In a conference, the WHO director advocates for a new definition of surveillance

Robust surveillance to prevent future pandemics requires collaborative work, and collaborating is not an easy task, highlighted the Assistant Director General of the World Health Organization (WHO), Chikwe Ihekweazu. “If we pretend that collaboration is something easy, we will fail,” he said last Monday (7/29), during the second edition of the Global Pandemic Preparedness Summit 2024 (GPPS 2024), organized by the Department of Health, Fiocruz and the Coalition for Epidemic Preparedness Innovations (Cepi), at the Windsor Marapendi Hotel, in Rio de Janeiro.

The Assistant Director General of the World Health Organization (WHO), Chikwe Ihekweazu (photo: Peter Ilicciev)

Chikwe Ihekweazu leads the Hub for Pandemic and Epidemic Intelligence, also known as the WHO's Surveillance Hub in Berlin. When speaking on the panel Surveillance State: Progress, Gaps and Opportunities , he highlighted that “a new definition of surveillance is the most important thing we must have ”. For the Nigerian epidemiologist, it is necessary to think, for example, about the use of artificial intelligence to monitor the population movement, and to integrate information so that institutions can work together. “(The work) will always have to be done by several institutions, not just one. It is important for countries to develop, but there will always be work for us to do together.” 

In this aspect, he mentioned the work done at the Hub, of which Fiocruz is part, as an example of effective information sharing. “We (at WHO) are collaborating with each other. The challenge is for the rest of the world to work with us and for each one of us to achieve our goals.”

Director of Pandemic and Epidemic Intelligence Systems at the Hub, Oliver Morgan returned to the topic later in the Brief Conversations session, when addressing Collaborative Surveillance: A new vision for understanding pandemic threats. Morgan presented the challenges, and the complexity of the information needed, with the classic epidemiological presentation of surveillance data that often does not capture extremely important elements for prevention. Several factors, such as economic and environmental ones, in addition to the public health dimension itself, need to be considered. “Reality is much, much more complex, and that complexity is quite difficult to capture. It is this complex interaction that we try to understand and that is important when we try to consider the risk of a pandemic.” 

All of this generates a huge volume of data. And, as the detection capacity increases, it also increases the amount of work to be done. According to Morgan, around 9 million pieces of global data are processed each month, which go through filtering processes until they reach 43,000 signals. Of these signals, 4,500 are investigated further, resulting in nearly 30 that are truly worrying from an epidemic point of view – that is, one per day. “The numbers grow as our ability to detect increases. We are increasing detection and increasing response. There are two major forces that boost innovation in public health surveillance and help us manage both complexity and volume: the innovations and revolutions happening in laboratory science and the fast increase in data science technologies and tools we have at our disposal.”

The Secretary of Health and Environmental Surveillance of the Department of Health, Ethel Maciel, in turn, highlighted in the same session the strength of the Brazilian Unified Health Service (SUS), mentioning that Brazil is the only country with more than 200 million inhabitants with a connected system in all municipalities. But he highlighted that there are still many challenges, such as training the staff in all cities and making the various existing systems talk to each other.

When talking about Technologies and best practices of Brazilian health surveillance systems in early alert to detect potential public health emergencies , Ethel Maciel highlighted the importance of prevention and of the partnership with Fiocruz, which produces the Infogripe and Infodengue reports. 

“Infodengue was extremely important when, in September last year, it predicted that we would possibly reach 4 million cases, which was unthinkable at the time. Based on this alert, we ordered diagnostic tests from Fiocruz. If there had not been the alert, we would have reached the biggest dengue epidemic the country has faced without tests, without important tools”, he said. She also mentioned the joint work with the Center of Data and Knowledge Integration for Health (Cidacs/Fiocruz Bahia), in “prevention before events take hold”.