Enhancement of Ebola Preparedness across Africa

Enhancement of Ebola Preparedness across Africa Chloe E. Morozoff , David M. Pigott, Osman Sankoh, Sandra Laney, and Simon I. Hay Author affiliations: Institute for Health Metrics and Evaluation, Seattle, Washington, USA (C.E. Morozoff, D.M. Pigott, S.I. Hay); Wellcome Trust Centre for Human Genetics, Oxford, UK (D.M. Pigott, S.I. Hay); INDEPTH Network, Accra, Ghana (O. Sankoh); University of the Witwatersrand, Johannesburg, South Africa (O. Sankoh); Njala University, Njala, Sierra Leone (O. Sankoh); Vulcan, Inc., Seattle (S. Laney) Suggested citation for this article

a well-rounded discussion of preparedness planning efforts. Discussion topics spanned from animal surveillance efforts to health behavior and education to health system strengthening.

Agenda
The first day of the workshop focused on estimating the zoonotic niche of Ebola. Richard Suu-Ire from the Forestry Commission in Ghana spoke about his experience sampling bat species in Ghana. Although Ghana has not had a case of EVD in humans, Suu-Ire and his colleagues have identified Ebola virus-seropositive bats in Ghana (9), suggesting the potential for spillover infection. Sampling bats is essential for EVD preparedness planning, so an interactive map that could assist in pinpointing sampling sites was presented to workshop attendees (http://vizhub.healthdata.org/ebola/). Using this tool, as well as Google Earth layers, participants determined national sampling sites specific to their region and formed groups with other regional members to discuss their rationale for site selection.
The second day of the workshop focused on the social influences that may affect the scale of any subsequent outbreak. The online map included metrics of travel time, population vulnerability, and infrastructural coping capacity (expanding on a preexisting risk quantification approach) (10), enabling identification of areas at greater risk for an index case, local outbreak, and widespread outbreak. Participants explored these layers to understand where best to focus public health efforts. Afterwards, teams from Sierra Leone, Liberia, Uganda, and the Democratic Republic of the Congo reported how their countries have responded to past outbreaks, lessons learned, and the current systems in place to control future outbreaks. Finally, participants returned to their regional groups to discuss preparedness planning measures.

Reception
Persons from a wide range of occupations from countries with varying experiences with Ebola outbreaks were present, which created a culture of knowledge sharing. The collaborative nature of the workshop led to an appreciation for involvement at both the animal and human level and across national borders. To have a sustainable impact on prevention and control of EVD and other zoonotic diseases, countries must integrate into their healthcare systems a one health approach: an approach involving strong interdisciplinary collaboration and an appreciation that animal and human health are interconnected (11). The online visualization tool permitted the participants to observe the areas environmentally suitable for bat populations and compare them with the areas where human populations are most vulnerable.
Although the map cannot pinpoint where the next EVD outbreak will start, participants communicated that the online map was especially helpful in understanding the greatest at-risk areas within their own regions. The online map can be used to translate data into useful information for policy makers, who can now prioritize resource allocation in preparation for any potential outbreak. In the tool, susceptible areas can be visualized at a subnational level within a country. The simplicity and interactivity of this tool was favored by participants, who expressed it would be easy to share with a wide audience. A blog post on the IHME website describes in further detail the participant's feedback on the online tool and workshop (http://www.healthdata.org/acting-data/mapping-ebola-prepare-future-outbreaks).

Next Steps
The expectation is that participants will return to their countries and use these tools to open up a narrative about Ebola preparedness, leveraging what they learned from both the maps and those countries that have experienced outbreaks. The workshop's focus on networking fostered a culture of collaboration between animal and human health experts, as well as across countries.
This work opens up an opportunity for broader epidemic preparedness protocols and collaborations to be developed. The West African outbreak showed that there is a potential for these rare and often small-scale outbreaks to spread from local to national and international levels. This workshop laid the foundation for an open dialogue on the best use of geospatial techniques for prevention of pandemics and showed that interactive maps can be useful to decision makers. IHME currently has a publicly available version of the Ebola map (http://vizhub.healthdata.org/ebola/) and plans to expand our work to other zoonoses with pandemic potential (12-15). Users can explore the risk for a local outbreak spreading to neighboring regions, at the district (admin 2) level.
Countries can ensure emergency response operations are in place for a possible outbreak, identifying where quarantine restrictions may be required, as well as where expanded surveillance activities should be undertaken.
Visualization tool in progress; contact authors for access.