The need for a multisector approach to global health security
Our interconnected world is at increasing risk of the emergence and spread of infectious diseases. The 2016 Zika virus outbreak in the Americas and the 2014 Ebola outbreak in West Africa are stark reminders of our collective vulnerability, joining other infectious diseases that have emerged as global threats in the past two decades, such as avian influenza, Middle East respiratory syndrome (MERS), and severe acute respiratory syndrome (SARS).
However, the global interconnectivity that creates the risk of pandemics also provides the means to collaborate on the systems and solutions that enable the world to prevent, detect, and respond to public health threats.
The Global Health Security Agenda, a growing partnership of nations, international organizations, and nongovernmental stakeholders, was launched in 2014. It aims to help build countries’ capacity to help create a world safe and secure from infectious disease threats and elevate global health security as a national and global priority.
In 2015, PATH joined with the US Centers for Disease Control and Prevention (CDC) and other organizations to advance the US government’s pledge to support, assist, and empower countries in anticipating, preventing, and overcoming infectious disease outbreaks, under the Global Health Security Partnership (GHSP). This five-year effort, funded by the CDC, will strengthen public health systems in the Democratic Republic of the Congo, India, Senegal, Tanzania, and Vietnam by expanding infectious disease surveillance, strengthening laboratory capacity, and developing effective information systems.
The GHSP in Vietnam
Key to the success of the GHSP in Vietnam are close collaborations between PATH and the Ministry of Health (MOH), local organizations, and the CDC. Together, we are strengthening, integrating, and sustaining systems that are critical to preventing epidemics, detecting threats early, and responding rapidly and effectively.
Through these partnerships, PATH has helped to establish emergency operations centers to improve disease surveillance and ensure stronger and better-linked health information systems (HIS). PATH is now providing technical assistance to the MOH and to hospitals and their laboratories to strengthen infection prevention and control (IPC) systems, improve hospital-acquired infection (HAI) surveillance, and accelerate surveillance of antimicrobial resistance (AMR).
To ensure these systems are fully functional and sustainable, the GHSP focuses on building capacity of staff at local agencies and organizations by developing training materials and courses and offering tailored technical assistance.
PATH leverages extensive country experience and partnerships to strengthen critical health systems in Vietnam. The GHSP work is bolstered by PATH’s substantial portfolio of work in Vietnam and the Mekong Region—projects focused on tackling infectious diseases through the development of new vaccines, improving immunization systems by engaging digital and mobile solutions, and increasing access to a wide range of HIV services and products for those most at risk. Additionally, PATH is working to build the capacity of public and private local health services to diagnose, treat, and manage infectious diseases, such as tuberculosis.
Progress so far
Availability and effective use of robust data are key to Vietnam’s ability to respond to health threats. Between 2016 and 2018, PATH provided technical guidance to develop and strengthen Vietnam’s event-based surveillance (EBS) system, in alignment with the 2005 International Health Regulations. A pilot EBS system in six provinces focused on reporting of patterns of events and disease occurrence from the community level that could potentially signal the appearance of an outbreak or other public health event needing immediate attention—to help detect an outbreak even before individuals seek care at a health care facility. After the successful pilot, together with the CDC, PATH supported the General Department of Preventive Medicine (GDPM) to scale up the system by supporting finalization of the national EBS technical guidance and facilitating three workshops to share the guidance, the plan for scale-up, and experiences of establishing and implementing an EBS in Vietnam.
Between 2016 and 2018, the GHSP supported establishment of a comprehensive electronic disease reporting system and development of a centralized data warehouse and visualization platform that will help leaders from the National Institute of Hygiene and Epidemiology (NIHE) and Pasteur Institute in Ho Chi Minh City (PIHCMC) make rapid, strategic decisions and reduce the impact of outbreaks. This system supports NIHE and PIHCMC to detect and report threats more rapidly, efficiently monitor trends, and produce actionable data for public health planning and response.
Hospitals are prime sites for the rapid spread of infections. Since 2017, in close collaboration with the CDC, PATH has been working to support the MOH to implement rigorous IPC procedures within hospitals. Health workers and managers are supported to identify the potential spread of HAIs through a CDC/PATH-supported national HAI surveillance system that tracks bloodstream and urinary tract infections (BSIs and UTIs) across 18 hospitals; PATH provided technical assistance for case identification and the use of an electronic reporting system to submit data, on a monthly basis, and data visualization. IPC quality improvement pilot projects have provided opportunities to apply systematic approaches to implementing well-known best practices in the prevention of the four most common HAIs—central line–associated BSI, catheter-associated UTI, ventilator-associated pneumonia, and surgical site infections—with promising results. It is anticipated that the new IPC improvement methods trialed in these projects will cascade to other departments and other facilities as IPC capacity and commitment grows.
Between 2017 and 2019, in collaboration with the CDC and the World Health Organization (WHO), PATH helped to accelerate the process of finalizing ten national-level guidelines for IPC within health care led by the MOH. Commitment to IPC among leaders and knowledge about IPC among practitioners was increased through two national workshops for more than 300 hospital directors and leaders, as well as a study tour to the CDC in Atlanta, Georgia, and hospitals in the United States for MOH and hospital leaders.
Southeast Asia in general and Vietnam in particular have some of the highest rates of AMR in the world. Understanding and tracking AMR are critical in addressing this growing challenge. In 2018, PATH and the CDC supported the MOH in establishing a reporting portal to collate AMR WHONET data files from 16 hospitals and provided technical assistance to hospitals to ensure completeness of the data. PATH also worked with two hospitals to pilot initiatives to prevent multidrug-resistant infections and enhance the appropriate use of antibiotics.
Finally, PATH has piloted and evaluated the feasibility and acceptability of HIV self-testing (HIVST) among people who inject drugs (PWID) and their female sex partners (FSP). The results revealed that HIVST is highly acceptable among PWID and their FSP. PWID who were first-time testers and FSP younger than 35 years old were more likely to opt for HIVST.
These efforts have brought Vietnam closer to comprehensive disease surveillance, prevention, and control, with the intent to reduce the burden of infectious diseases on the nation.
Next steps
Between September 2019 and September 2020, the GHSP in Vietnam will:
- Expand efforts in building IPC capacity to additional hospitals using a quality improvement approach.
- Expand the HAI surveillance system to include more hospitals and more diseases.
- Advance the AMR reporting system by incorporating an auto-validation function and data visualization and expand the system by bringing more laboratories into the network.
- Enhance connections between HIS and laboratory information systems in 16 hospitals to improve the AMR surveillance data timeliness and completeness and promote data use and analysis.
- Migrate the HAI and AMR surveillance systems from District Health Information System 2 to a platform based on an open source JHipster framework, which offers improved functionality for data submission and analysis.
- Together with the CDC, continue to follow up with the GDPM on activities related to strengthening HIS.
For more information about the GHS Partnership in Vietnam, please contact Dr. Nguyen To Nhu at nnguyen2@path.org.
This publication was supported by Cooperative Agreement 6NU2GGH001812-03-11, funded by the US Centers for Disease Control and Prevention (CDC). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the CDC or the US Department of Health and Human Services.