African Epidemic Risk Index and Innovative Outbreak Financing

Robert Kwame AgyarkoLead Advisor

Outbreaks and Epidemics

Conflict of Interest Declaration

No Conflict of Interest to Declare

Africa epidemic Risk Index and Financing outbreaks

The presentation Focuses on these broad areas:– What informs the construction of the ARC O&E Pilot Epidemic

Risk Profiling Framework? Why and what.

– What does the tool measure and how: The Methodology and components

– What is the usefulness and value addition of this tool to existing tools and country epidemic preparedness work

– Scaling up for additional priority pathogens, domains and country implementation

What has informed the need for our epidemic risk profiling framework

The case for O&E Insurance Product

THREAT – In 2015 African Ministers of Finance requested the ARC Agency to develop a product to address countries’ financing needs to contain infectious disease outbreaks common to the African continent.

ACTION – The ARC Agency is developing a new parametric insurance product for outbreaks and epidemics to enable rapid country-led responses to stop the spread of a nascent infectious disease outbreak.

EXPECTED RESULTS• Faster and more predictable funding• Early action by governments• Catalytic funding to start country response• Reduced impact of outbreaks and epidemics

The 4 Workstreams of the O&E pilot

WS 1: Risk Profiling

Development of pathogen-and country- specific riskprofiles and gap analyses,based on the assessment ofdisease surveillanceinfrastructure, and country-level response capacity.

Workstream 3: Risk Modeling, indexing and trigger design

Development of a robust epidemic risk model using historical and near real-time surveillance outbreakdataset in combination with risk and capacity profiles to inform an objective, independent, andverifiable preparedness index, and design appropriate insurance triggers and payout rates.

WS 2: Contingency Planning

Development of pathogen-and country- specificcontingency plans based onpublic health emergencypreparedness and responsestandards and guidelines.

WS 4: Economic Analysis

Assessment of the value formoney for investing in an O&Eparametric sovereigninsurance over other nationalrisk management andmitigation strategies through acost-benefit analysis.

What does the Epidemic Risk Profile Framwork measure and how: Methodology

and components

Epidemic Preparedness Index (EPI)

● National-level measure (188 countries worldwide)● Integrated into Metabiota’s disease-spread model● Employed in insurance policy pricing algorithms

Recently published in BMJ Global Health

● Methodology

● Empirical validation

● Benchmarking against JEE and IHR

Oppenheim et al, 2019; BMJ Global Health

EPI compared against JEE: the Epidemic Preparedness Index (EPI ) is a

comparable preparedness assessment metric to JEE composite scores

The Index will be similar to published &validated work

Objectives of Risk this profiling

○ Profile country capacity to prevent, detect, and respond to select diseases

○ Provide strategic information to guide investment in O&E risk management

○ Generate information to realistically simulate disease outbreaks

○ National level → subnational granularity

○ Pathogen agnostic → pathogen specific metrics

○ Crowded space; avoid duplication of efforts

Current Frameworks for Assessing Risk and Capacity

Risk Tools

Strategic Ranking of Potential Health Threats

Preparedness Tools

Evaluation Tools to Measure Preparedness for Acute Health Events

Health Event Guidelines

Technical Guidelines for the Management of Acute Health Events

● STAR Assessment Tool (WHO)

● Rapid Risk Assessment of Acute Public Health Events (WHO)

● The Vulnerability and Risk Analysis & Mapping platform (WHO)

● IHR Core Capacity and Monitoring Framework (WHO)

● GHSA Assessment (GHSA)

● Joint External Evaluation (JEE)

● EVD Consolidated Preparedness Checklist (WHO)

● IDSR in the African Region 2nd Ed. (WHO AFRO)

● Ebola and Marburg Virus Disease Epidemics (WHO)

● Managing Meningitis Epidemics in Africa (WHO)

● Sendai Framework for Disaster Risk Reduction (UN)

● Many validated tools to learn from as above

● No existing subnational assessment tool with pathogen-specific features and metrics

Preparedness Index Structure

DOMAIN

SUB-DOMAIN

Preparedness Index

Surveillance

Event-based surveillance

Community surveillance

Indicator-based surveillance

Zoonotic surveillance

Surveillance data quality

Response

Response plans

Medical countermeasures

Response team

Infection control

Clinical capacity

Laboratory capacity

Lab protocols

Biosecurity/ biosafety

Specimen collection/ transport

Lab performance

Commodity supply chain

Risk comms

Risk comms systems

Partner coordination

Public comms

Rumor listening and

management

Governance

Political stability

Corruption

Bureaucratic capacity

Violent conflict

Vital registration

Financing

Poverty

Government revenue

mobilization

Infrastructure

Road network

Logistical capacity

Mobile phone coverage

Water

Electricity

Health expenditure

Per capita income

Data Sources for the ARC O&E Index

● Existing Assessments - e.g., WHO IHR & JEE assessments

● Existing Country Metrics - e.g., African Union health-financing scorecards,

World Bank & Administrative Statistics produced by National Bureaux of

Statistics

● New National Data - Primary data collected from interviews with national

experts and focal points

○ New Subnational Data - Primary data collected from interviews with subnational focal

points (e.g., district health officers)

○ Pathogen-specific Data - Primary data collected from interviews with both national and

subnational focal points

Preparedness Index Structure

DOMAIN

SUB-DOMAIN

Preparedness Index

Surveillance

Event-based surveillance

Community surveillance

Indicator-based surveillance

Zoonotic surveillance

Surveillance data quality

Response

Response plans

Medical countermeasures

Response team

Infection control

Clinical capacity

Laboratory capacity

Lab protocols

Biosecurity/ biosafety

Specimen collection/ transport

Lab performance

Commodity supply chain

Risk comms

Risk comms systems

Partner coordination

Public comms

Rumor listening and

management

Governance

Political stability

Corruption

Bureaucratic capacity

Violent conflict

Vital registration

Financing

Poverty

Government revenue

mobilization

Infrastructure

Road network

Logistical capacity

Mobile phone coverage

Water

Electricity

Health expenditure

Per capita income

Example: Assessing Specimen Collection & Transport

JEE Indicator Detect.1.2

Specimen referral and transport system

Scoring

1. No system is in place for transporting specimens from

intermediate level to national laboratories

2. System is in place to transport specimens to national

laboratories from less than 50% of intermediate level

3. System is in place to transport specimens to national

laboratories from 50- 80% of intermediate level

4. System is in place to transport specimens to national

laboratories from at least 80% of intermediate level

5. Demonstrated capability plus, transport specimens

to/from other labs in the region; specimen transport is

funded from host country budget

Limitations:

● JEE indicator score indifferent to country capacity to collect and transport specimens from specific suspected diseases

● JEE indicator score focuses on national capacity, obscuring potential subnational variance in implementation

○ Both collection and transport vary greatly at intermediate levels for different pathogens

ARC Assessment of Specimen Collection & Transport

Specimen Collection & Transport Concepts

1. Specimen Referral/Transport:

a. Subnational: Number of hours it take for a suspected [pathogen] to be transported from health facility to

laboratory

b. National: JEE Detect 1.2

2. Pathogen-Specific Issues:

a. Subnational: Number of facilities that are capable of collecting [pathogen] for diagnostics

b. National: Routine availability of packaging, cold-chain, and transport equipment and supplies for

transporting [pathogen]

ARC Subnational Specimen Collection & Transport

Advantages

● Incorporates validated JEE indicator

● Assess pathogen-specific capacities for specimen collection and transport

● Assess and visualize subnational capacities for specimen collection and transport

● Can be linked with disease emergence estimates to subnational localities at risk

○ Inform country resource allocation decisions

Steps

1. Gather national, subnational, and existing data sources

2. Engage Delphi Panel to weight and calibrate index (components, sub-

domain, and domains)

3. Combine data and weights

4. Generate scores

For each pathogen, estimate:

• National level score: combining a weighted average of subnational indicators + national-level indicators

20

Preparedness Index Computation Process

Index Weighted through Delphi Panel▪ The relative importance of each of the components in the subdomain, and

domains in the overall preparedness index is determined through a Delphi panel

▪ Delphi panel drew on expert knowledge to generate quantitative estimates where objective data is otherwise unavailable.

▪ Index calibration/weighting was informed by leading experts from institutions and pilot countries.

▪ WHO AFRO, ▪ Africa CDC, ▪ Nigeria CDC, ▪ Infectious Disease Institute, Makerere University, Uganda, ▪ Public Health Emergency Operations Centre, Uganda, ▪ National Health Security Agency, MOH Guinea, ▪ Noguchi Medical Research Institute, University of Ghana▪ Liverpool School of Tropical Medicine

Preparedness Index Score

(per pathogen)

Laboratory Score

* WeightSurveillance Score

* Weight…

Sample collection and

Transportation Score * WeightLab SoPs Score * Weight

Transportation

time Score

* Weight

Lab Supplies Score

* Weight

…

…

Index

Domain

Sub-domain

Component

Indicators

Index Computation Process

Pathogen

Specific

Preparedness

Score

Index Computation Process (Visual)

District scores National scoresRegional estimates

Pathogen agnostic

Pathogen Specific (VHF)

+

Pathogen agnostic Pathogen agnostic

Pathogen variant (VHF) Pathogen variant (VHF)+ +

Agn

ost

icS

pec

ific

What is the usefulness and value addition of this

framework to existing tools and country epidemic

preparedness work, and the utility of an Africa wide

pathogen specific preparedness scores

The Africa Epidemic Risk Index

The concept and the need for an African Epidemic Risk Index is informed by the following principles:

– Absence of a single standardized, reproducible and comparable pathogen-specific metric that combines both national and subnational preparedness, health and non-health factors

– Need for a transparent metric to guide rational decision-making process at national and subnational level in epidemic preparedness

– Lessons from previous outbreaks and the massive investments in preparedness which should translate to a measurable and comparable Index for the continent

Limitations of the existing metrics

• Despite the massive investments in epidemic preparedness, there’re only handful of realistic metrics to measures of optimal epidemic preparedness and response

• Where they exist like JEE, and IHR assessment, they largely focus at national level preparedness with no subnational granularity

• They are focus on all-hazard approach, obliterating the uniqueness of infectious agents

The Africa Epidemic Risk Index

• Transparent, standardized and Reproducible metric

• Pathogen-specific metrics that build on existing epidemic preparedness frameworks like JEE

• Incorporates both health and non-health factors

• Will comprise of weighted indicators and sub-domains

• Will comprise both national and subnational resolutions

Next steps of Index development & scale up

ARC, in collaboration with Africa CDC aims at expanding its current risk profiling framework to;

– increase the pathogen span from current four (EBV, MRV, Lassa Fever and Meningococcal meningitis) through wide consultations and expert opinion, and add additional domains such as Impact of outbreaks and Vulnerability of communities affected

– garner consensus on the scope of preparedness and risk analysis as add-on to the existing mechanisms i.e. JEE, STAR, VRAM, World Bank Reports etc

– Develop a validated standardized sampling methods contextualized at national level and subnational levels, including standardized weighting and calibration criteria

– Develop an open-access online interface/platform where Member States through the National Public Health Institutes can quickly conduct epidemic risk assessment

Conclusions

• Supporting Member States to Institutionalize rational Public Health decision-making process for epidemic preparedness

• Subnational index granularity that ensures optimal resources allocation

• Guiding Member States to prioritize investment in the different domains of epidemic preparedness

Website: www.africanriskcapacity.org

Twitter: @ARCapacity