In June 2023, 15 professionals from Cambodia, Ghana, Kenya, Tanzania, Uganda and Yemen gathered at Tanzania’s National Public Health Laboratory in Dar es Salaam with one common goal: to gain an understanding in certifying biological safety cabinets. Proper certification to verify that biological safety cabinets function as designed by the manufacturer is vital to a laboratory’s capacity to safely handle infectious materials, a need that is only amplified during disease outbreaks. The four-day course was packed with demonstrations, discussions and measurement practice.
A biological safety cabinet is a specialized type of laboratory equipment that provides a clean work environment and protects laboratory staff when working with infectious agents or toxins. Biological safety cabinets have high-efficiency particulate air (HEPA) filters that trap biohazards and ensure that only microbe-free exhaust air is discharged from the cabinet. They provide important protections but must be properly maintained.
Prior to 2022, pursuing biological safety cabinet certification training required travel to North America or scheduling visits from North American experts. Recognizing the unsustainable nature of this arrangement, APHL partnered with the US Centers for Disease Control and Prevention (CDC), subject matter experts and Muhimbili University of Health and Allied Science (MUHAS) in Dar es Salaam to create and launch a three-week online course followed by in-person hands-on practice at the Tanzania National Public Health Laboratory.
This course is taught by MUHAS instructors who are mentored and coached by the course developer, a subject matter expert from Thermo Fisher Scientific. The course prepares participants to complete the NSF Basic Accreditation testing.
Professionals attending the course this summer were only the second cohort to go through the training program, and almost all came from the public sector. Of the 15 course participants, 11 stayed on immediately following the hands-on portion to complete the three-day NSF accreditation testing. Those who pass NSF’s written and seven practical tests will be listed as NSF-accredited certifiers. Thanks to ongoing collaboration with APHL and partners, MUHAS intends to offer the course and bring NSF to Tanzania every summer, which will continue to build global capacity for handling disease threats.
Click through this slideshow to see photos from the training:
Field certifiers from Tanzania listen to presentations from instructors during the first day of the hands-on biological safety cabinet certification training session. | www.APHLblog.orgCourse Instructor provides an overview of cabinet features during hands-on session during a biological safety cabinet certification training in Tanzania. | www.APHLblog.orgField certifiers being guided through a rare look under the hood of a biological safety cabinet. Opening a cabinet typically voids the warranty. | www.APHLblog.orgTraining participants listen as a course developer provides broader context during hands-on session during a biological safety cabinet certification training in Tanzania. | www.APHLblog.orgA field certifier from Uganda takes measurements of a biological safety cabinet during the NSF accreditation practical test. | www.APHLblog.orgField certifiers from Kenya and Cambodia take measurements during their NSF accreditation practical test. | www.APHLblog.org
Countries in Africa are no strangers to major disease outbreaks that can result in illness and death of millions of people. In the past two years alone the continent has experienced infectious disease outbreaks of cholera, meningitis, Ebola Virus Disease, Lassa fever, and Yellow fever, and other public health emergencies such as drought and famine.
Understanding the big picture
Training participants from Zanzibar discuss the development of an emergency management program.
It is vitally important to have a big picture perspective on emergency management and response – if one country is not prepared for a public health emergency, then all the countries in the region are susceptible to public health threats that can easily cross borders and impact surrounding countries. This is where public health emergency management (PHEM) comes in. In-country PHEM capacities and systems can be strengthened to support global health security. When the workforce is trained, emergency management infrastructure is in place, and functional systems exist, a country is better positioned to execute a coordinated response that can mitigate risk and save lives.
CDC and other international partners support ongoing efforts to help countries across Africa build capacity in outbreak detection and response. This includes preventing avoidable epidemics, detecting public health threats early, and responding rapidly and effectively to outbreaks of international concern. CDC provides expertise in PHEM to train emergency management technicians, provide input on emergency management operations, and guide development of functional processes and systems for ministries of health around the globe.
Getting the workforce ready to respond
In August 2017, CDC spearheaded a 5-day PHEM workshop in partnership with the World Health Organization, the United States Defense Threat Reduction Agency, and Public Health England. The workshop brought together 55 emergency management staff members from across Africa to learn from experts in the field about how to enhance coordination and response capabilities of their country’s PHEM programs.
Participants came from seven countries – Tanzania, Uganda, Kenya, Ethiopia, Liberia, Sierra Leone, and Nigeria – which all share common interests and challenges related to emergency response. The training focused on developing core principles in PHEM, including trained staff, physical infrastructure, and processes to run a fully functional Public Health Emergency Operations Center (PHEOC). The training highlighted best practices, but since many of the participants had first-hand accounts of responding to public health events in their own countries, they were encouraged to share experiences and network with their peers.
Sharing knowledge and expertise
Public health professionals who work in emergency response know that it’s important to build relationships before an incident so that during a response you work effectively and efficiently with partners. One participant noted that the “rich, valuable contributions from other people’s experiences to build upon what I already knew” was one of the most rewarding parts of the workshop.
The tabletop exercises at the end of the workshop emphasized the importance of information and idea sharing. Participants engaged in tabletop exercises that simulated a response to a Yellow Fever outbreak in northern Tanzania. Participants were divided into 7 teams: management, plans, logistics, operations, finance and administration, communication, and partners. Each team had a mix of participants from different countries. Teams utilized information they had learned throughout the workshop to developed response products, including an organizational structure chart, objectives for the response, and an initial situation report. This exercise led to a robust conversation about different approaches to public health emergency response.
Seeing response in action
Public Health Emergency Operations staff survey the scene after mudslides in Regent, Sierra Leone.
A highlight of the training was when Dr. Ally Nyanga, the Tanzania Ministry of Health PHEOC Manager and an alumni of the CDC Public Health Emergency Management Fellowship, took workshop participants on a tour of the Tanzania PHEOC, a small room on the third floor of the Ministry of Health building. Previously used as a storage area for the library, the 10 x 20 foot PHEOC is now an efficient space that staff can use when they respond to public health emergencies and outbreaks. To date, Tanzania’s PHEOC has been activated to respond to widespread cases of Aflotoxicosis, a type of severe food poisoning, and cholera outbreaks in Tanzania.
While the workshop is over and participants have returned home, the work that they do to prepare for the next public health emergency is ongoing. The workshop highlighted some important takeaways – you do not need a big space and high-tech equipment to respond quickly and efficiently to a public health emergency. Instead, coordination to share information, resources, and ideas is vital to a successful emergency response, both in-country and across an entire region.
Today President Obama announced the United States and 30 other nations have committed to join together to achieve the targets of the Global Health Security Agenda (GHSA). APHL is proud to be a key partner in the effort to make the world safe from infectious disease threats.
APHL is working closely with US federal agencies as well as domestic agencies within African and Asian partner nations to achieve the following GHSA targets:
Countering antimicrobial resistance
Preventing the emergence and spread of zoonotic disease
Advancing a whole-of-government national biosafety and biosecurity system in every country
Establishing a national laboratory system
Strengthening real-time biosurveillance
Advancing timely and accurate disease reporting
Establishing a trained global health security workforce
Establishing emergency operations centers
APHL in Africa Guinea, Kenya, Liberia, Sierra Leone, Tanzania, Uganda
To address the limited laboratory capacity and capability in many African nations, we are currently partnering with the African Society of Laboratory Medicine (ASLM) to provide technical and management assistance for design, development and implementation of the African Public Health Laboratory Network (APHLN). Working with ASLM, APHL will convene stakeholders to develop the operational rules for the network, support laboratory accreditation and set goals for national public health laboratories. We will leverage existing laboratory models, notably the US Laboratory Response Network (LRN), to design an effective laboratory network for the continent.
As our GHSA work moves forward, APHL is also planning to initiate laboratory assessments, inventory and review of laboratory policies, training and mentoring of laboratory staff, support for development of biosafety facilities, and review of specimen referral systems, quality management system programs and capacity for detecting anti-microbial resistance.
APHL in Asia India, Indonesia, Vietnam
In Asia, APHL is working directly with ministries of health and other national health officials to develop laboratory systems capable of safely and accurately detecting and characterizing pathogens causing epidemic disease. Lucy Maryogo-Robinson, APHL’s global health director, is traveling to partner countries in southeast and central Asia to plan activities under GHSA. In November she traveled with an APHL team to Vietnam to discuss projects to expand APHL’s longstanding relationship with that country. Ongoing development of informatics systems and strengthening of capacity to respond to infectious diseases will be priorities.
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