african epidemic risk index and innovative outbreak...
TRANSCRIPT
African Epidemic Risk Index and Innovative Outbreak Financing
Robert Kwame AgyarkoLead Advisor
Outbreaks and Epidemics
Africa epidemic Risk Index and Financing outbreaks
The presentation Focuses on these broad areas:– What informs the construction of the ARC O&E Pilot Epidemic
Risk Profiling Framework? Why and what.
– What does the tool measure and how: The Methodology and components
– What is the usefulness and value addition of this tool to existing tools and country epidemic preparedness work
– Scaling up for additional priority pathogens, domains and country implementation
The case for O&E Insurance Product
THREAT – In 2015 African Ministers of Finance requested the ARC Agency to develop a product to address countries’ financing needs to contain infectious disease outbreaks common to the African continent.
ACTION – The ARC Agency is developing a new parametric insurance product for outbreaks and epidemics to enable rapid country-led responses to stop the spread of a nascent infectious disease outbreak.
EXPECTED RESULTS• Faster and more predictable funding• Early action by governments• Catalytic funding to start country response• Reduced impact of outbreaks and epidemics
The 4 Workstreams of the O&E pilot
WS 1: Risk Profiling
Development of pathogen-and country- specific riskprofiles and gap analyses,based on the assessment ofdisease surveillanceinfrastructure, and country-level response capacity.
Workstream 3: Risk Modeling, indexing and trigger design
Development of a robust epidemic risk model using historical and near real-time surveillance outbreakdataset in combination with risk and capacity profiles to inform an objective, independent, andverifiable preparedness index, and design appropriate insurance triggers and payout rates.
WS 2: Contingency Planning
Development of pathogen-and country- specificcontingency plans based onpublic health emergencypreparedness and responsestandards and guidelines.
WS 4: Economic Analysis
Assessment of the value formoney for investing in an O&Eparametric sovereigninsurance over other nationalrisk management andmitigation strategies through acost-benefit analysis.
Epidemic Preparedness Index (EPI)
● National-level measure (188 countries worldwide)● Integrated into Metabiota’s disease-spread model● Employed in insurance policy pricing algorithms
Recently published in BMJ Global Health
● Methodology
● Empirical validation
● Benchmarking against JEE and IHR
Oppenheim et al, 2019; BMJ Global Health
EPI compared against JEE: the Epidemic Preparedness Index (EPI ) is a
comparable preparedness assessment metric to JEE composite scores
The Index will be similar to published &validated work
Objectives of Risk this profiling
○ Profile country capacity to prevent, detect, and respond to select diseases
○ Provide strategic information to guide investment in O&E risk management
○ Generate information to realistically simulate disease outbreaks
○ National level → subnational granularity
○ Pathogen agnostic → pathogen specific metrics
○ Crowded space; avoid duplication of efforts
Current Frameworks for Assessing Risk and Capacity
Risk Tools
Strategic Ranking of Potential Health Threats
Preparedness Tools
Evaluation Tools to Measure Preparedness for Acute Health Events
Health Event Guidelines
Technical Guidelines for the Management of Acute Health Events
● STAR Assessment Tool (WHO)
● Rapid Risk Assessment of Acute Public Health Events (WHO)
● The Vulnerability and Risk Analysis & Mapping platform (WHO)
● IHR Core Capacity and Monitoring Framework (WHO)
● GHSA Assessment (GHSA)
● Joint External Evaluation (JEE)
● EVD Consolidated Preparedness Checklist (WHO)
● IDSR in the African Region 2nd Ed. (WHO AFRO)
● Ebola and Marburg Virus Disease Epidemics (WHO)
● Managing Meningitis Epidemics in Africa (WHO)
● Sendai Framework for Disaster Risk Reduction (UN)
● Many validated tools to learn from as above
● No existing subnational assessment tool with pathogen-specific features and metrics
Preparedness Index Structure
DOMAIN
SUB-DOMAIN
Preparedness Index
Surveillance
Event-based surveillance
Community surveillance
Indicator-based surveillance
Zoonotic surveillance
Surveillance data quality
Response
Response plans
Medical countermeasures
Response team
Infection control
Clinical capacity
Laboratory capacity
Lab protocols
Biosecurity/ biosafety
Specimen collection/ transport
Lab performance
Commodity supply chain
Risk comms
Risk comms systems
Partner coordination
Public comms
Rumor listening and
management
Governance
Political stability
Corruption
Bureaucratic capacity
Violent conflict
Vital registration
Financing
Poverty
Government revenue
mobilization
Infrastructure
Road network
Logistical capacity
Mobile phone coverage
Water
Electricity
Health expenditure
Per capita income
Data Sources for the ARC O&E Index
● Existing Assessments - e.g., WHO IHR & JEE assessments
● Existing Country Metrics - e.g., African Union health-financing scorecards,
World Bank & Administrative Statistics produced by National Bureaux of
Statistics
● New National Data - Primary data collected from interviews with national
experts and focal points
○ New Subnational Data - Primary data collected from interviews with subnational focal
points (e.g., district health officers)
○ Pathogen-specific Data - Primary data collected from interviews with both national and
subnational focal points
Preparedness Index Structure
DOMAIN
SUB-DOMAIN
Preparedness Index
Surveillance
Event-based surveillance
Community surveillance
Indicator-based surveillance
Zoonotic surveillance
Surveillance data quality
Response
Response plans
Medical countermeasures
Response team
Infection control
Clinical capacity
Laboratory capacity
Lab protocols
Biosecurity/ biosafety
Specimen collection/ transport
Lab performance
Commodity supply chain
Risk comms
Risk comms systems
Partner coordination
Public comms
Rumor listening and
management
Governance
Political stability
Corruption
Bureaucratic capacity
Violent conflict
Vital registration
Financing
Poverty
Government revenue
mobilization
Infrastructure
Road network
Logistical capacity
Mobile phone coverage
Water
Electricity
Health expenditure
Per capita income
Example: Assessing Specimen Collection & Transport
JEE Indicator Detect.1.2
Specimen referral and transport system
Scoring
1. No system is in place for transporting specimens from
intermediate level to national laboratories
2. System is in place to transport specimens to national
laboratories from less than 50% of intermediate level
3. System is in place to transport specimens to national
laboratories from 50- 80% of intermediate level
4. System is in place to transport specimens to national
laboratories from at least 80% of intermediate level
5. Demonstrated capability plus, transport specimens
to/from other labs in the region; specimen transport is
funded from host country budget
Limitations:
● JEE indicator score indifferent to country capacity to collect and transport specimens from specific suspected diseases
● JEE indicator score focuses on national capacity, obscuring potential subnational variance in implementation
○ Both collection and transport vary greatly at intermediate levels for different pathogens
ARC Assessment of Specimen Collection & Transport
Specimen Collection & Transport Concepts
1. Specimen Referral/Transport:
a. Subnational: Number of hours it take for a suspected [pathogen] to be transported from health facility to
laboratory
b. National: JEE Detect 1.2
2. Pathogen-Specific Issues:
a. Subnational: Number of facilities that are capable of collecting [pathogen] for diagnostics
b. National: Routine availability of packaging, cold-chain, and transport equipment and supplies for
transporting [pathogen]
ARC Subnational Specimen Collection & Transport
Advantages
● Incorporates validated JEE indicator
● Assess pathogen-specific capacities for specimen collection and transport
● Assess and visualize subnational capacities for specimen collection and transport
● Can be linked with disease emergence estimates to subnational localities at risk
○ Inform country resource allocation decisions
Steps
1. Gather national, subnational, and existing data sources
2. Engage Delphi Panel to weight and calibrate index (components, sub-
domain, and domains)
3. Combine data and weights
4. Generate scores
For each pathogen, estimate:
• National level score: combining a weighted average of subnational indicators + national-level indicators
20
Preparedness Index Computation Process
Index Weighted through Delphi Panel▪ The relative importance of each of the components in the subdomain, and
domains in the overall preparedness index is determined through a Delphi panel
▪ Delphi panel drew on expert knowledge to generate quantitative estimates where objective data is otherwise unavailable.
▪ Index calibration/weighting was informed by leading experts from institutions and pilot countries.
▪ WHO AFRO, ▪ Africa CDC, ▪ Nigeria CDC, ▪ Infectious Disease Institute, Makerere University, Uganda, ▪ Public Health Emergency Operations Centre, Uganda, ▪ National Health Security Agency, MOH Guinea, ▪ Noguchi Medical Research Institute, University of Ghana▪ Liverpool School of Tropical Medicine
Preparedness Index Score
(per pathogen)
Laboratory Score
* WeightSurveillance Score
* Weight…
Sample collection and
Transportation Score * WeightLab SoPs Score * Weight
Transportation
time Score
* Weight
Lab Supplies Score
* Weight
…
…
Index
Domain
Sub-domain
Component
Indicators
Index Computation Process
Pathogen
Specific
Preparedness
Score
Index Computation Process (Visual)
District scores National scoresRegional estimates
Pathogen agnostic
Pathogen Specific (VHF)
+
Pathogen agnostic Pathogen agnostic
Pathogen variant (VHF) Pathogen variant (VHF)+ +
Agn
ost
icS
pec
ific
What is the usefulness and value addition of this
framework to existing tools and country epidemic
preparedness work, and the utility of an Africa wide
pathogen specific preparedness scores
The Africa Epidemic Risk Index
The concept and the need for an African Epidemic Risk Index is informed by the following principles:
– Absence of a single standardized, reproducible and comparable pathogen-specific metric that combines both national and subnational preparedness, health and non-health factors
– Need for a transparent metric to guide rational decision-making process at national and subnational level in epidemic preparedness
– Lessons from previous outbreaks and the massive investments in preparedness which should translate to a measurable and comparable Index for the continent
Limitations of the existing metrics
• Despite the massive investments in epidemic preparedness, there’re only handful of realistic metrics to measures of optimal epidemic preparedness and response
• Where they exist like JEE, and IHR assessment, they largely focus at national level preparedness with no subnational granularity
• They are focus on all-hazard approach, obliterating the uniqueness of infectious agents
The Africa Epidemic Risk Index
• Transparent, standardized and Reproducible metric
• Pathogen-specific metrics that build on existing epidemic preparedness frameworks like JEE
• Incorporates both health and non-health factors
• Will comprise of weighted indicators and sub-domains
• Will comprise both national and subnational resolutions
Next steps of Index development & scale up
ARC, in collaboration with Africa CDC aims at expanding its current risk profiling framework to;
– increase the pathogen span from current four (EBV, MRV, Lassa Fever and Meningococcal meningitis) through wide consultations and expert opinion, and add additional domains such as Impact of outbreaks and Vulnerability of communities affected
– garner consensus on the scope of preparedness and risk analysis as add-on to the existing mechanisms i.e. JEE, STAR, VRAM, World Bank Reports etc
– Develop a validated standardized sampling methods contextualized at national level and subnational levels, including standardized weighting and calibration criteria
– Develop an open-access online interface/platform where Member States through the National Public Health Institutes can quickly conduct epidemic risk assessment
Conclusions
• Supporting Member States to Institutionalize rational Public Health decision-making process for epidemic preparedness
• Subnational index granularity that ensures optimal resources allocation
• Guiding Member States to prioritize investment in the different domains of epidemic preparedness