Global Health

Building Global Health Security from the Ground Up

July 12, 2017  • Peggy Clark, Maura O’Neill & Katie Drasser

Global disease pandemics often begin in remote areas with weak medical infrastructure. In this time of rapid air, bus, and truck travel, by the time anyone detects a disease it has spread like wildfire. The global response becomes a race, with stakes so high the toll is counted in billions of economic dollars and millions of lives. Lessons from Ebola and Zika post stark returns: We are nowhere near ready for the next pandemic. This is one of the most critical and dangerous issues we face in global health today, and it touches every economy in the world.

To kick off Spotlight Health, the Aspen Global Innovators Group assembled a diverse group of 35 leading thinkers and practitioners to incubate actions to aid in fortifying our global health security. Over the course of an evening and a day, the Incubator group explored and brainstormed ideas to address this critical issue area and discussed work for the year ahead. Finally, the group made commitments for future actions and collaborations to address global health security from an equity lens.

This year’s convening, the third annual Aspen Ideas Incubator, was titled Building Global Health Security from the Ground Up: Solutions at the Last Mile, and used the lens of last mile health delivery to discuss critical new strategies to prepare for and respond to the next global epidemic. In attendance were leading experts, practitioners, and decision-makers working at the forefront of community health systems, pandemic preparedness, and global security. Participants came from diverse backgrounds, experiences, and expertise, including the CDC, Department of Defense, Ministries of Health in Rwanda, Malawi, and Sierra Leone, Facebook, Vulcan, TED, nonprofits, pharmaceutics, and foundations.

Dr. Tom Frieden, former director of the CDC, and Dr. Raj Panjabi, CEO of Last Mile Health, kicked off the convening with two presentations on the Ebola epidemic in West Africa from two different vantage points. Dr. Panjabi described his experience working on the ground in rural Liberia, and the myriad challenges associated with stopping transmission on an outbreak in a global health “blind spot” – among last mile communities. He described the critical need for robust, well-trained community health workers (CHWs) to detect and respond to these epidemics. Dr. Frieden described the numbers behind the spread of Ebola from Liberia into other West African countries, and illustrated the case study of rapid response in Nigeria as a lesson in how an appropriate intervention was able to quickly stop the Ebola transmission chain in Nigeria.

Two groups that have grown out of previous Aspen Ideas Incubators presented their progress to the group. Dr. Panjabi, who recently won the prestigious $1 million TED Prize, presented his TED Wish to build a Community Health Academy, a digital platform providing high-quality, standardized education to community health workers and others working within national Ministries of Health. He engaged the Incubator participants to workshop specific issues around how best to operationalize the TED Wish, and to garner feedback on specific challenges Last Mile Health is currently grappling with.

Likewise, Dr. Prabhjot Singh, whose innovative disease surveillance tool Atlas received support from the first Incubator, reported on progress in piloting the tool and co-designing it with health workers over the last year. The innovative tool provides a user-friendly interface through which a health worker can overlay existing data sets by geographical area to greatly increase the information available to them when an epidemic hits. It immediately makes, often for the first time, blind spots or missing places more visible to people on the frontline of providing community-based health care services. The Atlas system is open source and housed at the Arnold Institute for Global Health at the Mount Sinai Health System.

For this year’s discussion and idea generation, the Aspen Ideas Incubator focused on two main streams: PREPARE, which focused on how to prepare for future epidemics, and RESPOND, which tackled new approaches in responding to epidemics as they are unfolding. By the end of the convening, the group had come up with a number of ideas tackling different aspects of this layered, dual issue, agreeing that preparation and response are far from mutually exclusive.

Building on a lively discussion, the group hatched five ideas:

  1. Launch a Global Communications SAFE Campaign: It was noted that creating a sense of urgency within the public sphere and for policymakers was of critical importance. Without a spotlight on the ongoing threat of pandemics and the need to properly prepare, the world risks falling into the false complacency that “Ebola is over.” One group discussed the need to create a simple, common language and brand that the global community could rally around. One group helped us understand that among all the global health security expertise what Americans and people around the world want is to be safe. We need to use language that is accessible and communicate the danger of doing nothing as well as a hopeful tone of what is possible with appropriate early action. Mark Henderson of Wellcome Trust offered to lead the charge in investigating a narrative campaign that could be rolled out globally.
  2. Develop a Community Health Worker Backpack at scale: The groups discussed the utility of a simple backpack pre-loaded with a common set of tools for health workers to use in last mile communities. These tools could include digital tools to build data sets on current conditions within communities and their needs, in order to report back to centralized groups and allow for data aggregation. There are several of these types of backpacks that have been piloted at relatively small scales, but none have been rolled out in a coordinated way at a large scale. Phyllis Heydt from the MDG Health Alliance offered her expertise in developing one of the existing backpack pilots as a starting point to scale.
  3. Build a Community Health Worker Training Academy: Different variations of this idea were discussed at length, and the group agreed that a standardized curriculum for community health workers would be incredibly helpful in ensuring that all last mile communities are receiving a high level of care, and that the health workers are properly equipped. There is a high level of variability across CHW networks, and this training would ensure that CHWs all had standardized, accurate information, and were part of a larger global network. This training could involve a certification process for different levels of completion, and could even be tied to career progression. Dr. Agnes Binagwaho, vice chancellor of the newly launched University for Global Health Equity (UGHE) in Rwanda, proposed that UGHE could participate as a partner institution to pilot this program. Raj Punjabi and his team at Last Mile Health will also lead on this idea through the launch of the Community Health Worker Academy, his TED wish.
  4. Create a Global Health Security Emergency Corps: Taking a broad view of global health security and the needs within the throes of a pandemic, the group discussed the need for a large emergency corps of workers who could be quickly deployed within each geographic region when needed. With the issue of delay being such a critical problem to overcome, the emergency corps would participate in preparatory training “boot camps” before a pandemic hit, sign up to be part of an ongoing system of communication, and commit to serving when called upon. A first step of this process would be to map and identify different areas of talent and need before recruiting prospective members.
  5. Scale an Emergency Information System: Richard Ragan from Vulcan, Inc. discussed the urgent need to create a communication system that can be reliable “to provide clarity in the fog of war.” This system could be built within a number of channels, and would likely need to be adapted by country depending on their level of connectivity and the social norms around communication. This system could be built within existing platforms like Facebook and WhatsApp, or by creating standalone apps with national or international buy-in to create robust networks that can be leveraged during emergencies. Within the information platform, the group discussed the need for simple checklists and action items that could be updated in real time as new information is released. Lisa Foster from Facebook offered to assist in pushing out a campaign through the Facebook platform, and in thinking through ways to capitalize on Facebook’s Workplace product.

The energy in the room was palpable as participants discussed next steps. Lack of communication and coordination was a common diagnosis in examples of inadequate responses to global pandemic emergencies, and the participants agreed that this network and community of practice is an important step in building the robust and prepared global network that is desperately needed in a world where the threat of future pandemics is no longer the exception, but the rule.