PRESS CONFERENCE BY GLOBAL HEALTH INTELLIGENCE NETWORK
Ted Turner, in his capacity as Co-Chairman of the Nuclear Threat Initiative and contributor to the Global Public Health Intelligence Network II (GPHIN II), helped launch the initiative, which is an internet-based early-warning network that gathers and disseminates preliminary reports on public health threats in a “real-time, 24/7” basis. This second such global system has been enhanced to provide early warning in all official United Nations languages -– Arabic, Chinese, English, French, Russian, and Spanish -- allowing for speedier screening and sharing of additional information on such threats, whether natural or manmade.
Joining Mr. Turner in New York were: former United States Senator, Sam Nunn, who is also Chief Executive Officer and Co-Chairman of the Nuclear Threat Initiative; Ujjal Dosanjh, Canada’s Health Minister; Dr. Stephen J. Corber, Area Manager of Disease Prevention and Control for the Pan-American Health Organization of the World Health Organization; David Butler-Jones, Chief Public Health Officer of Canada; and from Ottawa, via satellite, Dr. Ron St. John, Director General, Centre for Emergency Preparedness and Response with the Public Health Agency of Canada. Lynn Le Sage, also with Canada’s Public Health Agency, moderated the briefing.
Mr. Dosanjh said that, in a world where diseases respected no borders, it was important that everyone cooperated across borders internationally. There was a fundamental need for a strengthened network of international cooperation and communication, and the GPHIN II would be essential in addressing that need. The GPHIN I prototype had been developed largely through the joint efforts of the Canadian Government, Canada’s Nstein Technologies, the Nuclear Threat Initiative, and the World Health Organization (WHO). The GPHIN was the primary source of information for the WHO’s global outbreak, alert and response network. The WHO in Geneva used that data to dispatch resources or confirm or refute alerts in a timely manner.
He said that the GPHIN had been used by government authorities worldwide, including in the United States, the United Kingdom and the European Union. An enhanced GPHIN was integral to the Canadian Government’s plan to strengthen the public health system. Canada’s first minister, namely the Premier and the Prime Minister, had recently emerged from a very successful meeting committed to strengthening and enhancing health care across the country. Public health was a key component of that agreement. The fact that today’s announcement came so soon after the creation of Canada’s public health agency and the appointment of the first-ever Chief Public Health Officer was another sign of the high priority his Government attached to the public health. Relationships with international contacts were paramount to Canada’s own public health efforts.
Mr. Turner said he was honoured to be involved in the incredibly important project, namely to get out to the entire world new developments in the field of infectious disease. The quicker that information was made available, the quicker the response. On behalf of the other Nuclear Threat Initiative partners, he said he was privileged to be working with Canada on the important project.
Mr. Nunn said he was also honoured to be working with the Canadian Government and top health officials of the WHO, which was providing early warning to the world about infectious disease outbreaks and possible bioterrorism, as well as about contaminated food and water outbreaks, and exposure of individuals or groups to chemical or radiological agents. Donning his ‘nuclear hat’, he said the Canadian government had continued to prod the world to think about catastrophic terrorism. The launch of the GPHIN II would truly help protect the health of people around the world.
He said that the world was in a race between cooperation and catastrophe, both in the nuclear and biological arenas. The response to biological outbreaks, whether natural or man-made, depended on the global public health infrastructure. Doctors, nurses and laboratories would be the front line of defence, and not ships, tanks and planes. Disease had to be stopped wherever and wherever it occurred. Thus, early warning was essential to saving lives and preventing its spread. The expansion of that system was a quantum leap forward in potentially saving millions of lives. The fight against infectious disease had always been a moral imperative; in today’s age, that was also a security imperative.
Dr. Corber of the WHO said that the global health intelligence network –- the GPHIN -– was a tool that served as an early warning function within the WHO’s global surveillance system to identify public health events of potential concern, such as outbreaks of infectious disease. The GPHIN represented a paradigm shift for infectious disease surveillance. The prevention and control of infectious diseases was a cornerstone function of public health, and it was a basic mandate of the WHO to assist countries in controlling the international spread of infectious diseases. The key to successful outbreak control was effective detection and response at the source.
He said that the risk of infectious diseases and the means available to control their spread had changed greatly over the years, as, today, millions of people crossed national borders daily and could travel around the world in less than 24 hours. Traditionally, surveillance and reporting systems had been set up so that local physicians or local laboratories notified local governments of confirmed cases of infectious disease. That information was then passed to the provincial or State level, then to the national level, and eventually -– usually taking weeks or even months –- to the international level. The GPHIN, on the other hand, gathered electronic media reports with possible public health relevance and made those available worldwide in a user-friendly platform in near real time.
After further assessment of a situation, a response to an outbreak might occur much sooner, he explained. On a daily basis, the WHO actively sought and received information from a variety of sources, with a view to identifying and assessing public health events of potential international concern, in order to facilitate and mobilize timely and appropriate public health responses. That was aimed at reducing the suffering and death, as well as the economic burden, of such potential outbreaks. Over the past few years, the GPHIN had provided the initial report for approximately 30 per cent of the outbreaks identified and assessed by the WHO as being of international concern. As such, the GPHIN was the WHO’s “single, most important reporting source for identifying these outbreaks”.
For example, last January, the WHO had followed a media report detected by the GPHIN, which described a disease in Bangladesh causing 25 per cent mortality and for which the cause was unknown. At the request of that country, the WHO, with the support of the Global Outbreak and Alert Response Network, had provided technical assistance to investigate and control the outbreak. The causative viral agent was identified, as well as factors relating to its transmission, which allowed prevention and control strategies to be much better targeted.
He said that the GPHIN had also been invaluable in the past year by providing the WHO with “heads-up” information to monitor the avian influenza outbreaks in both human and animal populations in the Asian countries. As another example, SARS had been a global public health emergency during which public health resources were taxed to the limit. The GPHIN team in Canada provided the WHO with daily summaries of the media reports and greatly helped the organization filter the huge volume of media information that was generated during that period, thereby enabling it to better monitor the situation.
The GPHIN’s new platform offered better coverage of media reports from around the globe and improved functionality, such as through the translation of articles, he said. The GPHIN II, along with the essential contributions of astute health care professionals and strengthened laboratories, would play a vital role in the WHO’s global surveillance of public health events of potential international concern.
A correspondent in Ottawa asked about how the GPHIN could assess the accuracy and reliability of media reports. Mr. Dosanjh said he assumed that that assessment would be made by people on the ground. A system was now in place that would filter out irrelevant information.
Dr. Corber added that he had understood that the Canadian system had sifted information electronically and that was then reviewed by health professionals, who made the decision about whether that information was new and potentially significant. The WHO put that data through a screening process of its own, using such criteria as the extent of mortality, the need for assistance, and the risk of international spread. That information was then evaluated by a senior team and a decision was made. The screening process was also followed up at the country level, which enabled the WHO to confirm what was going on in a country, and whether it needed assistance.
Responding to several questions from New York about financing, Mr. Dosanjh said that the Canadian Government had invested more than 9 million Canadian dollars in the GPHIN, which operated at a cost of approximately 1.5 million Canadian dollars yearly. The Nuclear Threat Initiative had contributed approximately 500,000 Canadian dollars.
Via satellite from Ottawa, Dr. St. John, added that [development investment] in the GPHIN II had been approximately 800,000 Canadian dollars from Health Canada and 560,000 Canadian dollars from the Nuclear Threat Initiative. Subscriber fees for governments was 250,000 Canadian dollars per year, moving down to as low as 30,000 Canadian dollars per year for non-governmental organizations and universities. Dr. Butler-Jones explained that all subscriber fees went into a trust for the further development of the GPHIN system, and not for its ongoing maintenance.
Dr. St. John replied, to a further question, that the GPHIN picked up approximately 20,000 reports each month. Of those, about half were discarded by the ‘quasi’ intelligence built into the system, in order to ‘un-duplicate’ reports and discard the unessential and irrelevant material. The GPHIN analysts then went through the remaining half, by spending all day at a computer screen and adding a human judgement to the process. All of that then boiled down to about 100 to 150 per day posted on the system. Those were further reviewed by other organizations, such as the WHO. Dr. Corber added that the WHO saw some 250 reports per week, and through a sifting process, asked for verification of about four to five per week.
Asked what was being done to work more effectively to determine whether a biological outbreak was natural or an act of terror, Mr. Nunn said the good news here was that the things that should have been done around the world to protect against infectious diseases, which were killing 16,000 people daily, were now a security imperative and on the front screens of security, because of bioterrorism. It might not be possible in many cases to determine for days or perhaps even weeks whether a biological outbreak was natural or deliberate. The public health mechanism to deal with either form of attack was really the same and would vary according to the particular incident. An intelligence report, along with the outbreak, might indicate whether an attack was man-made. For all outbreaks, partnerships were essential across the board, he said.
To a question from Ottawa about how much of a difference the GPHIN could have made with the SARS outbreak had it been operating in the Chinese language, Dr. Corber said the answer was hypothetical. A media or wire report certainly would have led to an investigation. The GPHIN was one part of the system. The idea was to give early warning to the WHO and others, which were then verified by the originating country. An early report about the disease, along with good communication and collaboration, could have made a difference.
Adding the GPHIN I was operating at the time of the SARS outbreak, Dr. St. John said that the system had not had language capacity. A Chinese-speaking analyst at the GPHIN would scan Chinese articles periodically and try to make them available. It was speculation as to whether or not the GPHIN could have made a significant difference. Late in 2002, and early in 2003, he knew something was going on in China, whether that was influenza or early SARS. But, that was a new disease, for which there was no test. But, the GPHIN was on the alert and had understood that any disease outbreak in China was worthy of attention. Now, with the language capacity, it had much broader coverage for China and elsewhere.
Replying to a question in New York about what was in place to get around the politics of a possible bioterrorism attack, Dr. Corber said there were many instances where governments were reluctant to provide information about infectious disease outbreaks, for economic, political or other reasons. The WHO was familiar with that history. Regarding its experience with SARS, where the Chinese Government had been slow to report, was a very good example of the repercussions in today’s globalized village. He hoped similar events in other countries would be reported much more openly and quickly.
He added that China had experienced SARS episodes since the initial outbreak, and those had been reported quickly and with excellent cooperation. The GPHIN represented a paradigm shift, because it also put pressure on governments. The traditional system where physicians did not have it as their primary responsibility to notify governments and where governments had not always notified physicians had been circumvented by the GPHIN’s system of picking up media reports and then asking governments to verify them.
Asked about the main motive for creating the GPHIN, Mr. Dosanjh said the initiative had begun in 1998, before some of the more recent emphasis on terrorism stemming from the “9/11” attacks. The GPHIN was about the protection of public health, no matter the source of the threat.
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