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BNITM’s LAB-SPHERE course is replicated in Guayaquil, Ecuador.

A new bio-security lab is boosting Ecuador’s pandemic preparedness

Why Ecuador’s government and health workers are determined to make their health system more resilient – and how German technical cooperation supports this endeavour.

Leandro Patiño will never forget the events of March 2020. On his way to work as Technical Coordinator to Ecuador’s National Institute of Research and Public Health (INSPI), based in the busy port of Guayaquil, he witnessed first-hand the devastating effects of the COVID-19 pandemic on the city. Guayaquil, home to over three million people, experienced one of the world’s most lethal outbreaks of COVID-19 per capita, with excess deaths nine times the city’s usual number of deaths per month. An estimated 65% of the city’s residents were infected, including Leandro’s father-in-law, who had to be hospitalised. Thankfully he survived, but with hospitals overwhelmed and collapsing, countless others did not: Morgues were full to bursting, and bodies piled up in the streets.

The pandemic exposed Ecuador’s lack of preparedness

As the city went into lockdown, Leandro Patiño and his colleagues at INSPI were working 24/7 to analyse samples and report the results to the Minister of Health in the shortest possible time. However, although the country has had a network of public health laboratories since 1994, none was sufficiently equipped to analyse COVID samples. Sending viral samples abroad for testing in the USA and elsewhere slowed Ecuador’s response to the pandemic, with lethal consequences.   

We need to better prepared for future pandemics – not just wait for others to do the testing. That’s one of the key things we have to do.

Leandro Patiño

Although the 2008 Constitution guarantees the universal and free right to public health beyond a welfare vision for the most vulnerable people, the pandemic shone a spotlight on Ecuador’s weak health system and lack of pandemic preparedness. ‘In Ecuador, there is a lack of a solid public policy for epidemiological surveillance and control,’ admits Dr Manuel Mancheno, Under-Secretary at the Ministry of Health.  ‘That’s why during the COVID-19 pandemic it did not have an early and sufficient response capacity.’ As a result, the government requested urgent support from German development cooperation to strengthen its pandemic preparedness.

Documenting learnings for GIZ’s Sector Network Working Group on Global Health Security

GIZ’s Working Group on Global Health Security advocates a ‘One Health’ approach to health security and health systems strengthening. Comprised of multidisciplinary experts dedicated to facilitating evidence-informed policy for the detection, prevention and control of infectious disease, it meets regularly to share information, gather base-line knowledge and hold discussions through thematic workshops. According to Damien Bishop, Speaker of the Group, ‘you can’t have health security without resilience, and you can’t have resilient health sectors without health systems strengthening.’ In the past, says Bishop, global health security has often been a ‘knee-jerk reaction’ to health crises such as AIDS, Ebola, and more recently COVID and, he argues, ‘We can’t go back to this situation.’  By documenting its learning on Healthy DEvelopments, the working group wants to build institutional memory and facilitate links with other partners to ensure that the lessons learned from projects like the one covered in this article are sustained.

Launch Event of the Programme “Pandemic Prevention and Response, One Health” in March 2022 in Quito, Ecuador
Launch Event of the Programme “Pandemic Prevention and Response, One Health” in March 2022 in Quito, Ecuador

German development cooperation’s contributions to partner countries’ pandemic preparedness

The German Epidemic Preparedness Team (SEEG) was commissioned in 2015 by the Federal Ministry for Economic Cooperation and Development (BMZ) with the Federal Ministry of Health (BMG) in response to the Ebola epidemic in West Africa.  The Federal Ministry of Food and Agriculture (BMEL) joined in 2021. SEEG now supports partner countries to prepare for and respond to disease outbreaks – quickly, flexibly, professionally and globally. This work is carried out in collaboration with five German specialist agencies who each bring a different set of expertise to the table: the Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH, the Bernhard Nocht Institute for Tropical Medicine, Charité ‒ Universitätsmedizin Berlin, Friedrich-Loeffler-Institut and the Robert Koch-Institute.   

Recognising that fast detection and effective containment of infectious disease outbreaks relies on comprehensive and sensitive surveillance systems, well-equipped, functional laboratories and health-care facilities, as well as trained and committed specialist staff, SEEG works with partner countries to ensure that they are better prepared to detect, diagnose and contain disease outbreaks that otherwise may develop into epidemics or even pandemics. 

This work is part of Germany’s Global Programme on “Pandemic Prevention and Response, One Health” and GIZ’s Sector Network Working Group on Global Health Security (see text box above) that works not only in Ecuador, but also in other areas in South-East Asia, Africa and in Central America to strengthen the capacity of health systems to respond to epidemics by implementing the One Health approach, i.e. working together at the intersections of human, animal and environmental health . 

Building on past efforts to strengthen laboratory capabilities 

As part of this One Health approach, Danilo Granda Moncayo, a lab specialist working for GIZ, says due to the pandemic GIZ and SEEG started working with INSPI to strengthen the existing health system by strengthening laboratory capabilities, including  capacity development and equipment donation (details can be found in this article). A SEEG mission to Ecuador in May 2020 was genesis of an expanded programme of activities, with the focus on building advanced Biosecurity Level Three Laboratory (BSL-3), capable of dealing with indigenous or exotic microbes that can cause serious and/or potentially lethal outcomes (such as Influenza, SARS, Zika, Yellow fever, Hantavirus, Arenavirus etc). A BSL-3 lab – the first of its kind serving public health purposes in the country – would help Ecuador to identify COVID-19 and other infectious diseases much more rapidly through specialised techniques i.e., inactivation, culture and neutralization test of virus, and training specialist staff to use it.

Representatives of MSP, INSPI and the German Embassy, at the launch in March 2022 in Quito, Ecuador
Representatives of MSP, INSPI and the German Embassy, at the launch in March 2022 in Quito, Ecuador

The country package of the global programme was officially launched in March 2022 during a workshop with Ecuador’s Minister of Health, Germany’s Ambassador in Ecuador  and other authorities, along with representatives of GIZ and INSPI. Design plans for the lab have been drawn up and it is hoped construction will be completed in 2023 and be fully functioning by early 2024.

Why is a BSL-3 lab needed?

A Biosecurity Level 3 Laboratory must be designed, equipped and commissioned according to strict, internationally recognised technical guidelines for infrastructure, equipment and procedures, which allow for safe handling of pathogens and their containment in the laboratory. The security measures include access restriction, double door entry, differentiated pressure systems, air filtration, the use of a biological safety cabinet for all work with infectious materials and an autoclave for decontamination of waste. All procedures are carefully documented.

Design example for a BSL-3 laboratory
Design example for a BSL-3 laboratory. Source: WHO Laboratory Biosafety Manual, 3rd edition

With German support several alternatives for establishing such laboratory were assessed and compared. On this basis consensus was reached that it would be best to upgrade INSPI’s existing infrastructure at the Influenza and Other Respiratory Viruses Laboratory to the BSL-3 standard. Once upgraded the BSL-3 laboratory will provide specialised and safe diagnostic services that are not currently offered in Ecuador. It will be based in and managed by INSPI, and enhance the Institute’s other current research and surveillance activities. In addition, the lab will expand knowledge about the potential diseases circulating in the population and how to diagnose and prevent them safely. It will offer the opportunity to carry out international research programmes and projects in collaboration with local universities, benefiting students and expert education. 

Leandro Patiño, INSPI’s main focal point on the project, hopes the upgraded facility will enable it to respond much more quickly to future infectious disease outbreaks and not only to identify micro-organisms, but also evaluate how different therapies and drugs are working. 

It’s a dream that the institution has had for a long time. So this is a great opportunity to finally be able to concretise it and to have this kind of facility.

Leandro Patiño

Political support is essential for the project

Three key factors have been essential for making the project happen, says Leandro. The first is that the pandemic convinced the political authorities of the need for BSL3 and made them realise how important it was to improve epidemiological surveillance. The current vice president has a medical background and has been very supportive of the project. ‘I think this is very important for us to have this backing and support from this level of government,’ says Leandro. The second key factor is collaboration with partners such as German development cooperation, who are supporting the project. And finally ‘we need investment – both in facilities and equipment and in people’.

Plenary session at the LAB-SPHERE course in Guayaquil, Ecuador.
Plenary session at the LAB-SPHERE course in Guayaquil, Ecuador

Intensive training is crucial, too

In parallel with the design of the lab and equipment purchases, vital capacity development and training has already started to ensure that technicians and management will be able to make full use of the new facility and improve the laboratory capacity. Charité University Hospital in Berlin provides targeted capacity building for the personnel in charge of the laboratory. 

Additionally, Rubén Armas, who is responsable for the Influenza and Other Respiratory Viruses Laboratory of INSPI received training in September 2022 on ’Laboratory Systems and Public Health in Resources-Limited Settings LAB-SPHERE’  at the Bernhard Nocht Institute for Tropical Medicine in Germany. This training was replicated in December 2022 in Ecuador for 16 further participants from INSPI. It included topics such as public health, diagnosis, biosafety, biosecurity, laboratory management, a One Health strategy for the surveillance and analysis of infectious diseases, and the use of new tools and equipment for the diagnosis, prevention, control and containment of outbreaks. 

‘It is a very intensive execution of the project because we are working in several fronts at the same time, to try to meet the project indicators within two years,’ says INSPI’s Leandro Patiño. ‘This is the way we need to work to make sure we are ready.’

BNITM’s LAB-SPHERE course in Hamburg, Germany, brought together professionals from five different continents.

Thinking beyond the lab

Dr Manuel Mancheno, worked as an external GIZ consultant during the preparatory feasibility study for the BSL-3 lab and is now Under-Secretary at the Ministry of Health. He believes the lab with its permanent staff will have a catalytic effect that goes far beyond its construction and day-to-day operation. It will also have an important training role to play for other lower-level public health laboratories in the regions and it will facilitate and strengthen coordination of outbreak investigation and reporting approaches at local and regional levels from the district public and animal health officer to extension workers.  In collaboration with universities it will train future specialist lab technicians, conduct research and improve testing capabilities. Finally, it will enhance political decisions and crisis management systems in the health sector by supplying more timely and accurate epidemiological data. 

The need for constant vigilance 

According to Ecuador’s Central Bank, nearly 17% of Gross Domestic Product (GDP) was wiped out in in 2020 and over half a million jobs were lost, illustrating that pandemic preparedness goes far beyond human and animal health and impacts every aspect of life, from food production to children’s education and international trade. 

Dr Manuel Mancheno believes only a ‘One Health’ approach can mitigate the future effects of highly pathogenic diseases, and that the opening of Ecuador’s new BSL-3 lab next year will represent a significant step in strengthening the country’s early warning defences and organisational capacity to respond. However, he warns against a loss of vigilance and weakened institutionalised coordination between animal and human health authorities when there is no crisis to drive such cooperation. ‘It is important that the organisational gains that have been made are now consolidated,’ says Dr Mancheno. He thinks the next step should be the establishment of a permanent interdepartmental working group charged with overseeing disease surveillance and reporting, updating contingency planning, and first response during an outbreak. 

‘We are very excited about this laboratory,’ says Leandro Patiño. ‘We will keep it running, that’s for sure.’ The dark days he witnessed in 2020 may have eased, but the challenges and threats from infectious disease outbreaks remain. There will be no overnight solutions, but the new bio-security laboratory and parallel training will be a big step towards sustainable future pandemic preparedness and control of infectious diseases – not only for Ecuador, but for global health security too.  

Ruth Evans
January 2023

© WHO Laboratory Biosafety manual, 2004
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