Partnering for health security in the Indo-Pacific

CANBERRA — A total of $43 million Australian dollars ($30.2 million) will be available to support activities to address health security issues in the Pacific and Southeast Asia as part of two new funding rounds from the Indo-Pacific Centre for Health Security, with up to AU$14 million allocated for vector control.

Open to public; private; academic and research; and nongovernment organizations, the funding will be delivered as part of the “ASEAN-Pacific Infectious Disease Detection and Response,” or APIDDaR, program and “Pacific Infectious Disease Prevention,” or PIDP, program.

PIDP proposals focus on Papua New Guinea, Timor-Leste, and priority Pacific island countries — Solomon Islands, Vanuatu, Fiji, Tuvalu, Kiribati, Nauru, Samoa, Tonga, Cook Islands, and Niue. APIDDaR has expanded to include Vietnam, Cambodia, Laos, Myanmar, the Philippines, Indonesia, and Timor-Leste.

It is the latest in a range of initiatives aimed at engaging new partners in Indo-Pacific health security, with consultation occurring late in 2018 providing insight into key objectives for the center.

Reaching out to 34 organizations representing universities, government, NGOs, and the private sector, the center aimed to understand Australian health initiative supporting the Indo-Pacific region and how the work of the Australian aid program could assist or expand upon this work.

Its objectives surrounded six priorities areas — infectious disease modelling projects; strengthening laboratory capacity; immunization activities; vector control and surveillance; public health surveillance; and infection prevention and control. Through workshops, the Indo-Pacific Centre for Health Security has helped identify key areas for partnerships the funding will support.

Understanding the insights from these workshops can help shape applications for funding — including understanding the benefits of consortium proposals.

Modelling health security

“Modelling for emerging infectious diseases and vector-borne diseases, in order to provide information to decision makers, is a high priority for the Centre,” the center explained in its workshop consultation document.

Among existing partnerships, a focus on ways to better utilize modelling to support planning, situational awareness, and response to health risks in the Indo-Pacific region is missing. But the workshops identified potential partners for collaboration.

Seqirus, a vaccine manufacturer, is developing machine learning models of the immune system to support better influenza vaccines. The Centre for Research Excellence in Policy Relevant Infectious diseases Simulation and Mathematical Modelling is developing models of tuberculosis for the Asia-Pacific region to assist the development of TB programs — among a range of other health risks modelling supporting the Indo-Pacific region, including yellow fever.

There is a range of challenges to supporting better modelling in the region — good models require good data, which may or may not exist. 

“Data quality is uncertain or poor,” the workshop consultations concluded. “For example, increases in incidence could be due to a change in behaviour of collectors rather than in true incidence, because data are collected in an ad-hoc way and case definitions are not standardised. The algorithm for outbreak detection is also simplistic.”

The capacity to implement, use, and interpret models may need to be built.

For Australian organizations, there is a role in supporting the delivery of modelling services, developing templated models that can be customized within countries to suit their circumstance, as well as knowledge sharing and training.

The call for proposals will aim to better support this work. But the Indo-Pacific Centre for Health Security is also working to connect Australian experts with opportunities in the Mekong, Vietnam, and Cambodia — regions which the center sees as key areas of opportunity for Australian aid in health modelling to support emergency responses.

Strengthening laboratory capacity

In preparing and responding to viral outbreaks, laboratories play a critical role. But within the Indo-Pacific region, the capacity of laboratories to respond to critical health risks is a concern.

Laboratory availability, equipment, staffing, and standards are all challenges in the region. In PNG, for example, there is only one physical containment level two laboratory which has the capacity to contain microorganisms. Availability of mid- and later-stage career scientists to further mentor doctoral students is lacking. And Pacific laboratories generally trail developing countries in technology, including lack of laboratory information systems.

Provision of equipment and training from the center was identified as a way Australia could help improve capacity and reduce costs. But through partnerships, there are also opportunities for Australia to enable its scientists to mentor and supervise students or early-stage researchers in developing countries. Twinning programs, which enable exchanges between institutions in separate countries, are also areas Australian institutes are currently helping to improve capacity.

The Centre for Infectious Diseases and Microbiology, part of Westmead Hospital in New South Wales, is among the organizations that have established a laboratory twinning project supporting the Maldives to assist in epidemic preparedness. Their program is supported by the World Health Organization.

The challenge with twinning programs is lack of coordination and clear objectives for partners. The Indo-Pacific Centre for Health Security identified playing a role in assisting organizations and institutions to take a more strategic approach in supporting laboratory twinning and capacity building. But it hopes to further support partnerships through funding proposals that are focused on laboratory strengthening.

“The establishment of consortia for proposals under the open call is encouraged,” the Indo-Pacific Centre for Health Security said.

Immunization activities

For the Indo-Pacific Centre for Health Security, strengthening immunization is an important focus, and part of both emergency and community level programs. The challenges in the region include the ability of Indo-Pacific countries to assess, regulate, and deliver new vaccines.

“If the Centre are supporting action on immunisation, PNG is front and centre,” it is written in the workshop report.

PNG is a key area of focus due to its proximity to Australia, with partnerships already funded to support activities in this space, as well as the targeting of vaccine-preventable diseases, which the center is looking to target through a STOP TB-like campaign.

The workshops suggested that helping to inform and strengthen regulatory programs is an important role Australian aid — and the center — can play to support the Indo-Pacific in improving immunization rates, along with support for monitoring vaccinations and capacity building.

The importance of understanding immunization rates in the region is among the activities that Ausvet, an Australian-based health consulting company, will be delivering as part of a recently commissioned body of work to deliver an Indo-Pacific health security risk report. And this will be used to better plan opportunities for partnerships and collaborative work to improve health outcomes.

Surveillance, protection, and control

Surveillance of health risks, protection, and control all require strong policy and health systems — which in the Indo-Pacific region need strengthening. Outdated legislation, poor design, and facilities within hospitals are among the challenges that exist.

Among the center’s work, it is hoping to improve the capacity of diagnostics through its product development partnerships. And enhancing the field epidemiology workforce has been identified as a priority.

The partners the center has identified that can support capacity building and solutions for the benefit of the region include the Australian Red Cross, Burnet Institute, as well as universities and initiatives such as the Atlas of Environmental Health — among partners that could be submitting proposals for surveillance, protection, and control programs.

While the Indo-Pacific Centre for Health Security sees funding and partnerships as important in delivering its Australian aid outcomes, it also sees itself as playing an important role in facilitating partnership outside of aid. New partners and ideas are encouraged to support its goals to drive change and innovation in health security.

What is on offer?

Under APIDDaR, the center is offering between AU$8-10 million for laboratory strengthening, AU$10-12 million for workforce development, and AU$8-10 million for outbreak detection and management systems and processes.

Under PIDP, it will offer AU$6-8 million for infection prevention and control, AU$10-14 million for vector control, and AU$5-7 million for surveillance of infectious diseases, immunization coverage, and treatment resistance in pathogens and vectors.

To be a partner for health security in the Indo-Pacific, proposals are due by May 31.

Update, April 29, 2019: This article was updated to incorporate the total value of AU$43 million available through this funding.