from the start? How does this funding improve public trust in medical science while removing the medical science paternalism? Get smart on resources we already have, and speak up when new funding is unaware of refinement possibilities. If someone is feeling under-represented, address it right away. Do not rely on a global group to attempt solutions that proactive attention could have addressed.
*Define real-time. Data from three months ago should not be fed to the public as “real-time”. Do not tell countries and their populations what will be good enough. Just do better.
*Define with acceptance of geopolitics and management of inefficiency. If the virulence is unknown for any reason, including when one country selfishly withholds data as it cheer leads for current broken political set up, the virulence should be categorized based on symptoms and response. There should be an algorithm for unknown virulence, too. Selfishness will not remedy itself quickly, nor does incompetence, and we don’t have time to wait on remediation. Meet countries where they are, not where we want them to be, not where our global health funders tell us they are. Respectfully review a country’s history of medical response and data transparency. Respectfully address best actions for improved collegiality. It is disrespectful to hide feelings, and it is disrespectful to hesitate and waffle on identified relationship issues. Get serious about international relationships, and demonstrate the ability to accept constructive criticism in hopes that others may do the same.
*Assign response categories when definitions are contingent on data unsubmitted or unknown. If territories or geographies are missing or lagging real-time submission, say so openly in the data reports. Apply a real-time higher risk, regardless of how long we are in the high risk category, based on data unknown or unsubmitted. Even with geopolitical selfishness or secrecy, we must respond. And this response should be a conservative higher risk. Be honest, clear and objective, regardless of any one country’s emotional response. Every single person in our world of billions matters, regardless of a political system’s carelessness.
*Form consensus on the current monitoring in place. The information sources most frequently used should be assigned specifics: how are they being used, who is using them, what information can be used for real-time analytics, who is funding them, is there risk of funder bias, and what data is missing [3]? Seek clarity on country reliance to these international information groups, and ask for honesty about any country public health hesistancy with the information groups. Confidence and concern is important to address.
*Decide on new tools right away. Make space for new epidemiological tools, and discuss with international peers. If the work is redundant, say so and move on. If the work and tools can be utilized, tell the funders and make it happen [4]. Remove bias and ask for country input.
*Incorporate epidemiology in country guides to outbreak management. It is patronizing to tell a country’s public health how to manage something only after the paternalism of global medicine decides it is what it is. Countries should know exactly how, why and when epidemics and pandemics are declared, with contributions from their country [5]. Reflect internally, and reflect on country reliance. Instead of feeding the paternal approach, help countries in their own epidemiological leadership. And help international approaches with consensus on the epidemiological algorithms.
*Review the guidelines for monitoring and response to communicable disease from 2006, and detail lessons learned with specific action items [9].
https://apic.org/monthly_alerts/outbreaks-epidemics-and-pandemics-what-you-need-to-know/
https://www.ecdc.europa.eu/en/threats-and-outbreaks/epidemic-intelligence
https://www.who.int/emergencies/diseases/managing-epidemics-interactive.pdf
https://www.who.int/csr/resources/publications/surveillance/WHO_CDS_EPR_LYO_2006_2.pdf
Comments
Post a Comment