Expert teams from Germany provide rapid support for laboratory diagnostics
Last year, as SARS-CoV-2 continued its steady march across the globe, it became clear that no single country will be safe from the virus until all are. As part of Germany’s commitment to solidarity in response to the pandemic, the German Epidemic Preparedness Team (SEEG) supported partners in 13 countries with training and supplies to conduct molecular testing for SARS-CoV-2.
As the spread of SARS-CoV-2 accelerated across the globe, the Director-General of the World Health Organization (WHO) had a simple message for member countries: test, test, test. ‘You cannot fight a fire blindfolded,’ he said in a press conference on March 16, 2020. ‘And we cannot stop this pandemic if we don’t know who is infected.’
In many countries, however, putting the WHO’s recommendation into practice was close to impossible. Not only were there too few laboratories with the capacity to do molecular testing, but there were also major shortages of the reagents needed to carry out reverse-transcription polymerase chain reaction (RT-PCR) tests, the gold standard for diagnosing infections.
Early cooperation among countries – including the sharing of the SARS-CoV-2 genetic sequence and laboratory protocols by a team at the Institute for Virology at Charité Universitätsmedizin in Berlin – gave way to a race to corner the market for tests. In late April, John Nkengasong, the director of the Africa Centers for Disease Control (CDC), gave voice to the frustration felt in many countries when he observed: ‘The collapse of global cooperation and a failure of international solidarity have shoved Africa out of the diagnostics market.’
The German Epidemic Preparedness Team springs into action
Recognising the challenges many partner countries were facing in ramping up laboratory capacity and securing COVID-19 test kits on the open market, the German Epidemic Preparedness Team (SEEG) worked tirelessly over the course of 2020 to provide quick, flexible support to laboratories in 13 countries across Africa, Asia and Latin America. Teams of experts crisscrossed the globe, training laboratory specialists in molecular testing techniques and delivering more than 2.4 million tests for SARS-CoV-2, along with extraction kits and swabs.
While the missions helped in the short term to narrow the gap in testing capacity for SARS-CoV-2, they also were investments in the future: As humans encroach ever deeper into wilderness areas and come into closer contact with animals, more zoonotic pathogens are certain to emerge. Trained laboratory specialists and well-equipped, functioning labs are among our best lines of defense.
A quicker and more effective response to health crises
Germany’s Federal Ministry for Economic Cooperation and Development (BMZ) and Federal Ministry of Health (BMG) established SEEG in late 2015, in the wake of the Ebola Virus Disease outbreak in West Africa. Implemented by the Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ), SEEG draws upon the expertise of some of Germany’s leading public health and research institutions: the Bernhard Nocht Institute for Tropical Medicine, the Robert Koch Institute and, for the COVID-19 response, Charité Universitätsmedizin. Responding to requests from partners, it assembles multi-disciplinary teams of experts – including microbiologists, virologists and epidemiologists – who work directly with their peers in partner countries to strengthen systems for detecting and containing infectious disease outbreaks.
Between 2015 and the end of 2019, SEEG carried out 15 missions focusing on a range of pathogens, from Dengue fever (Sri Lanka) to Zika (Peru) and Lassa fever (Sierra Leone). Then COVID-19 hit and everything changed: ‘It was an absolutely crazy year,’ says Dr Michael Nagel, a senior project manager with GIZ responsible for SEEG’s operations. ‘The workload was so massive that we sometimes had two or three different teams deployed at once.’
During 2020 SEEG carried out missions to four countries in Africa (Benin, Namibia, Sierra Leone and Togo), one in Central Asia (Kyrgyzstan), and nine in Latin America (Bolivia, Colombia, Costa Rica, the Dominican Republic, Ecuador, Guatemala, Honduras, Mexico and Peru). They also assisted the Government of Nepal with materials and distance training, and supported the African Union and Africa CDC’s Partnership for Accelerated COVID-19 Testing (PACT) with urgently needed diagnostic supplies.
Molecular testing capacity for COVID-19 comes to Namibia
SEEG’s first mission related to COVID-19 was to Namibia, and it came just in the nick of time. In response to a request from Namibia’s Ministry of Health and Social Services, a four-person team arrived in Windhoek on February 29, just two weeks after the first case of SARS-CoV-2 had been diagnosed on the African continent (in Egypt).
Labs in Namibia had plenty of experience testing for pathogens, including HIV, tuberculosis and malaria, and had PCR testing platforms in place. But until the SEEG team arrived, it didn’t have the ability to do molecular testing for COVID-19 because it lacked the necessary test kits. Samples would have to be sent to neighbouring South Africa for processing, adding two or three days to the time needed to confirm a positive case.
By the time the SEEG team left Namibia, six laboratory staff from the Namibian Institute of Pathology and two other institutions – University of Namibia and the Central Veterinary Laboratory – were fully prepared to do molecular testing for COVID-19. As it turned out, the first case of SARS-CoV-2 in Namibia was detected just the following week. The labs were ready and could immediately ramp up testing.
The mission to Namibia was not only significant in terms of its timing, but also because it brought together partners from three different laboratories to be trained jointly. ‘The veterinary aspect is very important in pandemic preparedness, but in comparison with human health often doesn’t get the attention it deserves,’ explains Michael Nagel. With the growing attention to One Health – the interrelationship between human, animal and environmental health – SEEG saw an opportunity to increase the capacity of animal health experts in Namibia to detect new pathogens: ‘If you learn to do molecular detection for SARS-CoV-2, which is a zoonosis, you can use it in the future for other zoonoses.’
Emergency support for Peruvian labs serving vulnerable populations
If the mission to Namibia aimed to strengthen the country’s preparedness for an outbreak which had not yet begun, the SEEG mission to Peru, carried out in late June, sought to bolster the country’s response to a full-scale health emergency.
Responding to a request from Peru’s Ministry of Health, a two-person SEEG team landed in Lima on June 23, bearing 100,000 tests for SARS-CoV-2. Since early March Peru had already confirmed more than 254,000 infections, making it the third most-affected country in the Americas after the United States and Brazil. More than 8,000 people had already died of COVID-19. Difficulties in securing personal protective equipment, medical equipment, oxygen, and supplies for molecular testing had hampered the response.
The two experts spent a week in the country, assessing laboratory capacity and training specialists to safely conduct molecular testing for SARS-CoV-2 using the tests which they had brought from Germany. Twenty thousand tests were delivered to the national reference laboratory in Lima – a well-equipped facility which works to international standards, but which at that moment had no access to test kits.
The others were directed to regional laboratories, serving vulnerable populations, which had previously had very limited ability to offer molecular testing for SARS-CoV-2. The SEEG team took 30,000 tests to the regional laboratory in Tumbes, a city near the border with Ecuador, where large numbers of migrants from Venezuela live in crowded, difficult conditions. The remaining 50,000 tests were flown to the laboratory in Iquitos, the largest city in the Peruvian Amazon, where the already strained health system was buckling under a surge of infections.
Both the emergency support and the SEEG experts’ recommendations for laboratory strengthening were welcomed by Peruvian counterparts. ‘This pandemic has taught us that, apart from all the weapons we already know, we must face it with solidarity,’ said Deputy Minister of Health, Nancy Zerpa, in her official remarks welcoming the team to Peru.
In line with One Health agenda, SEEG broadens its focus to include animal health
After the extraordinary events of the past year, what does 2021 hold in store for SEEG? With the world still squarely in the grip of the COVID-19 pandemic, missions related to SARS-CoV-2 will continue to play an outsized role. But given the inevitability of new zoonoses arising without warning, SEEG will be broadening its approach to include a focus on animal health, as well as human health, in line with the BMZ’s One Health agenda.
According to the World Organisation for Animal Health (OIE), 75% of emerging infectious diseases are zoonotic in origin. Closer cooperation between institutions specialising in human and veterinary is therefore an urgent priority. The Friedrich Loeffler Institute, a German federal research institute for animal health, is joining SEEG as an official partner and will bring its expertise into future missions. One of SEEG’s unique selling points, and the key to its success, has been its design as a joint endeavor between multiple specialist institutions. Now, with the addition of animal health expertise, it is even better positioned to contribute to global efforts to prevent future pandemics.
January 2021