INFECTIOUS DISEASES INSTITUTE ADVOCACY: Stronger global health security
As a young clinician at the Infectious Diseases Institute (IDI) at Makerere University a decade and a half ago, I routinely observed first-hand the great devastation caused by HIV/AIDS. At present, I have the great privilege of leading this same institute, and I have had the honour to lead teams that are contributing to the well-being of individuals, families and entire communities by ensuring that essential interventions such as antiretroviral therapy get to the most vulnerable populations (including refugees) in Uganda. What has been achieved seemed unimaginable a few decades ago when these life-saving treatments emerged. I have witnessed the concerted global efforts and resources that have made a difference in the lives of millions of individuals.
IDI is an established Ugandan non-profit organisation with a mission “To strengthen health systems in Africa, with a strong emphasis on infectious diseases, through research and capacity development”. Since inception in 2002, IDI has been contributing to development by addressing the challenges of life-threatening and life-limiting infectious diseases all within the context of a long-term strategic vision. The IDI programmes support treatment for more than 270,000 People Living with HIV (PLHIV) in Uganda, about 25% of the national effort; address other infectious diseases such as Cryptococcal Meningitis, Malaria, Tuberculosis and Hepatitis B; and immediately respond to epidemic outbreaks (Ebola and the like) as part of national response teams.
Required investment
I cannot help but draw parallels between the earlier days of the response to the HIV pandemic and what I see happening in Uganda and the East and Central African region today. In the past two years, Uganda experienced outbreaks caused by high-consequence pathogens including Ebola virus disease, Marburg virus disease, Rift Valley Fever and Congo Crimean Hemorrhagic Fever (CCHF). These are diseases where no licensed therapeutics exist, where health workers may be at risk of infection during patient care and, in the case of Ebola and Marburg, where delays in outbreak detection can result in severe public health and economic consequences.
Sadly, I observe that the same level of investment will be required of the global community to stem the huge risks posed by high-consequence infectious disease threats. I see that some efforts are currently under way and I feel gratified that IDI is making significant contributions towards preventing, detecting and responding to these threats.
On the front line
Having served on the front line of previous outbreaks, IDI works with government stakeholders and development partners to support Uganda’s global health security strategies by strengthening Uganda’s capacity to prevent, detect and respond to infectious disease outbreaks and other biological threats. Importantly, IDI has leveraged capacity (including clinical care and laboratory systems) and partnerships developed through previous investments in HIV, tuberculosis and malaria to make a strategic shift to confront the threat of emerging infectious diseases, which could be a model for other institutions to emulate.
IDI’s efforts focus on prevention of the emergence and spread of antimicrobial resistance (AMR), establishing a national biosafety and biosecurity system, supporting the national laboratory system, surveillance, preparedness and medical countermeasure systems. A dedicated IDI team supports the national response when an outbreak occurs.
The global health security programme at IDI has supported the establishment of biorisk expert networks across human health and veterinary disciplines, and builds the capacity of health workers in biosafety and biosecurity.
Antimicrobial resistance
To combat AMR, the programme is focused on enhancing capacity to identify and perform susceptibility testing, strengthening AMR surveillance, establishing a national AMR surveillance and stewardship group, tracking use of commonly prescribed antibiotics, establishing an antimicrobial stewardship system, and strengthening national infection prevention and control capacity.
The programme is building capacity for the national laboratory system through enhancing the specimen referral network between different levels, enhancing laboratory information and supply chain management systems and increasing the number of laboratories that participate in national and international quality assurance programmes and proficiency testing in Uganda. In support of the Uganda National Health Laboratory Services, IDI is working to operationalise the National Reference Microbiology Laboratory by supporting staffing and quality-management systems, promoting laboratory-based surveillance for antimicrobial resistance in Uganda.
IDI is part of the Joint Mobile Emerging Diseases Intervention Clinical Capabilities consortium that is establishing capacity to conduct drug trials to demonstrate safety and preliminary efficacy against especially dangerous pathogens that cause deadly outbreaks. To my knowledge, this is the first standby clinical research team for outbreaks in Africa that seeks to integrate a clinical trial into the outbreak response. Capability development is ongoing to facilitate deployment to remote locations to conduct research on investigational compounds at the site of the outbreak.
Coordinated action
The Global Health Security Agenda represents one of the most significant coordinated efforts to strengthen capacities for health security. However, I feel that more can be done by the global community to invest the required resources to ensure that in a timely manner, all countries meet minimum capacities for health security. Lessons learned from the HIV response tell us that we must act fast and act early to ensure that outbreaks do not become expensive and long-lasting pandemics.
I would like to see more resources committed by the global community, including the G20, towards the enhancement of regional and national capacity in the East and Central Africa region. Specifically, resources to enhance national frameworks and structures to boost the prevention, detection and response to high-consequence infectious diseases threats. The work of national and regional resources like the IDI at Makerere University will be enhanced and sustained by resources from a more concerted global effort.
