Foresight China II: the Identification and detection of ...

Foresight China II: the Identification and detection of ...

Foresight China II: the Identification and detection of infectious diseases Jianshi (Jesse) Huang, Weiyi Xiong, Angus Nicoll Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China; European Centre for Disease Prevention and Control, Health Protection Agency, London I will discuss What is the Foresight method? Why does China need the Foresight Project ? What is Foresight China II

Methodology Preliminary results Conclusion/Implications 2 01/28/20 What is the Foresight method? A scientific approach to the Future Combining future look at diseases & threats with opportunities for mitigation & control 3

01/28/20 Eight Foresight project areas to 2006 Brain Science, Addiction and Drugs Cognitive Systems 4 Detection and Identification of Infectious

Diseases Flooding and Coastal Defence Intelligent Infrastructure Systems Cyber Trust and Crime Prevention Obesity Exploiting the Electromagnetic Spectrum 01/28/20

What is the Foresight method? 10 areas of science of 5 relevance to detection, identification and monitoring systems were reviewed and analyzed: Intelligent sensor networks Data mining and fusion Non-invasive scanning and screening Predictive and real-time 01/28/20 Why does China need Foresight Project ?

Todays world is a small village. What happens in China could have significant impact on Europe and vice versa. It is better to have a capacity to anticipate significant changes in infectious diseases for emergency preparation. However, It is very difficult to make predictions, especially about the future. (American Sage) Without some moderately accurate predictions or at least early warning, we cannot have a safe global village. 6 01/28/20 Why does China need Foresight Project ?

Quantitative Predictions The existing methods used to predict future trends in infectious diseases: (quantitative predictions) Predictions Modelling Drawbacks: Predictions - short term, max. 5 years Modelling by definition all models are wrong but some are useful 7 01/28/20 Why does China need Foresight Project ? The existing quantitative approach is problematic:

when we look well beyond five years. When we look groups of infections, especially emergence of unknown pathogens. When more than one drivers influence the occurrence of infectious diseases There is much that we just cant use the quantitative model to predict, or 8 01/28/20 Chinese Sage?

9 01/28/20 translation from an American

Sage There are known knowns, 10 known unknowns and unknown unknowns. Each year some of the known unknowns become known knowns. But equally each year we become aware of some more unknown unknowns so that they become known unknowns or even known knowns. 01/28/20 Of course sometimes we realise

Why does China need Foresight Project ? Instead of looking at specific disease Foresight method identified a series of families of factors drivers or risks for the study of likely trends in those drivers and hence, families of diseases. 11 01/28/20 Why does China need Foresight Project ? Two applications of information from the Foresight approach:

Surveillance prioritization to detect if the threat is materialising Identification of needed countermeasures 12 01/28/20 What was Foresight China I Foresight China: A novel and simple approach to anticipating likely future trends in drivers and families of infectious diseases and therefore, needs for surveillance and public health

preparedness. 13 01/28/20 What was Foresight China I Foresight China I: 2004-2006 Basic Risk Model for Infectious Disease Risks was adapted from UK colleagues, 36 leading Chinese experts were consulted. Supported by Foresight Funding, Enacted by PUMC, HPA & China CDC 14

01/28/20 What was Foresight China I? Some important factors affecting future risks were identified. Output: Predicting changing risks not actual disease trends so as to plan for surveillance systems improvement and for public health preparedness. 15 01/28/20 mportant factors affecting future risks Increasing movements of people, animals and animal

products More and greater migrations of people Increasing tourism Increasing amounts of animal waste Changing sexual lifestyles Changing public attitudes Increasing genetic uniformity of crops and livestock Rising wealth and levels of education 16 01/28/20 ssons learnt from Foresight Chin Better definitions of each driver in the questionnaire would have improved

consensus Need to ask the panel to predict the future of the driver not its potential effect on diseases Need for an expanded expert panel 17 01/28/20 Hence Foresight China II Foresight China II: 2007-2008, A continuation of Foresight China I Improved methodology Expanded number of experts consulted to 180 Supported by British Embassy Beijing

Enacted by PUMC & China CDC 18 01/28/20 Foresight China II: Methodology Three new features over Foresight China I: Systematic literature review to identify the scientific evidence for drivers Extensive analysis of existing infectious disease surveillance systems in 4 countries to identify how they capture data on drivers Consultations with leading experts in 12 areas to confirm the improvement opportunities and to assess feasibility of the opportunities

19 01/28/20 Basic Risk Model for Infectious Disease Risks Drivers Climate change, Socio-economic drivers, etc. Sources Zoonoses Natural mutation Available niches Pathways

Soil Airborne Food-borne Waterborne Vectors Direct contact Waste disposal Risk Analysis Outcomes Future diseases and levels of infection in: People Plants Animals Ecosystems

Risk Estimate Prioritisation of Surveillance and Control Measures (Preparedness) 20 Source:Professor Joyce Tait, University of Edinburgh 01/28/20 model for Climate Change and Health: Direct and Indirect Effects 21 Source: A. McMichael et al, The Lancet 2006; 367: 859-869.

01/28/20 Foresight China II: Findings Systematic literature review 22 01/28/20 oresight China II: Preliminary finding Reviewed recent experience of newly reported emerging human pathogens 35 30 15 10

vCJD 20 5 0 1980 1985 1990 1995 SARS 25

HIV-1 Cumulative no. spp 40 2000 2005 25 (66%) are RNA viruses >80% have animal reservoir/origins; broad range Diversity of transmission routes and drivers of 23 emergence 01/28/20

But only a few emerging diseases are of great public Number of EID events per decade Reference:Kate E. Jones, Nikkita G. Patel, Marc A. Levy,ect. Global trends in emerging infectious 01/28/20 24 diseases,nature,2008,451(21):990-994. Global richness map of the geographic origins of EID events from 1940 to 2004 Reflection of local strength of surveillance ? Reference:Kate E. Jones, Nikkita G. Patel, Marc A. Levy,ect. Global trends in emerging infectious

01/28/20 25 diseases,nature,2008,451(21):990-994. Global distribution of relative risk of EID event Zoonoses from wildlife Drug resistant pathogen Zoonoses from non-wildlife Vector-borne pathogen Reference:Kate E. Jones, Nikkita G. Patel, Marc A. Levy,ect. Global trends in emerging infectious diseases,nature,2008,451(21):990-994. 26 01/28/20

The 12 families of drivers in Foresight China II 1.Governance and social cohesion 2.Demography and population change 3.Conflict 4.Technology &Innovation and their governance 5.Agriculture and land use change 6.Economic factors 7.Trade and Market related factors 8.Transport and Tourism 9.Human activity and social pressure 10.Environment related factors 11.Iatrogenic related factors 12.Animals and plants related

factors Foresight China II Foresight China I 1.Governance and social cohesion 2.Demography and population change 3.Conflict 4.Technology &Innovation and their governance 5.Agriculture and land use change 6.Economic factors 7.Trade and Market related factors 8.Transport and Tourism 9.Human activity and social pressure

1.Environment related factors 2.Iatrogenic related factors 3.Animals and plants related factors 27 01/28/20 The inventory of 12 families drivers and their 50 elements 28 01/28/20 The inventory of 12 families drivers and their 50 elements 29

01/28/20 Foresight China II: Findings Extensive analysis of existing infectious disease surveillance systems in 4 countries Do the surveillance systems capture data on the drivers? E.g. social factors driving tuberculosis spread 30 01/28/20 How do infectious diseases

relate to the 12 family of drivers We identified 18 priority infectious diseases according to: WHO criteria Leading causes of death/high morbidity Ease to spreading On the international surveillance list Have a good, feasible preventive measures Case definitions are clear and ease to detect Have a clear goal for elimination/eradication Of 37 reportable diseases in China, those are 10 leading cause of death of reportable diseases 10 diseases with highest incidence rate 10 diseases with highest fatality rate 31

01/28/20 18 priority infectious diseases Tuberculosis (TB) Measles Typhoid\paratyphoid Malaria newborn tetanus hydrophobia/rabies gonorrhea Syphilis HIV/AIDS Hemorrhagic fever with Renal Syndrome (HFRS)

32 encephalitis B epidemic cerebrospinal meningitis Leptospirosis plague dengue fever Viral Hepatitis bacillary and amoebiasis dysentery bird flu 01/28/20 Do China surveillance systems collect data on the drivers?

Not a lot! 33 01/28/20 Percentage of 12 drivers/50 elements data surveillance system collected by countries Percentage % 34 12 family drivers, 50 elements, regarding to the 18 priority surveillanced infectious diseases. One element scores 1, The y-axis is the percents of elements that surveillance system have. 01/28/20

Foresight China II: Findings Leading experts consultations in 12 areas Characteristics of the experts Results 35 01/28/20 Foresight China II: Findings Leading experts consultations in 12 areas Characteristics of the experts

(available on request) Results 36 01/28/20 Foresight China II: Findings Leading experts consultations in 12 areas Characteristics of the experts Results 37

01/28/20 Experts opinions on Four elements of Environment Related Factors in Foresight-China Study. The variables presented below are n (%). 38 01/28/20 Experts opinions on Four elements of Environment Related Factors in Foresight-China Study. The variables presented below are n (%). 39 01/28/20 Experts opinion on driver 1: Governance and social cohesion

Expert s opi ni on re: dri ver 1: governance and soci al cohesi on 100% Yes%, 86% Yes%, 80% 80% 60% 40% 20% 0% Dr i ver s of I nf ect i ous Di seases ? Need sur vei l l ance?

Expert s opi non re: The change t rend of t he f act or? Weak% 13% No change % 17% St rong% 70% 40 01/28/20 Experts opinion on the 12 families of drivers Exper t

100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% over al l opi ni on r e: 86%

12 dr i ver s 80% D r i ver s of I nf ect i ous D i seases ? 78% Need sur vei l l ance? Feasi bi l i t y of sur vei l l ance?

The change trend of the f actor? Weak, 13% No Change, 17% St r ong, 70% 41 01/28/20 Feasibility of surveillance for 50 Elements? 42 01/28/20

Feasibility of surveillance (experts opinion) Of 50 elements, 47 are identified as major influencing elements Of the 47 major influencing elements, for 46 of them the experts considered it would be important to monitor them But of the 46 elements, only 32 are considered to be feasible for monitoring surveillance 43 01/28/20 Feasibility of surveillance

(experts opinion) Of the 46 elements: 16 elements were considered likely to result in trends that would be beneficial to the control of certain infectious diseases, e.g. education & economic development - food poisoning, tuberculosis 44 01/28/20 Experts opinions on Trends in Drivers Of 46 elements: 30 elements were

considered to be associated with worsening occurrence and spreading of infectious diseases 45 01/28/20 Experts opinions on Trends in Drivers Of these 30 elements: o 7 elements were considered likely to improve in the future e.g. poverty, hospital infection control and associated diseases would lessen. o 18 elements are likely to deteriorate

e.g. immigration, bioterrorism o 5 elements were considered likely to stay unchanged e.g. unemployment, environmental pollution 46 01/28/20 Feasibility of surveillance One Family of Drivers 1. Governance and social cohesion Readily Doable 1.Bio-security governance 2.International/national/regional interactions affecting governance 3.lack of interaction between policy and regulatory agencies

4.Marginalization of some groups specify Can be done with some effort E.g. Illegal practices Difficult to do or measure ? Consider later E.g. Social cohesion, political leadership 47 01/28/20 Conclusions/Implications We identified improvement opportunities for identification and detection of infectious disease using the Foresight framework in China We are able to predicting changing risks not actual disease trends of infectious diseases. Thirty two (32)

elements are identified as doable for sureillance systems improvement. Now astudy is needed to test Foresight findings in test location. 48 01/28/20 References Kate E. Jones, Nikkita G. Patel, Marc A. Levy,ect. Global trends in emerging infectious diseases,nature,2008,451(21):990-994. Louise Swift, Paul R. Hunter, Alexander C. Lees, ect. Wildlife Trade and the Emergence of Infectious Diseases. Ecohealth ,2007,4:25-30. Mary E. Wilson. Travel and the Emergence of Infectious Diseases. Emerging infectious disease journal.1995,1(2):39-46. McNeill WH. Plagues and peoples. Garden City, N.Y.:Anchor

Press/Doubleday, 1976. Stephen S. Morse. Factors in the Emergence of Infectious Diseases. Emerging infectious disease journal.1995,1(1):7-15. Anthony Zwi, Pilar Ramos-Jimenez. Conflict, crisis and infectious disease.TDR Nnews.2002,68. Strategic social ,economic and behavioral research. special programme for research &training in tropical disease(TDR). 2005,12. Gaetan Gavazzi, Francois Herrmann, Karl-Heinz Krause. Aging and Infectious Diseases in the Developing World. Aging and infectious disease. 2004,39:83-91. Elizabeth M. Prescott. The Politics of Disease: Governance and Emerging Infections. Global Health Goverance, 2007,1(1):1-8. The Impact of Globalization on Infectious Disease Emergence and Control: Exploring the Consequences and Opportunities, Workshop 01/28/20 49 Summary .http://www.nap.edu/catalog/11588.html.

Acknowledgements UK-China Partners in Sciences Dr David Concar - British Embassy Beijing Ms. Duying - British Embassy Beijing 142 experts consulted 64 field interviewers 50 01/28/20 THANKS Q&A How to work with HPA and European countries?

51 01/28/20

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