A basic introduction into the subject of health system preparedness for emerging and re-emerging infections, including the definitions of EIDs and preparedness, as well as, one of many conceptual frameworks for preparedness.

1. Preparedness of Health
System for Emerging and
Re-emerging Infections
Prepared by:
Samah Abdelaal
Under supervision of:
Prof. Ghada ElSharkawy

2. Objectives
• Emerging infections
Definition
Classification
Examples
Underlying factors
• Emerging Infectious Diseases (EID)
Preparedness
Definition
Framework

3. Emerging infections
(EIs)

4. Emerging infections (EIs)
Definition:
Infections that have newly appeared in a population or have
existed previously but are rapidly increasing in incidence or
geographic range.
EIs are classified as:
• newly emerging
• re-emerging/resurging
• deliberately emerging

5. Emerging
infections (EIs)
• Newly emerging infections are those that
have not previously been recognized in
man
• Re-emerging and resurging infections are
those that existed in the past but are now
rapidly increasing either in incidence or in
geographical or human host range
• Deliberately emerging infections are those
that have been developed by man, usually
for nefarious use

6. Fauci A. S. 2001: Red represents newly-emerging, blue is Re-emerging and black is deliberately
emerging infections.

7. Factors
Underlying the
Emergence of
Infectious
Diseases

8. Factors Underlying the Emergence of Infectious Diseases
include genetic, biological, and social, political and
economic factors:
• Microbial adaptation and change
• Climate and weather and
changing ecosystems
• Human demographics and
behavior
• Economic development and land
use
• International travel and commerce
• Technology and industry
• Breakdown of public health
measures
• Poverty and social inequality
• War and famine
• Lack of political will

9. Preparedness of the
Health System for EIs

10. Preparedness
of the Health
System for EIs
• The term ‘preparedness’ refers to the
ability of governments, professional
response organizations, communities
and individuals to anticipate and
respond effectively to the impact of
imminent or current hazards

11. Conceptual
Framework for
Emerging
Infectious Disease
(EID) Preparedness

12. Hardware vs Software
• Health system ‘hardware’ refers to the tangible
organizational arrangements and resources that structure
any health system
• The ‘software’ encompasses the ideas, values and norms
that guide actions and underpin the relationships among
system elements

13. Conceptual Framework for Emerging
Infectious Disease (EID) Preparedness
Hardware
Surveillance
Workforce
Infrastructure
Communication
mechanisms
Software
Governance
Trust

14. Conceptual
Framework
for Emerging
Infectious
Disease (EID)
Preparedness

15. EID Preparedness: Hardware
1- Surveillance
• Effective patient screening processes for EIDs
• Established contact tracing and monitoring procedures;
contact identification and listing, classification of risk status,
daily monitoring for symptoms and the effective
management of symptomatic contacts (including
precautionary quarantine)

16. EID Preparedness: Hardware
1- Surveillance
• Functional data management system and procedures for data
sharing
• Effective human − animal health collaboration and coordination,
including linkage of human and animal disease surveillance
systems, to promote early detection of potential pandemic
pathogens.

17. EID Preparedness: Hardware
2- Workforce
• Availability of frontline healthcare workers in sufficient numbers
and with appropriate training
• Appropriate distribution of workforce at the sub-national level,
rather than just a target aggregate number of health workers
nationally
• Continuity of health worker training, particularly around
infection prevention and control

18. EID Preparedness: Hardware
2- Workforce
• Inclusion of veterinary public health awareness
• Training for health managers in outbreak and emergency
response systems
• Sufficiently skilled epidemiologists
• Field epidemiology training

19. EID Preparedness: Hardware
2- Workforce
• Trained laboratory officers with capacity to collect, prepare,
analyze and store specimens
• Trained community health workers (CHWs) to enhance the
routine provision of essential primary health care services in
addition to outbreak response activities

20. EID Preparedness: Hardware
2- Workforce
• Financing and incentivizing the health workforce for effective
EID preparedness
• Financial (along with logistical and managerial) investment in
the health workforce

21. EID Preparedness: Hardware
3- Infrastructure
• Adequate numbers of health facilities and inpatient beds for
population size, and their distribution relative to the
geographic location of communities
• Presence of operationally ready isolation centers
• Accessibility of health care facilities, both geographically and
financially
• Available and well-maintained medical equipment and
personal protective equipment (PPE)

22. EID Preparedness: Hardware
3- Infrastructure
• Public health laboratory system underpinning early EID outbreak
detection and response
• Readiness of trained personnel and accessories for appropriate
specimen collection
• Availability of sample transport kits
• Safe and rapid transport mechanisms to both national and
international reference laboratories

23. EID Preparedness: Hardware
3- Infrastructure
• Timely characterization of pathogens with mechanisms for the
efficient feedback of results to national focal points to enable
rapid and appropriate responses
• Low-cost, easy-to-use diagnostic testing in underserved areas to
improve early containment of emerging threats.
• Point-of-care diagnostic assays

24. EID Preparedness: Hardware
4- Communication mechanisms
• Risk-communication strategy to guide a timely, coordinated and
standardized approach to information sharing during outbreak
management
• Involving people and institutions who are credible when
communicating public health risks
• Partnership between national health organizations and media
agencies to ensure dissemination of clinically accurate messages

25. EID Preparedness: Hardware
4- Communication mechanisms
• Bi-directional communication in devising educational messages
“empowerment model”
• Community leaders are enabled to contribute positively to
programs that embrace and represent the values of their
community members, with the aims of reducing fear and
stigma, and to encourage care-seeking.

26. EID Preparedness: Hardware
4- Communication mechanisms
• Established and documented protocols and procedures:
Health worker protocol for infectious disease management
Procedures for patient Isolation
Community-centered infection prevention and control
protocols
Laboratory biosafety protocol
Directory containing the contact details of reference
laboratories and contact information of key national (and
subnational) laboratory personnel

27. EID
Preparedness:
Software
1- Governance
• Refers to a relational view emphasizing the
making, changing, monitoring and enforcing
of the rules that govern the demand and
supply of health services

28. EID
Preparedness:
Software
1- Governance
• Empowered global health leader (i.e the
WHO) in steering the overall direction
• Shared regional and national governance in
mitigating the transboundary threat posed by
many EIDs
• Sub-national governance structures that
promote local coordination and management
of EID response

29. EID
Preparedness:
Software
1- Governance
• Capacity of governments to engage and
partner with non-state actors and civil
society
• Ability to rapidly mobilize additional
resources in the event of an EID
outbreak – including emergency teams
of clinicians and logistics personnel

30. EID
Preparedness:
Software
1- Governance
• Public-private partnerships to
strengthen the capacity of affected
countries to handle infectious disease
outbreaks while maintaining the
provision of basic health care.
• Strategies of supervision that overcome
barriers to in-person follow-up, such as
the use of mobile phones or telehealth

31. EID
Preparedness:
Software
2- Trust
• The notion of trust has been defined as
encompassing both interpersonal trust
between, for example, patient and
provider as well as institutional trust
between individuals/communities and
the health system or government

32. EID
Preparedness:
Software
2- Trust
• Inclusive and robust community
engagement with the health system
• Close, long-term engagement with
community members and local leaders,
and the incorporation of community
preferences into infection prevention
and control measures

33. EID
Preparedness:
Software
2- Trust
• Initiatives to strengthen a health system
must embed explicit efforts to build
mutual trust, respect and dignity
between health actors and the
communities they serve as well as
health workers’ trust in their local
health leadership and government

34. Conclusion
• Understanding how to achieve health
system preparedness for EIDs
requires recognition of the centrality
of software components of the health
system which hold the hardware
together.

35. References
• Morens, D., Folkers, G. & Fauci, A. The challenge of emerging and
re-emerging infectious diseases. Nature 430, 242–249 (2004).
https://doi.org/10.1038/nature02759
• Palagyi A, Marais BJ, Abimbola S, Topp SM, McBryde ES, Negin J.
Health system preparedness for emerging infectious diseases: A
synthesis of the literature. Glob Public Health. 2019
Dec;14(12):1847-1868. doi: 10.1080/17441692.2019.1614645.
Epub 2019 May 14. PMID: 31084412.

36. Thank you