Supporting
a strong global health security force
Populations around the world require protection from emerging public threats. The World Health Organization (WHO) defines global public health security as the activities required to minimize the danger and impact of acute public health events that endanger people’s health across geographical regions and international boundaries. The COVID pandemic—which killed more than 7 million people—highlighted for everyone the importance of this work, as well as the difficulties. The Task Force has many programs working to shore up protections and minimize the risk of such events.
One example is the effort to eradicate polio. The Task Force plays a key part in this global initiative by reinforcing countries’ capacity for polio outbreak preparedness and response. Launched in 1988 at the World Health Assembly, the Global Polio Eradication Initiative has reduced polio by 99 percent (from 1988 to 2023), from an estimated 350,000 cases in more than 125 endemic countries to just 12 reported cases of wild poliovirus in two endemic countries (Afghanistan and Pakistan). The Task Force’s Polio Eradication Surge Capacity Support team, funded by the CDC, responds when a new case has been detected—with team members deployed within 72 hours to help countries provide vaccinations, analyze surveillance data and assess the risk of virus spread. During the past four years, The Task Force has contributed to efforts to vaccinate more than 200 million children in 16 African countries.
Strengthening Outbreak Notification and Response (SONAR) is an initiative of the Global Fund implemented by The Task Force. Combining the capacities of several Task Force programs to help 14 countries in Africa and Asia, SONAR builds early-warning disease surveillance systems to respond to outbreaks and better respond to future pandemics. SONAR taps our expertise in field epidemiology, public health informatics and building immunization systems, as we collaborate with ministries of health and other partners to ensure alignment at every step in the surveillance and response chain. We bring together experts in human health, animal health and environmental health, the private sector, pharmacies, educators, health clinic staff and patients and many others—and coordinate with WHO and the Africa CDC to achieve the goals of the participating countries.
A Task Force program known as the Brighton Collaboration works with a range of partners to continuously improve methods to monitor vaccine safety. This work, with a network of 1,300 members in 110 countries, is helping to shorten the time it takes developers to produce safe, effective vaccines against emerging pandemic pathogens.
Ebola Response Inspires Dr. Squire’s Career in Early Disease Warning Surveillance
“There are still houses that are locked up because the Ebola outbreak of 2014 wiped out entire families,” reflects Dr. James Squire, who worked as a District Medical Officer at the epicenter of the 2014 Ebola outbreak in Kailahun, a district of the Eastern Province in Sierra Leone. The heartbreaking and lasting signs of the outbreak in the community ignited Dr. Squire’s dedication to work tirelessly to set up early warning disease surveillance systems for Sierra Leone—to ensure such devastation could never happen again.
Early warning disease surveillance systems allow countries and their healthcare workers to detect threats to a community, notify relevant health authorities, and then rapidly respond to threats so they can be contained quickly.
When the Ebola outbreak wreaked havoc in the Kailahun district, Dr. Squire recalls that there was simply no infrastructure in place to respond.
“At that time, we could not detect the [Ebola] outbreak on time. By the time we detected it, the disease had spread to communities infecting many with lives lost. I lost over 55 healthcare workers. From that time to now, almost 10 years, I have been passionate about being part of work involving early warning disease surveillance systems so that what happened in 2014 and 2015 in Sierra Leone would not be repeated.”
A medical doctor and epidemiologist, Dr. Squire has more than 15 years of public health experience and currently works for The Task Force for Global Health. He serves as the national lead for Sierra Leone on the Strengthening Outbreak Notification And Response (SONAR) project. SONAR helps countries in Africa and Asia build early-warning disease surveillance systems to respond to outbreaks. The Task Force, in collaboration with Africa Centres for Disease Control and Prevention, and World Health Organization (WHO) – is the implementing partner for The Global Fund’s SONAR project.
Dr. James Squire facilitating the opening session at an event-based surveillance training-of-trainers workshop, Makeni district, March 18, 2024. Photo courtesy: James Squire.
Creating a Sustainable Early Warning Disease Surveillance for Sierra Leone
Dr. Squire works with Sierra Leone’s Ministry of Health and the National Public Health Agency to ensure that early warning surveillance systems, such as event-based surveillance, are sustainably implemented.
He explains how he has worked with his colleagues to improve surveillance systems in Sierra Leone since 2016.
“We have an electronic integrated disease surveillance system that operates at all of our important health facilities. Once a healthcare worker detects a notifiable disease condition based on the case definition, the healthcare worker immediately notifies us and the district. Then, the national level can easily see that notification and be able to put up a response system. We are leveraging that for the SONAR project.”
Dr. Squire adds that involving other sectors will ensure commitment to the importance of surveillance for global health security of a country.
“With SONAR, we are using the One Health approach. We are involving other sectors like the Ministry of Agriculture and the Ministry of Environment. We have seen ownership from all these sectors in implementing the SONAR project. With that collaboration and coordination among the sectors, we will be able to effectively and sustainably implement early warning surveillance and shorten the time from outbreak detection, notifications and response.”
The echoes of civil war, disease outbreaks, and other health emergencies in Sierra Leone are felt even today. Yet Dr. Squire is motivated by the dedication and persistence of the people, like the Maternal Child Health Assistants of Sierra Leone, who have shown immense compassion and dedication to healthcare during some of Sierra Leone’s most devastating emergencies.
“After 10 years of civil war [Sierra Leone Civil War from 1991-2002], the health systems were devastated. We had shortages of healthcare workers across different cadres and there was a dire need for health services to be delivered, especially in hard-to-reach areas.”
“As a stop-gap measure, we had Maternal Child Health Assistants (MCHAs), who were trained to provide basic maternal and child health services. Over the years, their roles evolved and they supported surveillance activities in the health facilities. The SONAR project is also contributing to building the capacity of this cadre of staff. So far we have trained over 300 MCHAs across health facilities in Kailahun, Kenema, Kambia and Western Area Urban on event-based surveillance. The MCHAs are pivotal in achieving our vision of SONAR. The SONAR project will ensure they have the resources needed to carry out the early warning functions.”
After experiencing constant loss and tragedy due to health emergencies, Dr. Squire and his public health colleagues stand as public health heroes who work every day to strengthen the public health infrastructure of Sierra Leone and fight future outbreaks effectively.
Group photo at Facility Event-Based Surveillance training in Kambia district, North-western Sierra Leone, April 13, 2024. Photo courtesy: Dr. James Squire.
