Global Health Security Agenda
Indian experiences/initiatives towards linkage between Detect 1 & 5
Dr Suresh S HonnappagolAnimal Husbandry Commissioner, DADF, Govt of India
New Delhi
GHSA RM, Bangkok, 5-7 Feb 2018 106 February 2018
GHSA Background• Launched in February 2014, the Global Health Security Agenda
(GHSA) is a global effort to strengthen the world's ability to prevent,detect, and respond to public health emergencies and infectiousdisease threats, whether they are naturally occurring, or accidentallyor intentionally released.
• India was represented by Sh. Lov Verma, Secretary Health & FamilyWelfare through video conferencing from WHO-SEARO Office.
GHSA RM, Bangkok, 5-7 Feb 2018 206 February 2018
Global Health Security
GHSA RM, Bangkok, 5-7 Feb 2018 306 February 2018
GHSA in India
• India is a member of 10-country GHSA Steering Group& largest of 17 GHSA phase 1 countries.
• Since September 2015, Indian government and non-governmental institutions received over $40 million fromUS Government to establish or expand activities toprevent, respond, detect under GHSA.
• Ministry of Health & Family Welfare, GOI isimplementing GHSA activities in India in closecollaboration with various ministries, departments andinstitutions.
GHSA RM, Bangkok, 5-7 Feb 2018 406 February 2018
GHSA in India – Governing Mechanism • GOI has demonstrated a commitment to GHSA by establishing a
GHSA coordinating office in the Ministry of Health and FamilyWelfare.
• The Technical Steering Committee under the chairmanship ofDGHS & DG, ICMR reviews all GHSA projects quarterly basis.
• The Steering Committee under the chairmanship of Secretary,Health & Family Welfare, GOI reviews all GHSA projects annually.
2nd Annual review meeting Jan 17, 2018 New DelhiGHSA RM, Bangkok, 5-7 Feb 2018 506 February 2018
Sites Implementing GHSA in India
GHSA Project Sites
GHSA RM, Bangkok, 5-7 Feb 2018 606 February 2018
Institutions Implementing GHSA in India1. All India Institute of Medical Sciences (AIIMS), Delhi (Two projects)2. Ministry of Health & Family Welfare, International Health Division (MOHFW-IH), Delhi 3. National Institute of Health & Family Welfare (NIHFW), Delhi4. National Institute of Epidemiology (NIE), Chennai5. National Institute for Research in Tuberculosis (NIRT), Chennai, National Institute of
Tuberculosis and Respiratory Diseases (NITRD), Delhi & National Tuberculosis Institute (NTI), Bangalore
6. National Centre for Disease Control (NCDC), Delhi7. National Institute of Virology (NIV), Pune8. National Institute of Mental Health & Neuro Sciences (NIMHANS), Bangalore9. Manipal University, Mangalore10. Society for Health Allied Research & Education (SHARE) India, Mumbai11. Christian Medical Association of India (CMAI), Delhi12. Public Health Institute (PHI), Chennai13. South East Asia Office for World Health Organization (WHO –SEARO), New Delhi14. World Health Organization (WHO) Country Office, New Delhi15. National Institute Of Veterinary Epidemiology And Disease Informatics (NIVEDI), Bangalore16. ECO Health Alliance, Delhi17. Food and Agriculture Organization of the United Nations (FAO), Delhi
GHSA RM, Bangkok, 5-7 Feb 2018 706 February 2018
“Core Four” GHSA Action Packages in India
Laboratory• Specimen referral network
reaching > 80% of districts
• National reference laboratory performing 6 testing methods under IHR
Surveillance• Surveillance for 3 core
syndromes• Capacity to analyze and
link data for functional real-time biosurveillancesystem
Emergency Operations• EOC activation when
needed• Functional ICT use for
preparedness and response
Workforce Development• National workforce
planning• Minimum of 1 trained field
epidemiologist per District
GHSA RM, Bangkok, 5-7 Feb 2018 806 February 2018
Tiered Approach to Workforce Development
GHSA RM, Bangkok, 5-7 Feb 2018 906 February 2018
Workforce Development
• New strategy to expand the public health workforcewith the goal of training 100 EIS officers/year.
• Train 100 districts per year in Frontline Epidemiology(basic 3-month field epidemiology targeted to districts)until all 700+ districts trained.
• Regional model for 2-year India EIS Program (hubs atNCDC, NIE (South), North, & Central).
• 3-year EIS hub at WHO (with the polio transitionworkforce) and at MOHFW (with the Central HealthService cadre).
GHSA RM, Bangkok, 5-7 Feb 2018 1006 February 2018
Workforce Development NCDC, in collaboration with CDC India, has implemented a 2-year India Epidemic Intelligence Service (EIS) Program since 2012.
• India EIS graduated 34 EIS officers who have investigated over 80 outbreaks in 23 states
• GHSA facilitating expansion of India EIS into multiple EIS hubs to help reach goal of 100 EIS officers per year
• Flagship program at NCDC, Delhi
• EIS South at National Institute of Epidemiology, Chennai
• EIS-Central Cadre hub for central government officers
• WHO-EIS hub targeting polio surveillance officers
• Future regional hubs potentially in west and east
GHSA RM, Bangkok, 5-7 Feb 2018 1106 February 2018
Frontline (District) and Laboratory Training
National Institute of Health and Family Welfare(NIHFW) coordinated initial implementation
• Multiple partners now working to achieve goal of100 districts per year
• NIHFW led training in Rajasthan (33 districts) andJharkhand (14 districts)
• NCDC leading training in Gujarat (33 districts)• NCDC and NIE leading training in Tamil Nadu (32
districts)
GHSA RM, Bangkok, 5-7 Feb 2018 1206 February 2018
Laboratory Strengthening• NCDC, Delhi: Leading the National
Laboratory Strengthening Initiative (NLSI).
• Developing /strengthening tiered laboratory networks for laboratory-enhanced surveillance.
• Building capacity within the network for routine laboratory-based or enhanced surveillance.
• Since September 2016:
160 district hospitals and medical colleges labs were assessed, gaps analysed in the system and individual laboratories.
1242 laboratory persons trained
GHSA RM, Bangkok, 5-7 Feb 2018 1306 February 2018
Laboratory Strengthening• AIIMS, Delhi strengthening ICMR & NCDC network laboratories for
accurate AMR detection and reporting.
A total of 24 labs from ICMR and 14 labs from NCDC network are enrolled for Nation-wide surveillance system for health care associated infections and its control.
Developing an External Quality Assurance System for phenotypic and Genotypic AMR detection.
• Manipal University: Hospital-based surveillance of Acute Febrile Illness (AFI) in India
Enhanced capacity in laboratory supported disease surveillance for emerging and re-emerging diseases (Zika virus, KFD, anthrax, brucellosis, scrub typhus etc.)
Tested over 32,000 samples for various pathogens causing febrile illness among admitted patients including Zika Virus.
GHSA RM, Bangkok, 5-7 Feb 2018 1406 February 2018
Laboratory Strengthening• NIMHANS, Bangalore: Laboratory support for surveillance of acute
encephalitis syndrome in India.
Built capacity at 20 district hospitals for quality assured testing for Japanese encephalitis virus, dengue and scrub typhus using IgM ELISA.
• NIV, Pune: building network laboratories for VHF & RI surveillance.
Biosafety preparedness and diagnosis of VHF and RI viruses enhanced.
• NIRT, Chennai: TB diagnosis by developing capacity for next generation sequencing (NGS) for identification of molecular markers of resistance.
Developing laboratory capacity to conduct NGS and also phenotypic DST using Sensititre plates to improve diagnosis of DR-TB.
GHSA RM, Bangkok, 5-7 Feb 2018 1506 February 2018
Laboratory Strengthening• CMAI: Labs for Life Project- Improving the quality of services of
20 identified labs at district and sub-district level.
• Eco Health Alliance: implementing laboratory testing ofPREDICT surveillance samples (both human and wildlife) at theSanjay Gandhi Postgraduate Institute of Medical Sciences(SGPGI), Lucknow.
Laboratory protocols have already been transferred andinitial standardisations initiated.
GHSA RM, Bangkok, 5-7 Feb 2018 1606 February 2018
Laboratory Strengthening• FAO_ICAR project: Addressing antimicrobial usage in Asia’s
livestock, aquaculture and crop Production systems
A veterinary laboratory network – Indian network for fisheriesand animal antimicrobial resistance (INFAAR) - establishedfor the surveillance of AMR
• NIVEDI, Bangalore: Establishment of central diagnostic facilityfor anthrax in animals, and detection of AMR in cattle withmastitis, at ICAR-NIVEDI.
GHSA RM, Bangkok, 5-7 Feb 2018 1706 February 2018
Laboratory Strengthening
DADF, MoAFW, GOISpecific Diagnostic Laboratories (ICAR Institutes)
Central Disease Diagnostic Laboratory
Disease Investigation Units (SAUs)
Mobile Surveillance Units
Regional DiseaseDiagnostic laboratory
District DiseaseDiagnostic Laboratory
VetsFarmers
• 250 existing disease diagnostic laboratories in the States
• One Central & • Five Regional Disease
Diagnostic Laboratories• South (Bengaluru)• North (Jallanadhar)• West (Pune)• East (Kolkatta)• NE (Guwahati)
GHSA RM, Bangkok, 5-7 Feb 2018 1806 February 2018
Laboratory Strengthening
Specific Diagnostic Laboratories (ICAR Institutes)
• Bhopal (Exotic diseases)• Mukteswar /Bhubaneswar (FMD)• Hisar (Equine diseases)• Bengaluru (NIVEDI)• Species specific institutes (on Goats, Sheep, Camel, Buffalo, Yak, Mithun, Pig, Poultry, Cattle)• IVRI (All species and diseases)
Central Disease Diagnostic Laboratory
Centre for Animal Disease Research and Diagnosis (CADRAD) (Indian Veterinary Research Institute (IVRI), Izatnagar)
Disease Reporting- IDSP (Human) through NCDC- NADRS (Livestock) through DADF- NADRES (Forecasting simulation models) through ICAR-NIVEDI- SAARC EpiNet Forum (livestock emerging diseases sharing in the region)
through DADFGHSA RM, Bangkok, 5-7 Feb 2018 1906 February 2018
Questions?
GHSA RM, Bangkok, 5-7 Feb 2018 2006 February 2018
