Long-term programmes for ICT use in risk management

Long-term planning is crucial to effective management of public health and natural disaster mitigation efforts. In the preparedness phase, emergency managers develop plans of action to be carried out when the disaster strikes. Common preparedness measures include proper maintenance and training of emergency services, development and exercise of emergency population warning methods combined with emergency shelters and evacuation plans, stockpiling of supplies and equipment, and development and practice of multi-agency coordination. Traditional media such as television and radio, as well as modern ICTs like Internet and e-mail, can be used in these disaster preparedness activities.

Mathew (2005) highlighted the strategic role of ICT in managing disasters and public health emergencies, suggesting that effective health response to disasters will depend on three important prongs of action: (a) long-term disaster preparedness, (b) emergency relief and (c) management of disasters. He proposed that work in these three critical areas may be facilitated by communication and space technologies, especially the Internet and remote sensing satellites. Matthew presented a model that manages disasters through the Health and Disaster Information Network that operates in coordination with Internet community centres. 'The Model for Public Health Management of Disasters for South Asia' deploys ICT in a strategic manner to meet the unique and urgent requirements of personnel involved in disaster management. The infrastructure proposed is intended to serve governments, non-governmental organizations and institutions working in the areas of disaster and emergency medicine. The creation of such an infrastructure is intended to provide connectivity to support the rapid transfer of data, information and knowledge from senior government officials to grassroots organizations, as well as across national borders to other concerned organizations in the South Asian countries.

Mathew (2005) also presented a case study of the statewide ICT network for disaster management established by the Government of Maharashtra in April 2000, as part of the Maharashtra Emergency Earthquake Rehabilitation Programme following the Latur earthquake that left more than 10,000 people dead and 200,000 homes destroyed. The main role of the network is to facilitate and provide a rapid flow of information, online connectivity, response planning, and control and monitoring of the situation in disaster areas. The network comprises an emergency operations centre, a central control room, an alternative central control room, control rooms at each of the six divisional headquarters of the state and district control rooms at each of the 32 districts. The network is connected via VSAT telecommunication links. It is designed to provide data, voice and video teleconferencing facilities. All sub-districts in the state are linked through a VHF wireless network with nodes located at the district control rooms. The case shows that ICT has an important role in disaster preparedness, response, and coordination and control.

SOPAC: Another example of ICT use in long-term risk management is the South Pacific Applied Geoscience Commission (SOPAC) project which seeks to ensure vulnerability reduction in the Pacific Island Countries through the development of an integrated planning and management system. A key component of the project is GeoCMS, a Content Management System which facilitates the collection and sharing of geographical data among the stakeholders in the project. This was developed using two existing Free and Open Source Software (FOSS) based applications, MapServer and Tikiwiki. This system has made it possible for the Pacific Island states to publish their geographical data on the Internet and to receive contributions from all over the world. Countries involved in this project include Cook Islands, Federated States of Micronesia, Fiji, Kiribati, Marshall Islands, Nauru, Niue, Palau, Papua New Guinea, Samoa, Solomon Islands, Tonga, Tuvalu and Vanuatu (Nah 2005).

AlertNet: Reuter's AlertNet is another example of the use of ICTs for long-term disaster preparedness. It was started in 1997 by the Reuters Foundation, an educational and humanitarian trust, as a humanitarian news network based around a popular website. It aims to keep relief professionals and the wider public up-to-date on humanitarian crises around the globe. Emergencies are categorized into four types: health-related, sudden onset, food-related and conflict. Some emergencies do not fit neatly into these categories, frequently overlapping in a complex manner that makes it difficult to separate cause and effect. AlertNet's presentation of emergency material aims to make clear these areas of overlap. Reuters is the main, though not the sole, source of information for AlertNet. It operates with a surprisingly limited full-time staff (Gidley 2005).

AlertNet tracks all emergencies for which it is possible to find reliable information, including those that receive only sporadic coverage elsewhere in the media, or the so-called 'forgotten' or 'hidden' emergencies. For example, the north-eastern Indian state of Assam has had massive floods several times, with thousands of people displaced and made homeless, but good warning and evacuation procedures have kept the death toll low. AlertNet highlights these types of disasters and attracts upwards of three million users a year. It has a network of 400 contributing humanitarian organizations and its weekly e-mail digest is received by more than 17,000 readers (AlertNet 2006).

ASEAN-Disease-Surveillance.Net: The ASEANSurveillance Net (ADSNet) is an Internet-based network established to improve ASEAN's long-term capability in detecting and responding to infectious disease outbreaks. It is sponsored by the Indonesian Ministry of Health and the ASEAN Secretariat and operated by the ASEAN Disease Surveillance Secretariat. The US Naval Medical Research Unit No. 2 (US NAMRU-2) and the South East Asia Foundation for Outbreak Regional Cooperation jointly support ADSNet. The network was established on the basis of a framework approved at the Regional Action Conference for Surveillance and Response: Infectious Disease Outbreaks in Southeast Asia held in Bali, Indonesia in September 2000. Consensus was reached at the conference, which was attended by 150 participants with Ministerial representation from 17 countries, to build systems to facilitate the exchange of outbreak information within Southeast Asia and the WHO-SEARO Grouping.

ADSNet was established to achieve several objectives: rapid dissemination of outbreak information within the region, establishment of a mechanism for sharing important information on epidemic disease transmission without compromising national sensitivity and confidentiality concerns, and provision of directory assistance in identifying regional expertise, including laboratory diagnostic capabilities that can support outbreak investigative activities. It also seeks to provide directory assistance in identifying outbreak causation, as well as training and educational opportunities within the region. ADSNet aims to accomplish its goals by undertaking the following activities which can be classified as examples of risk aversion and risk communication:

• Conducting outbreak response training workshops
  
  
• Developing laboratory diagnostic capabilities in identifying causative outbreak etiologies
  
  
• Facilitating outbreak investigations or interventions
  
  
• Establishing early warning outbreak recognition systems

ADSNet is a part of the Early Warning Outbreak Recognition System (EWORS) that currently maintains 18 surveillance sites in Cambodia, Indonesia, Lao PDR, Singapore, Thailand and Vietnam. Nepal and South Korea are expected to join EWORS in the near future. Local clinics in the participating countries make use of simple EWORS technology to upload syndromic data on disease outbreaks to hubs located at hospital computers. Algorithms running on these hub computers assess whether the uploaded data indicate any disease outbreaks. The system alerts local public health personnel if it determines that an outbreak has occurred. EWORS applications are designed to run on desktop computers, laptops and PDAs. The network's website is hosted in Singapore and jointly maintained by the Singapore Ministry of Environment and NAMRU-2. Plans are underway to link ADSNet with the Pacific Disease Surveillance Network (PACNET), so as to effectively cover 16 time zones, and eventually to integrate it into WHO's global network of networks.

In epidemic intelligence and systematic case detection, WHO Global Alert gathers information from formal sources as well as rumours of suspected outbreaks in order to get a clear picture of the epidemic threat to global health. With the advent of modern communication technologies, many initial outbreak reports now originate from informal sources in the form of electronic media and electronic discussion groups. More than 60 per cent of the initial outbreak reports come from unofficial informal sources, including sources other than the electronic media, which require verification. The information thus gathered is categorized and disseminated to public health professionals. Regular updates are issued to a network of electronically-interconnected WHO member countries (192), disease experts, institutions, agencies and laboratories through an Outbreak Verification List. WHO also reports verified outbreaks on its website, Disease Outbreak News.

Some private schools in Singapore are teaming up with Apple Macintosh Asia to develop ways of delivering education over the Internet to provide continuity of education during a pandemic. A technology is being tested by which both video and audio content as well as Powerpoint presentations can be broadcast through the Internet using Apple's iTunes.

Various capacity building efforts have been implemented at both international and national levels to help prepare countries to respond to and manage a pandemic incident such as Avian Flu. To support member states in their efforts to build the capacity of health care facilities to manage communicable disease emergencies of different orders of magnitude from a small number of patients to a widespread pandemic, the WHO worked with the Asian Disaster Preparedness Center (ADPC) to conceptualize the Health Care Facility Emergency Preparedness and Response to Epidemics and Pandemics (HCF-EPREP) Programme. The first phase of this programme culminated in the first training workshop in September 2006 in Bangkok attracting 39 participants from Bhutan, the Philippines, Thailand and Vietnam with facilitators from WHO, ADPC, Infection Control Plus (Australia) and the University of Texas School of Public Health. Associates from Brazil, India, Indonesia, Nepal, the Philippines, Syria, Thailand and the USA also participated. Most of the participants were directors of health care facilities; senior level specialists in infectious diseases, emergency medicine and infection control; and public health officials from national Ministries of Health and sub-national health authorities. The workshop paid special attention to using ICTs to disseminate information to both the public and health care professionals during the inter-pandemic phase (when the disease is spreading but has not yet become widespread) and the pandemic alert phase.³ Participants were also taught how to use official websites to educate the public about the pandemic.

Strategic Health Operations Centre: In the global arena, the WHO Department of Epidemic and Pandemic Alert and Response (EPR) is continuously monitoring and tracking evolving infectious disease situations, sharing expertise, sounding the alarm and initiating an appropriate response to protect the population from the effects of a communicable disease emergency. To provide a well-coordinated and systematic response, which is crucial in any public health emergency, the Strategic Health Operations Centre (SHOC) was established. It utilizes the latest ICT to support member states in managing health emergencies.

The SHOC was used effectively during the SARS epidemic when the WHO responded rapidly and effectively in collaboration with many key partners. The response was widely praised by the public health and infectious disease research community, especially the role of ICT in early detection and in fostering global collaboration and information exchange during the SARS epidemic. On 17 March 2003, the WHO called upon 11 laboratories in nine countries to join a collaborative multi-centre research project on SARS diagnosis. The network took advantage of e-mail and a secure WHO website to share outcomes of investigations of clinical samples, electron-microscope pictures of viruses, sequences of genetic material for virus identification and characterization, and post mortem tissues from SARS cases. Individual departments of affected hospitals also used websites and e-mail to rapidly disseminate clinical findings to health professionals. However, a review of the system revealed that it was not used to its full potential. This assessment led to the formation of the Global Public Health Intelligence Network (GPHIN)⁴ by Health Canada and the revised International Health Regulation or IHR (2005)⁵ that requires governments to report public health threats—in particular, public health emergencies of international concern (PHEIC) or disease outbreaks and natural disasters that could have an international dimension.

Animal Health Management and Biosecurity: Since August 2004, Australia has been working with ASEAN on a project aimed at Strengthening Animal Health Management and Biosecurity in ASEAN (SAHMBA). Funded through the ASEAN Australia Development Cooperation Program (AADCP), the project seeks to enhance the capability of ASEAN member countries to manage risks to the biosecurity of livestock industries particularly those related to trade and impacting on the poor. The project focuses on strengthening capabilities in risk analysis, disease surveillance and animal health information management at the ASEAN regional level. It has four components. Component 1 aims to develop a consistent approach to risk analysis based on international best practices. Component 2 seeks to develop a consistent approach to wide-area disease surveys including the collection and analysis of information to substantiate reduction of disease in livestock populations. Component 3 expects to facilitate the development of a regional animal health information database that will (a) promote the trade of animals and animal products throughout the region by clearly establishing a country's disease status, (b) facilitate the sharing of animal health information within the region and (c) streamline production of disease reports required to meet international obligations such as those of the World Organization for Animal Health (OIE). Finally, Component 4 responds to project management and monitoring requirements for successfully implementing the technical components and keeping stakeholders advised of the project's progress and performance (AADCP 2005).

In public health, measures to control and prevent disease often rely upon timely and accurate information transfer. Thus, the Internet is increasingly becoming the preferred platform for agencies designing systems to protect public health. The WHO's Communicable Disease Cluster is spearheading a global partnership called the Global Atlas of Infectious Diseases (WHO 2006b), a Web-based system that brings together an interactive information system, surveillance data, reports and documents on the major diseases affecting developing countries, including malaria, HIV/AIDS, tuberculosis, as well as diseases that are close to being eradicated, such as guinea worm, leprosy and lymphatic filariasis. The global atlas also covers epidemic-prone and emerging infections like meningitis, cholera and yellow fever. It also provides information on essential support services such as the network of collaborating centres and the Global Outbreak Alert and Response Network.