A Programme Proposed for Scientific Cooperation among States Parties to the Biological Weapons Convention and its Protocol
NetRED:
Network of Regional Epidemiological and Diagnostic Centres for Control of Emerging Infectious Diseases
World Health Organization
June 1999 revised Sept. 1999
Why the NetRED Programme Is Needed
The re-emergence of infectious diseases as a global problem in the late twentieth century has made the early control of outbreaks an urgent necessity to protect the health of people not only in the regions initially affected but all over the world. No region now has an adequate system for the rapid identification and diagnosis of new outbreaks, without which timely and effective response is not possible. Although efforts are underway in some countries to improve their capabilities, the parts of the world where diseases are most likely to emerge--those with high biodiversity, rapid ecological change, and a heavy burden of endemic disease--are often those with minimal capabilities and scarce resources. A global network of regional centres with sophisticated diagnostic laboratories and clinical outreach is urgently needed so that outbreaks can be contained without delay and epidemics prevented everywhere.
The World Health Organization (WHO) proposes to address this need by establishing a Network of Regional Epidemiological and Diagnostic Centres for Control of Emerging Infectious Diseases (NetRED). To be effective, international resources will be concentrated on a small network of strategically located regional Centres, each of which will establish a regional clinical network to act as sentinels for the recognition of new outbreaks.
As things now stand, vital time is often lost before the need for assistance is recognized, aid is mobilized, specimens are obtained and an outbreak is identified by a specialized laboratory that may be half-way around the world. When the outbreak is unusual, uncertainty as to its possible cause may lead to further delay as the specimens are transferred from laboratory to laboratory until the requisite expertise is accessed. Regional sentinel networks for active monitoring of infectious disease outbreaks, coupled with strategically-located and technically-capable regional diagnostic Centres, would speed the process, save lives and prevent the spread of disease. No programme of this kind now exists or is under consideration.
A network of regional diagnostic Centres would form a critical adjunct to WHO's other communicable disease activities, augmenting WHO's present efforts and making it possible to exploit existing programmes more fully. However, WHO cannot undertake such a programme under its regular budget, which is dedicated to WHO's primary role: the development of health policies, the stimulation of their adoption, and the coordination of international health activities.
No alternate sources of financial or other resources for the programme are currently available. Consequently, the programme cannot go forward unless it is adopted by the BWC and Protocol States Parties as a means for implementing Article X/VII. If the States Parties adopt NetRED, however, a discrete programme will be established, with its own budget, funding mechanism and scientific direction, as a part of WHO's Communicable Diseases Cluster. Contributions and cooperation from all States Parties will be required to make the programme work. No more effective means could be found by the States Parties for scientific cooperation for the prevention of disease.
Although the NetRED programme will benefit public health in all countries, the States Parties will reap special benefits, including the location of the Network Centres and priority in selection of personnel for training and in other assistance.
Outline of the NetRED Programme
About 10-12 existing national or private medical centres, strategically located geographically, will be selected and invited to participate in the programme, which will be coordinated by WHO.
The Centres will be located in developing regions with relatively high likelihood of disease emergence and weak epidemiological and diagnostic capabilities. The number of Centres will depend on the funding available; it will be important to have adequate funds for each designated Centre. A possible distribution of Centres might be: Southeast Asia, China, the Indian subcontinent, Middle East, North Africa, Francophone Sub-Saharan Africa, Anglophone Sub-Saharan Africa, Amazon, one or two other regions in Latin America, and Russia. In addition, several institutions in North America, Europe, and Australia/Pacific could be invited to participate at their own expense.
If sufficient support for this proposal is received, an international conference will be called to begin detailed planning of the programme and set its establishment in motion. Decisions such as the locations of Network Centres will be made by infectious disease experts representing all regions. Candidate Centres will be considered on the basis of: a) location, in terms of infectious disease threats and regional need; b) present laboratory, clinical and epidemio-logical capabilities; and c) potential for development and outreach.
Each Centre will be provided with training, equipment and other resources to: a) develop a broad diagnostic capability that can save critical time by diagnosing specimens of unknown nature with a variety of tests at one stop; and b) set up and train a clinical/epidemiological outreach network in the form of a regional sentinel system. The participating Centres will be designated as WHO Collaborating Centres and will work closely with other programmes at WHO.
Like all of the hundreds of WHO Collaborating Centres, the NetRED Centres will report outbreak information directly to the relevant Ministries of Health and to WHO, which will handle information confidentially until it is officially released by the governments involved. The programme will accelerate identification of outbreaks, enabling WHO to respond to requests for aid at an earlier stage when control is most feasible. The Network's coordinating office at WHO will collect the data, analyse infectious disease trends, create databases and stimulate research and development of needed vaccines and therapies on the basis of accumulated outbreak data.
The Network's activities will be coordinated by a central NetRED office at WHO, which will oversee the programme closely and build the capabilities of the Centres in the developing world by providing communications, training, analytical equipment and reagents, and other assistance, as well as salaries for additional scientists when needed. The coordinating office will maintain a quality control programme to assure that WHO standards are met. It will provide detailed instructions and guidance as needed.
In carrying out its functions, the NetRED coordinating office will, to the extent possible, call on services that already exist at WHO, the Centres, and other (self-supporting) institutions. NetRED will contract for those services or request their provision. For example, materials for quality control, diagnostic reagents, specialized reference laboratory services, and epidemiological training might be contributed by States Parties or international organizations on a cost basis or free of charge.
WHO will arrange for the training of Centre personnel at locations that will provide them with the best teachers and an opportunity to form international connections. Training of personnel for the regional network of each Centre will also be arranged, and regional meetings will be held so that the regional associates will form bonds with each other and become familiar with the Centre as their regional resource. The International Clinical Epidemiology Network (INCLEN) proposes a training programme that could be tailored for these purposes.
The NetRED programme will encourage (but not directly fund) the evolution of the Centres to become international research centres similar to the International Centre for Diarrhoeal Disease Research (ICDDR) in Bangladesh, carrying out research on prevention and cure as well as performing active monitoring and diagnosis and responding to prevent epidemics.
Because NetRED will benefit all nations, it would be appropriate for it to be multilaterally supported by contributions earmarked for NetRED from international organizations and the States Parties to the BWC and its Protocol. Direct contributions to individual Centres or governments for NetRED activities would not, in general, be consistent with an integrated programme. However, ancillary bilateral aid for specific purposes might be solicited by the NetRED office. NetRED's success will depend on the integrated functioning of all the Centres and of all aspects of the programme.
Assurance of adequate extra-budgetary funding will be necessary before WHO can start the programme. Financial contributions, as well as contributions in kind, participation in training programs, clinical cooperation, the sharing of information on methods of disease control, and other forms of cooperation would fulfill the obligations of both developing and developed States Parties to cooperate "for the prevention of disease" (BWC Article X) and to "promote public health, as well as the monitoring, diagnosis, detection, prevention and control of outbreaks of diseases," "through inter alia the provision of training and technical advice, [and, if appropriate,] equipment and reagents" (Protocol Rolling Text, Article VII).