WHO Director visits Fiocruz for cooperation in epidemiological intelligence

The implementation of a World Health Organization (WHO) hub for Pandemic and Epidemic Intelligence led the WHO to organize the visit of a top-level delegation, together with the Pan-American Health Organization (PAHO), to Fiocruz last Thursday (March 24). Led by the assistant director-general of the Division of Intelligence and Surveillance Systems for Emergencies in Health, Chikwe Ihekweazu, who is also the director of the hub, and Socorro Gross, representative of PAHO/WHO in Brazil, the committee got to get a closer look at the Foundation’s actions in this field. The idea of the hub, which operates from Berlin, is to aggregate more partners in order to strengthen the international surveillance system.

WHO and PAHO delegation visits Fiocruz (photo: Peter Ilicciev)

According to director Chikwe Ihekweazu, the most important is to discover how to develop the capacities of different countries so as to obtain the best data. “The goal of the hub is not to syphon data from countries and get to magical solutions, but to work with our member states to collectively build the capacity to work better”, he declared. “And why are in Brazil? Because this goal requires that we have strong partners all over the world. And I believe there is no other country in which our organization in this region is better established, but Brazil. We have made our coming here a priority - not only to Brazil, but to Fiocruz, because we acknowledge the intersection between public health and research”, he added.

Received by Fiocruz president, Nísia Trindade Lima, the WHO and PAHO committees were accompanied by the secretary of Surveillance in Health, Arnaldo Correia de Medeiros, and by the Emergency Coordinator in Brazil, Maria Almiron, in addition to other members of the Ministry of Health. Lima highlighted the different fields in which Fiocruz works, reminding the audience that the Foundation works as a sort of hub for science and technology, and that epidemiological surveillance has been a priority. “Together with genomic surveillance, we also had the fundamental issue of data integration and analysis”, she said.

Control towers

During the meeting with the delegation, Fiocruz representatives presented the work that has been being developed at the instutition. The PAHO representative, Socorro Gross, emphasized the collaboration between the organization and the Foundation during the pandemic. “Events such as the pandemic trigger moments of transformation, of aggregation of skills, of reflection, and windows of opportunity, in which health once again focuses on development. This window cannot be closed back”, she said, saying that this was the first WHO mission in the region in two years.

Medeiros, on the other hand, highlighted that the visit was a special opportunity to share experiences and build a better health and surveillance system. The general coordinator of Public Health Laboratories of the Ministry of Health, Carla Freitas, presented the National Network of Genomic Surveillance and the work of CGLAB (General Coordination of Public Laboratories in Brazil/Ministry of Health), explaining the complexity and the capillarity of this network of laboratories. There are 27 Central Public Health Laboratories (LACENs) all over Brazil, one at each capital. There are also many reference laboratories that monitor and research specific pathogens, as well as border laboratories that follow trans-border flows.

This was not the first contact between the assistant director general and Lima. In February 2020, they both shared a panel at the WHO Global Forum that discussed the new disease: COVID-19. Weeks later, Ihekweazu traveled to Wuhan, in China, as part of the WHO mission. What he found was a ghost city, under quarantine. “If we don’t learn with what has happened, then we have failed”, he said.

For him, the hub should work as the control tower of an airport: each country has its own, administrating its own airspace, but no airspace works by itself, as airplanes travel in between nations. “It is therefore necessary to have a shared language, shared standards, so we can communicate. This is what we are attempting to do: to create an understanding of our challenges regarding our data collection, its analysis and its use, so we can help each other out when it comes to making decisions”, he said. “My mission today is to hear you out and to understand what you’re doing”.

Data integration

To explain the work of the Foundation and how data transform into tools for orientation and application into public health, Fiocruz relied on the lectures of Marilda Siqueira, head of the Laboratory of Measles and Respiratory Viruses of the Oswaldo Cruz Institute; Mauricio Barreto, coordinator of the Center for Data Integration and Knowledge for Health (Cidacs/Fiocruz), and Daniel Vilela, coordinator of the Scientific Computing Program (Procc/Fiocruz).

Siqueira mentioned that Fiocruz has been collaborating with the WHO since 1951, when the Foundation was invited to become a National Influenza Center. She explained how the Genomic surveillance Network was built after 2020 and how, once COVID is gone, it can be a platform used for other diseases. Today the site uses graphs to present the dynamics of the different variants of Sars-CoV-2, and almost 37,000 genomes have been sequenced in Brazil alone.

“When the pandemic began, a key issue for PAHO was the fact that not all countries had the capacity to carry out its own genomic surveillance. The PAHO established a network, and our laboratory is part of it. We receive samples from other countries so we can sequence them”, said Siqueira, who also highlighted the development of diagnostic kits together with Bio-Manguinhos, kits that today are used at most government-run laboratories in Brazil.

Mauricio Barreto showed how numbers turn into information that is applied on everyday life. Created in 2016, Cidacs is a center for integration of data for health, in a country with a vast territory and with different kinds of registries. Two examples of the work done by Cidacs were a survey on the impact of dengue fever during pregnancy and the effect of long-term zika and its impact on the mortality of babies of infected mothers. Barreto highlighted the quality of the data generated in Brazil and the development of the Brazilian Privation Index, to measure inequalities, as well as its work to evaluate vaccine effectiveness.

“We are working with DataSUS to evaluate the effectiveness of COVID-19 vaccines, data of such good quality that a study was published on Lancet comparing the effectiveness of the Oxford vaccine in Brazil and in Scotland, one of the better centers for health data; they both presented similar results”, he said.

Vilela showed the work of the group dedicated to mathematical and statistic models which is monitoring severe cases of respiratory infections, the recent experience with COVID-19, and the analysis of the relationship between climate and infectious diseases. He also presented the work of InfoDengue, an alert system that monitors cases of the disease and which has also been extended so as to cover chikungunya and zika as well. “Monitoring Severe Acute Respiratory Syndrom was important for COVID-19, because we already had this tool ready since the beginning of the pandemic”, he explained.

For director Ihekweazu, it will be necessary to join forces during the upcoming years. “The function of the hub is to bring together expertise of different parts of the world so we can think together and come up with a support environment that makes us better”, he observed. New agendas between Fiocruz and the WHO/PAHO will need to be made to go deeper into this subject.