KfW and Bernhard Nocht Institute for Tropical Medicine shift the frontiers of outbreak detection in the EAC
Mobile laboratories for EAC countries shift the frontiers of diagnostic efficiency in outbreak detection in Africa. German financial cooperation, through KfW, provides funding for a project in which experts of the Bernhard Nocht Institute for Tropical Medicine guide EAC lab technicians in setting up and running a regional laboratory network for outbreak detection.
In May and then again in early August 2018, new Ebola outbreaks were declared first in Équateur Province and then in North Kivu, Democratic Republic of the Congo (DRC). For neighbouring countries the outbreak in North Kivu is of particular concern since it happened in one of DRC’s most densely populated provinces with over one million internally displaced people and high rates of cross border movement to and from the neighbouring countries. Following a formal rapid risk assessment, WHO determined the public health risk of these outbreaks to be high at the regional level. Dr Sonoiya, head of the health department at the East African Community (EAC) headquarters, Arusha, Tanzania, concurs with this WHO assessment.
For Dr Muna Affara and Dr Florian Gehre, a molecular and a microbiologist of the Bernhard Nocht Institute for Tropical Medicine (BNITM) in Hamburg, Germany, the new outbreaks in DRC underline the relevance of the project they currently support in Arusha, Tanzania. ‘To prevent the spread of epidemics, outbreaks need to be diagnosed at an early stage so that responsive action can be triggered right away’ explains Dr Gehre. ‘The network of mobile laboratories that this project is setting up across the region will allow the EAC to do just this.’ What exactly is this project about?
Adding an innovative, highly flexible component to the EAC’s pandemic preparedness
From 2017 until 2020, the KfW Development Bank, on behalf of the German government, provides funds for the establishment of a network of mobile laboratories as important new element for an early outbreak warning system in the East African Community (EAC). To provide the necessary technical support and capacity building for this endeavour, the EAC contracted the BNITM who deployed Dr Affara, Dr Gehre and administrative coordinator Lisa Reigl as full-time advisors to the EAC headquarters in Arusha. In the course of this first project cycle and in cooperation with the respective National Public Health Laboratories, they will support the setting up nine mobile laboratories in in the EAC countries Burundi, Kenya, Rwanda, South Sudan, Tanzania and Uganda. These laboratories add an innovative, flexible element to the region’s current German-supported efforts to build an early warning system for disease outbreaks that allows it to address them as soon as they occur.
‘At present, it may take up to three weeks for a suspected case in a remote area of an EAC country to be confirmed’, says Dr Affara. Blood specimens need to be transported from the periphery to a reference laboratory in the capital or by plane to more qualified laboratories somewhere else in the region. Meanwhile, valuable time which could be used to mobilise an effective outbreak response is lost. The mobile laboratories will change this. When and where an outbreak is suspected, they will be sent to the affected region and, once set up, be able to produce reliable diagnoses within 24 hours. Clearly, this does not just require laboratory equipment but teams of qualified laboratory technicians who can both assemble the laboratories and then perform the necessary tests.
Training country teams to assemble and run high-tech labs wherever they are needed
This is why, in December 2018, the BNITM team organized an intensive training course at their institute in Hamburg to kick-start the capacity building measures aimed at developing this capacity. ‘We brought together the expertise of three of our departments, namely Virology, Infectious Disease Epidemiology and Infection Diagnostics. All three topics are essential for the establishment of the mobile laboratories,“ explains Professor Jürgen May, head of the department of Infectious Disease Epidemiology at BNITM. In the preceding months, the BNITM team had selected two experts from each of the six partner countries who appeared well-positioned and qualified to work as part of a mobile laboratory team and, more importantly, to train other laboratory technicians in their countries in the required skills.
In the course of the four weeks they spent in Hamburg, the African experts learned how to quickly assemble a mobile laboratory from the 15 boxes, in which it is delivered, and to take it apart and pack it up again; how to make the mobile lab operational, if necessary with the help of power generators; how to identify different pathogens using sensitive diagnostic tests and, last not least, how to protect themselves from infection whilst working with highly infectious specimens. With the help of a so-called ‘glove box’ (see cover image for this article), an essential piece of equipment of the mobile labs, these are first de-activated before further tests are performed on them. Practising how to operate the glove box is a core element of the training course.
‘It was amazing to see how quickly the different country teams started working together, helping each other out, complementing each other’s skill sets. At this first training in Hamburg we saw how the EAC’s vision of a truly regional pandemic response could become a reality’, says Dr Gehre.
A follow-up training is now planned for May/June 2019, this time at EAC Headquarters in Arusha. Each country team will bring two more laboratory technicians and Dr Affara and Dr Gehre will support the already trained experts in sharing their skills and knowledge with them. Four laboratory technicians are the minimum number required to run a mobile lab. However, once all nine mobile labs have been procured to the six countries later this year, further trainings will be conducted by these teams so that the staff base for the laboratory network is gradually built up to 12 per country.
At the recent meeting of the EAC Heads of State on 1 February at Arusha, the EAC General Secretary, Ambassador Libérat Mfumukeko, named the mobile laboratories first when he listed initiatives in the field of health that the EAC is particularly proud of. For KfW and the BNITM project team, this is strong proof of the trust EAC governments put in this collaboration and encouragement for the next steps in its implementation.
Dr Peter Reff & Anna von Roenne, February 2019