Linking existing Early Warning, Alert and Response Systems (EWARS) for Emergencies

(This was conceptualised in 2014 in a country where there was established EWARS in place)

Background: During a disaster, it is essential to establish disease surveillance system with an early warning mechanism to ensure the early reporting of cases, to monitor disease trends, and to facilitate rapid detection and response to outbreaks. WHO has developed a guideline on establishing early warning systems after the disaster as Early Warning Alert and Response Network (EWARN).[1] It has stressed that it was important not to assume any prior knowledge of EWARN and to ensure the document offered practical, operational guidance for the implementation of EWARN in a step-by-step format, for use at the field level in an emergency situation.

At the same time, it also says on the implementation of an EWARS can range from strengthening the existing early warning and response component of a routine surveillance system to implementing a completely new system if nothing appropriate is currently in place. There is some evidence of linking existing system of early warning for the disaster (Disease Early Warning System- DEWS during flooding in Pakistan, early warning system in Haiti due to earthquake).[2] Several Pacific Island Countries are working to integrate routine disease surveillance with post-disaster risk assessments and early warning surveillance and response systems. The Solomon Islands, in particular, has demonstrated how to assess and respond effectively to disease threats in post-disaster settings.[3]

However, still there is a question, how many countries from developing world that have functioning early warning system for disease surveillance has linked with disaster management. Those countries, who have demonstrated as mentioned above has not linked to routine and functional early warning system for disaster after the disaster response is over.

Rationale for linking existing early warning system for emergencies:

  1. Provides an opportunity to link with existing or developing systems. Many countries have either already established or establishing early warning system as part of strengthening surveillance capacities required for IHR (2005) implementation. This will give opportunities to strengthen surveillance capacities to detect, verify, assess, inform and respond to potential threats during emergencies.
  2. Saves resources for implementation and immediately after disaster: the early warning system can instantly support for emergencies.
  3. During disaster existing system may disrupt and most of the system has developed continuity plan as part of contingency plan for disasters/emergencies. (WHO Guideline also mentions that during emergencies, the existing system may disrupt due to emergencies and the establishment of early warning system is required).
  4. This can further advocate government to develop continuity planning for surveillance for disaster and as well as for other health services.
  5. Not all disasters will disrupt completely existing surveillance system.

How to link existing early warning system:

  • Use of existing early warning system of surveillance system for early warning during emergencies.
  • Incorporate topic on surveillance for disaster on routine trainings of surveillance and EWARS of clinicians and health care workers on followings:
    • Recognizing priority diseases (Case definitions);
    • Reporting cases and mechanism to existing system during disaster/emergencies
    • Application of alert threshold
      • Sound an early warning and launching of investigation
      • Check epidemic preparedness and response (vaccination)
      • Prioritize the interventions
    • Application of epidemic threshold to confirm emergence of outbreak and to put control measures accordingly.
    • Laboratory Diagnosis for emergencies
    • In absence of emergencies, simulate them with two scenarios
      • First: without disruption of existing EWARS and
      • Second: with disruption of existing EWARS
    • Develop continuity plan as part of contingency plan of disaster (– use WHO guideline to set up and train surveillance team on this guideline in advance)
      • Selection of sites
      • Mechanism for relaying data or information
      • Response to alerts
      • Analysis and Feedback
    • Outbreak preparedness
    • Disease Control Initiatives

Step by Step Process of incorporating EWARS for Emergencies: 

  1. Initiate discussion with emergency response team and Surveillance Team if the teams are different.
  2. Establish a working group.
  3. Develop a training curriculum for EWARS training covering surveillance for disaster
  4. Run the training in some of the EWARS regions/districts as a pilot and simulate with two scenarios
    1. First: without disruption of existing EWARS and
    2. Second: with disruption of existing EWARS.

References:

[1] World Health Organization. Outbreak surveillance and response in humanitarian emergencies: WHO guidelines for EWARN implementation. Geneva, 2012

[2] Ministry of Health, Pakistan.  Outbreak Surveillance and Response Disease Early Warning System. Flooding Response in Pakistan. Operational Guidance. Pakistan. 2010

[3] Tenth Pacific Health Ministers Meeting. Outbreak surveillance and response priorities for mitigating the health impact of the disaster. WPRO. Samoa, 2013: Agenda Item 9; PIC10/9

Note: EWARS is an adjunct, not a substitute for the national disease surveillance system, and once the acute emergency phase is over, it should be re-integrated into the national surveillance system.

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