Bio and Health Surveillance in the Asia-Pacific Region

James R. Campbell, Ph.D., M.P.H.Asia-Pacific Center for Security Studies

Biosurveillance• Moving to “One Health” –

integrated management of human, veterinary and environmental health

• Requires methodologies, tools and models to systematically harvest and contextualize all sources of biosurveillance data

• Defines trigger points for policy decisions on countermeasure and response options

• Requires planning exercises to incorporate all sources of biosurveillance information

Emerging infections: conceptbecomes reality

Rift ValleyUsutu

Arthropod-borne Rodent-borne Other (including bats)

Alkhumra

SinNombre

VEEGuanarito

MayaroOropouche

MachupoAndes

TBEAvian fluSARS

KyasanurForestDisease

JE RossRiver

Hendra

Chikungunya

West Nile

Ebola (Reston)

DHFLassa

Ebola

Rocio

Marburg

NipahChandipura

Barmah ForestChikungunya

O’nyong nyong

What Can Technology Offer?• A biosecurity predictive, assessment and

analysis database and software system that would build a meta-structure of the problem and solution space

• Capture of all kinds of information including expert opinion

• Facilitate structured information retrieval• Provide tools to assess the problem and

solution space to identify the most critical information gaps

• Forecast unenvisioned problems and events, and identify the precursors to such events

• Facilitate structured risk assessments and informed risk management decisions

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Interconnectedness of Surveillance Data

• HIV/AIDS incidence tracks along international drug smuggling routes

• Immunocompromise associated with AIDS, and with aging, create new vulnerabilities in the Asia-Pacific region.

• International human trafficking, illegal cross-border movements correlate with spread of disease

Asia-Pacific Regional Security is Dependent on Health Security

• Ecologically, demographically and epidemiologically the Asia-Pacific is “ground zero” for epidemics of new human pathogens, both imported and “home grown.”

• Dense populations of humans and animals (especially birds)

• Wide open for international trade, giving exposure to agents arising elsewhere that make their way to the region

• Biosurveillance for recurrent epidemics is an important lens through which to examine trends in a variety of other aspects of regional change.

Emergent Disease Tests National and Regional Public Health Safety Nets

• Water and Sanitation• Disease surveillance• Laboratory capacity• Epidemic investigation and containment• Health care systems (often found in urgent

need of repair)• In epidemics, “ripple effects” across legal

regimes, trade, travel

Increasing Regional Economic Integration brings:

• Intensive investment in transnational science and research collaboration

• Common interest in preventing the heavy human and economic costs that disruption of trade and travel causes

• Increasingly robust electronic communications architecture within and across borders

• Public Private Partnerships – health systems and business

• Enduring regional health security change by increasing whole-of-nation resilience, by building capacity, capability and regional interoperability

Where are the Gaps?• Need cross-country communications

between Ministries of commerce, finance, tourism and health (Use APEC EIN, Access Grid video-teleconference)

• Need capability to “regionalize” trade sanctions, limiting imports only from affected areas of a given country (infected vs “disease-free” areas), so trade in poultry can continue, at a reduced rate, throughout the crisis – GIS?

• Data-sharing protocols for stockpiling shared resources

• Data on labor movements, within and between countries

• Non-communicable disease (NCD) surveillance (Oceania – public health emergency)

Implications for the Rebalance

• U.S. must be viewed as a reliable partner in public health surveillance in the region– U.S. – Singapore: Regional Emergency Disease Intervention

(REDI) center• Demonstrate that U.S. actions in public health are

collaborative, and not simply directed toward thwarting bioterror attack against the American people

• US PACOM has taken a leadership role in preparing the region’s militaries for cooperative response planning

Organizations Working Regionally on Biosurveillance

• CAREID (Canada Asia Region Emerging Infectious Disease project

• APEC Emerging Infections Network• GPHIN (Global Public Health Information Network)• WHO Geneva, WHO – APSED 2010 (Asia Pacific

Strategy for Emerging Diseases– WPRO Manila (ROK), SEARO New Delhi (DPRK)– competition, suboptimal coordination and cooperation

• TEIN4 (Trans-Eurasia Information Network) Connects 17 Asian countries via a high speed link