Ciro Oiticica (Fiocruz News Agency)
Fiocruz received last Friday (10/2), the Technical Leader of the World Health Organization (WHO) for COVID-19, Maria Van Kerkhove, to discuss projects in the fields of epidemiological surveillance and computational modeling for scenario analysis. Researchers of the Foundation presented their projects, which may help anticipate new health emergencies. The Vice-President of Research and Biological Collections at Fiocruz, Rodrigo Correia, moderated the conversations in the morning and welcomed everyone on behalf of Acting President Mario Moreira. “We are very happy to welcome all of you to this extremely important work in preparing for health emergencies to come”, he said.
Maria Van Kerkhove (center, right) met Fiocruz researchers (photo: Ciro Oiticica)
The Technical Leader Maria Van Kerkhove thanked for the welcome and stated that she greatly appreciates coming to Fiocruz and learning from the Foundation's experience. “It is great to be able to know what you did before and during the pandemic”, she commented, “it is the grounds for us to see what to do in the future”. She recalled an earlier visit, during the Zika emergency, and valued what has accumulated from that cooperation. “What you did in the face of Zika was a preparation to face Covid”, she asserted. “What we are doing now will serve us for future emergencies that we are not yet aware of”.
The representative of the Pan American Health Organization (PAHO/WHO) for Brazil, Socorro Gross, also participated in the meeting, with the perspective of partnerships in epidemiological surveillance in the region of the Americas. “It is an honor to be with you, in this Institution that has always supported us”. The PAHO representative praised the joint work with Fiocruz and Brazil. “This is a different cooperation because it is horizontal, it develops capacities. We have engaged in this cooperation because it can develop our communities”, she explained. Representatives of the Ministry of Health (MS) and the Municipal Health Department also participated.
The Climate and Health Observatory was one of the projects presented. Christovam Barcellos, from the Institute of Scientific and Technological Communication and Information in Health (ICICT/Fiocruz), explained that the research aims to gather data and tools for analyzing extreme weather events and their relationship with outbreaks. Data collection, which began in 2009, has enabled the construction of a base for research and public policies in order to adapt to climate change in Brazil. “Climate factors affect the distribution of the disease in different ways”, reflects Barcellos. “Several diseases are called sensitive to climate change, such as schistosomiasis and leptospirosis”. One of the goals of the Observatory is to support local decisions, mainly based on the Unified Health System (SUS).
Two surveillance systems were then presented: InfoDengue, for the monitoring of arboviruses, and InfoGripe, for respiratory diseases. Researcher Marcelo Gomes, from Fiocruz's Scientific Computing Program (ProCC), coordinates InfoGripe and presented the projects, in the presence of the researcher from the same program and coordinator of InfoDengue, Cláudia Codeço. “The main focus of the work is divided into two groups: Surveillance and model”, explained Gomes. Surveillance, according to him, would allow for the monitoring of severe respiratory infections and arboviruses, defining a framework of the moment. Modeling, in turn, referred to the production of statistics and computerized modeling. “What we need is not only what is happening now, but also what happened in the past”, explains Gomes. This would allow profiling of the delay between the event and its observation. “The next step is the ability to estimate what will happen”.
The last presentation of the morning addressed the Information System on Wildlife Health (Siss-Geo), the participatory surveillance platform for zoonosis emergencies coordinated by Researcher Márcia Chame, from the Institutional Platform for Biodiversity and Wildlife Health (Pibss/Fiocruz). “This system is a model for estimating the favorability of the emergence of zoonoses”, presented Chame, who explained the dynamics of the platform, which also has a mobile application. “Anyone using their mobile or on the web can register an animal alive, dead or ill. This generates points on the map by means of georeferencing from satellites. When abnormalities are observed, the system generates alerts that are distributed in real-time to managers, who take their team into the field to collect the animal and biological samples that are then taken to the laboratory”. The subject of study is yellow fever, but the project also addresses other zoonoses.
The last project, presented in the afternoon, is part of the work of the Center for Data and Knowledge Integration for Health (CIDACS/Fiocruz Bahia). This is the Early Warning System for Outbreaks with Epi-Pandemic Potential (Aesop). Researcher at the Gonçalo Moniz Institute (Fiocruz Bahia), Manoel Barral-Neto coordinates the project, presented at the occasion by the researcher from the same unit, Pablo Ramos. “This surveillance system exploits different types of data, artificial intelligence and machine learning techniques, in order to identify areas with the beginning of an infectious outbreak with the potential for spreading”, detailed Ramos. “There is the gathering of Primary Care data, in addition to those related to the manifestations of the disease, such as the sale of drugs and rumors on social media. The current focus is on calibrating methods to flag detections, engaging decision makers to access routine data”.
Social variables and regional cooperation
At the end of the meeting, a discussion started for an assessment and possible developments, mediated by the Advisor to the Presidency, Valber Frutuoso. WHO's Technical Leader Maria Van Kherkhove praised the quality of the presentations. “It is fantastic to keep learning with Fiocruz and staying connected”. She pointed out some of the goals contemplated with the visit. “I tried to find out how the country dealt with the COVID, how vaccines were applied, how systems were adapted to respond and how the preparation for new emergencies is going, in terms of surveillance and primary care”, she listed.
The Technical Leader emphasized that the way in which responses are given has been more important than knowing what needs to be done, which led her to highlight the importance of social aspects. “It is necessary to think about different types of data to integrate, combining Political Science, behavioral aspects, the role of disinformation, in order to further model trust and communication”, she points out. “It is less about what to do and more about how to do it, how to maintain the responsiveness, how to adjust, how to model the trust and misinformation dynamics,” she stated.
PAHO representative in Brazil, Socorro Gross was also pleased to see the development of the projects. “Whenever I come, I think I know what is being done, and I am always positively surprised”, she playfully stated. “There is always something that is starting or has grown a lot”. She then said she wanted to look at the region and emphasized the importance of resuming cooperation to strengthen the continent's response, which can be favored by ongoing projects. “With the pandemic, we were two years apart, countries were left alone, turned inwards, no longer sharing experiences and responses”, she lamented. “This is the opportunity to bring the countries together again, in important networks of knowledge, research, fixation. It is a great learning experience, it is a window of opportunities”.
Valber Frutuoso, in the end, thanked those present and highlighted some developments, such as the formulation of a draft with the different contributions that may support future actions. “We are now going to work on the draft of a document that will circulate among the present organizations so that we have the work as a whole and so that we outline the steps to be followed. On behalf of the Presidency, I thank you all”.
On the part of Fiocruz, in addition to the aforementioned authorities and researchers, Pedro Burger, Assistant Coordinator at the Center for International Relations in Health (Cris/Fiocruz); Luiz Augusto Galvão, Senior Advisor at Cris/Fiocruz; Tania Fonseca, from the Coordination of Health Surveillance and Reference Laboratory (CVSRL/Fiocruz); and Marilda Siqueira, Head of the Laboratory for Respiratory Viruses and Measles at the Oswaldo Cruz Institute (IOC/Fiocruz). Representing PAHO/WHO were Alexander Rosewell, Coordinator of the Technical Unit for Surveillance, Preparation and Response to Emergencies and Disasters in Brazil; Juan Cortez Escalante, National Emergency Officer; Rodrigo Said and Rodrigo Frutuoso, National Consultants for Emergencies; and Mábia Milhomem, International Consultant for Emergencies. Gislani Aguilar, Superintendent of Health Surveillance at the Municipal Health Department of Rio de Janeiro; and Márcio Garcia, Director of the Public Health Emergencies Department of the Ministry of Health, also attended the meeting.