Epidemic preparedness and response in Africa, the digital way to go

If recent events have taught us anything at all, it is that monitoring disease to target preventative measures can slow its spread. This goes for most pathogens. Disease surveillance data serve as early warning systems for impending outbreaks that could become public health emergencies. Monitoring the epidemiology of infectious surges can further help guide and prioritize public health policy and strategies, and evaluate interventions. 

A fast response to cholera outbreaks

To be efficient, disease surveillance systems need to detect outbreaks as quickly as possible – before the pathogens spread, cost lives, and become difficult to control. At Didida, we are working on digital solutions that help diagnose and monitor large scale spread of disease.

During the recent SARS-CoV-2 pandemic, an early warning system was designed, that helped pinpoint disease hotspots and areas of contagion. Under Didida this digital infrastructure was recently put to use as an alert system for another pathogen: cholera. A request for immediate support was made by the Department of Health (DOH) in Kisumu, a region in western Kenya, for technical assistance from Didida consortium member PharmAccess.

Earlier this year, the Kenyan Ministry of Health reported of few dispersed cases of Cholera throughout the country. Eager to act fast to prevent an outburst of contagion, and potential public health concerns, the Kisumu DOH reached out to PharmAccess in Kenya. They requested technical support in developing a digital data collection tool and a dedicated dashboard for tracking the suspected cases and results of testing activities for cholera.

There was an urgent need for a fast acting, accessible, and responsive system devoted to the water-born pathogen. Because Cholera is mostly spread through water, it became important to report on where identified carriers were collecting their water, did they treat or disinfect it, and how (boiled / chlorine / bleach etc.), as well as on the usual criteria which included measures of the experienced symptoms, duration of the infection, and location of the patient. A comprehensive dashboard was co-developed, containing separate information sheets on infection source, water source, water treatment, symptomatology, diagnostics, health outcomes and Google maps of facilities and patients’ locations.

Didida had a digital weekly disease outbreak monitoring system in place for 30 diseases as recorded by 27 public and private healthcare facilities in Kisumu. This digital infrastructure allowed ultra-fast development of a specific sub-dashboard for cholera, to help pinpoint hotspots and potential cholera patients in the County. Overall, the dashboard recorded suspected diarrheal cases presented at 6 facilities between May and August 2023. The digital tool provided automated, straightforward and time sensitive reports available on both computers and phones for doctors and health policy makers to act upon. Access to the dashboard was provided to 15 key staff at the County, including: DOH leadership, the disease surveillance team, the County epidemiologists, and the County data team.

The power of digital readiness and response

The Didida digital tool was rolled out fast and efficiently, and eventually showed no evidence of an immediate threat from Cholera. The outbreak (this time) was more limited than people feared for.

« The power of going digital stems from the subsequent speed of reaction to outbreaks, » details Tobias Rinke de Wit, professor at Didida partner Amsterdam Institute for Global Health and Development and Director Research of PharmAccess. « With the Didida dashboard, the Kisumu DOH received an informed vision of the situation, that allowed it to engage a swift reaction against an immediate threat to the health system. The rapidly adaptable and scalable dashboard provided prompt insights into what was ongoing on throughout the territory. Eventually, it helped show that this cholera outbreak didn’t necessitate costly unnecessary interventions. »

Pathogen surveillance typically involves sampling of infected individuals, requiring extensive specimen acquisition, clinical testing, and sequencing coordinated across different sites and laboratories. Uncoordinated, decentralized and unevenly distributed, this expensive and time-consuming clinical surveillance – fundamental to infectious disease response – goes to waste. Digitalising, regrouping and pooling national efforts optimises and fine tunes and accelerates outbreak preparedness and response by public health organizations, especially in underserved communities.

On the long run, Didida wishes to support implementation of a novel point-of-care cholera diagnostic test which would, in combination with its digital dashboard, help standardize best practices and be a great asset in detecting and preventing disease spread for any future cholera epidemics. Built on the existing infrastructure of 30+ disease monitoring, the dashboard will also be adapted to fight other problematic infectious diseases.

Preparing for future epidemics

The use case in Kenya was instrumental in showing the importance and the impact of such a rapidly implemented, centralizing and live-broadcasting digital surveillance tool. “There was an urgency. We reacted quickly to it by engineering an early warning system,” states Rinke de Wit. “And our digital tool proved to be exemplary . We trust it will continue to help ring-fence outbreaks in the future.”

Because of its inherent link to climate change, Cholera outbursts are expected to occur exponentially in the years to come. Droughts, leading to less clean water sources, but also floods, which contaminate water sources, increase risks of infection. Access to clean drinking water will become one of the biggest problems in the world – and certainly in Africa – leading down the line to outbreaks of waterborne infectious diseases like Cholera, in which case the Didida dashboard will be readily available to be immediately implemented.

In the years to come, over half of known human pathogenic diseases will be aggravated by climate change. The pressure will be particularly important in developing countries already struck by poverty, sanitary risks and insufficient personnel, infrastructures, and budgets.

With limited resources, efficiency will be key for developing countries,” explains Rinke de Wit. “Their need for digitalization to cope with certain health matters is even bigger. It is a cost-efficient way of dealing with challenges to the health system. Digitally mapping disease spread guides governments and target their efforts, helping them take the right decisions, to treat the right diseases, at the right places, at the right time.

We are entering a new era of infectious disease, defined by outbreaks of emerging, re-emerging, and endemic pathogens that spread quickly, aided by global connectivity and shifted ranges owing to climate change. Clever, affordable, easy-to-use in real time, digital diagnostic tools combined with informative, flexible and semi-real time dashboards like the Didida dashboard will be key to identify major disease outbreaks and take subsequent steps to treat them properly.

Building upon existing momentum, we have an opportunity to form the backbone of future surveillance capacity and scientific ecosystems in Kenya and beyond. Helping pinpoint possible outbreaks and spill-over risks, Didida provides local and international public health organizations the means to identify, prepare for, ensure readiness for, and respond to future epidemic threats in a timely, transparent, and effective manner.

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