Towards Effective Emerging Infectious Diseases Surveillance: Evidence from Egypt (NAMRU-3), Kenya (USAMRU-K), Peru (NMRCD), and the US-Mexican Border (EWIDS)

Towards Effective Emerging Infectious Diseases Surveillance: Evidence from Egypt (NAMRU-3), Kenya

(USAMRU-K), Peru (NMRCD), and the US-Mexican Border (EWIDS)

DTRA-ASCO VisitFY11 Proposal Presentations

Sophal Ear, Ph.D.8 July 2010

Disclaimer: Material contained herein is made available for the purpose of peer review and discussion and does not necessarily reflect the views of the Department of the Navy or the Department of Defense.

Indonesia, Cambodia, and Mexico Update:1st draft of Cambodia-Indonesia paper (April)

Mexico Research Trip (June)

Key Issues Identified by Interview Subjects by Country

Cambodia IndonesiaIssue Respondents

emphasizing issue (percent)*

Issue Respondents emphasizing issue (percent)

Low salaries 5 of 12 (42%) Poor host-donor relationship

13 of 26 (50%)

Donor dependence pathologies

5 of 12 (42%) Differing host and donor priorities

8 of 26 (31%)

Poor staff management/HR 4 of 12 (33%) Low salaries 7 of 26 (27%)Patronage networks 4 of 12 (33%) Decline in the MoH

quality6 of 26 (23%)

No compensation for culling

4 of 12 (33%) NAMRU-2 is misunderstood

6 of 26 (23%)

Differing host and donor priorities

3 of 12 (25%) Poor compensation for culling

4 of 26 (15%)

Local levels dont see reporting translated into response

4 of 26 (15%)

* By proportion of interview subjects

By proportion of interview sessions

Difference in calculation due to prevalence of group interviews in Indonesia

Puzzle/Research Question

Focus:

Effective surveillance of EIDs via understanding of the political / economic / cultural factors inherent to each country.

How do we accomplish this?

Having looked at Cambodia, Indonesia, Mexico, and the US (1976), add case studies of Egypt, Kenya, Peru, and US-Mexican border (both successes and failures).

EarlyWarningInfectiousDiseaseSurveillance

Outcome: Insight into the political, economic, and cultural challenges to effective surveillance of EIDsQuestions: What infrastructure is necessary to conduct

effective (timely, cost-effective) disease surveillance?

What would it take to actualize effective surveillance in developing countries?

What challenges to effective EID surveillance would we find in developing countries?

What can be done to mitigate or overcome these challenges?

Why should we care?

No report orno surveillance?Why?

US-Mexican border is 1,969 miles and the most frequently crossed international border in the world, with about 250 million people crossings per year. Early warning of EIDs is crucial.

Myriad problems exist in the political economy of pandemic preparedness:

Poor to non-existent surveillance in the developing world Poor diagnostic laboratory capability in the developing world Disincentive to report (bad publicity, bad for business => Cambodia) Viral sovereignty (=> Indonesia)

Why and how is this important to US national security?

This study specifically touches upon two areas: U.S. national security and its safety via interaction with developing countries.

The methods and lessons from my case studies tie back to U.S. national interest and security.

Cross-Border Issues Transnational Threats

UNCLASSIFIED

UNCLASSIFIED

Anticipating Threats &

Opportunities

Strategic Vision

Over-The-Horizon

Proliferation

Track II Strategic Dialogues on Threat

Reduction

Countering WMD

Proliferation

Strategic Foundations

21st Century Deterrence

Countering WMD

Terrorism

Sustaining Communities

of Interest

Preparing the Next

Generation

How will this help DTRA-ASCO meet its objectives?

Priorities (Referenced DTRA/ASCO Priorities) Ties into goals outlined in President Obamas National Strategy for Countering Biological Threats(proactive confrontation of WMD threats at their source and as far from American borders as possible)Development of analytical tools to detect and actively confront the full spectrum of WMD threats

Sustaining communities of interest, specifically referring to developing countries whose health have the potential to affect U.S. homeland security.Preparing the next generation (U.S. and global policy makers) to have a body of knowledge that analyzes and understands the infrastructures underlying the political economy of successful and unsuccessful national programs for EID surveillance.

Politics Trumps ScienceScientists too frequently see the surveillance of EIDs as a technical problem of science, pure and simple. The reality, however, is that on the ground, even the most advanced technology cannot trump politics.

Namru-2 Jakarta is shutting down. I have been very sad. Not only because I am losing my job, but more than that, Indonesia will loss [sic] an established laboratory research coz [sic] of political reasons

--Senior Indonesian scientist

E-mail11 April 2010

Scientists should be on tap, but not on top. Churchill

By which he meant scientists have a duty to inform politics, but they have no special insights beyond that, and must allow politicians to formulate policy based on social, economic and ethical principles.*

Barriers to effective preparedness span not only the technical and scientific, but cultural, political, and economic realms.* http://www.newscientist.com/blogs/thesword/2010/05/time-for-scientists-to-go-into.html

Objective:

To produce three more case studies that would be part of a third installment of a collection of policy reports studying the necessary components of an effective EID surveillance system.

Deliverables:

Set of policy reports on Egypt, Kenya, Peru, and US-Mexican border

Refereed journal articles Book chapters (even a

book)

Established Record of Productivity on Political Economy of AvianFlu Research in 2009/10:

Stanford Working Paper

University of Sussex/ESRCWorking Paper

Book chapter

Worlds Poultry Science Journal article

Towards Effective Emerging Infectious Diseases Surveillance: Evidence from Egypt (NAMRU-3), Kenya (USAMRU-K), Peru (NMRCD), and the US-Mexican Border (EWIDS)Indonesia, Cambodia, and Mexico Update:1st draft of Cambodia-Indonesia paper (April) Mexico Research Trip (June)Key Issues Identified by Interview Subjects by CountryPuzzle/Research QuestionOutcome: Insight into the political, economic, and cultural challenges to effective surveillance of EIDsWhy should we care? Why and how is this important to US national security?Slide Number 8Politics Trumps ScienceScientists should be on tap, but not on top. Churchill Slide Number 11Slide Number 12