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More investment needed as we celebrate our heroic disease detectives

“Mysterious Disease Kills 100 People in Rakai.” This was a front-page lead story published in Uganda’s The Star newspaper on 29 December 1984.

According to a study commissioned by Panos Eastern Africa in 2007, which analysed 25 years of media reporting on HIV in Uganda, this story prompted researchers led by Dr David Serwadda, who were then based at the Mulago national referral hospital in the capital Kampala to travel to Rakai, on the country’s southern border with Tanzania, to investigate the mysterious disease.

Publishing in The Lancet medical journal almost a year later, Dr Serwadda and colleagues reported on a recently recognized “slim” disease, describing its symptoms, who was being affected, possible causes, and possible origins.

Sixteen years later, another public health threat of “a strange disease” killing people in the northern Uganda town of Gulu was reported. A physician hailing from the area, Dr Matthew Lukwiya who was away in the capital Kampala pursuing postgraduate studies rushed home to investigate this new threat.

Upon studying the patients’ records at St Mary’s hospital Lacor where he worked, Dr Lukwiya suspected the highly infectious Ebola virus disease. He immediately embarked on a social mobilization strategy and initiated preventive measures and communicated to the Health ministry.

His fears were later confirmed, and sadly, the disease that he helped contain from spreading to the entire country killed him at the tail end of the outbreak. Doctors Serwadda, the late Lukwiya and thousands of their like in Africa and around the world are who we call field epidemiologists.

Put simply, they are the world’s “disease detectives” responsible for investigating public health signals to confirm outbreaks and identify cases, contacts and risk factors for disease to inform the appropriate response.

Starting this year, field epidemiologists will be celebrated and recognized every September 7, which is World Field Epidemiology day henceforth, for their efforts in protecting the health of populations and advancing global health security.

The ongoing Covid-19 pandemic has further underscored the work of these disease detectives. Increasingly, field epidemiologists are espousing the “One Health” paradigm on human health, animal health, and environmental health threats. Coming from multidisciplinary expertise, this allows them to respond effectively to a wide range of health issues.

Worth noting are veterinary field epidemiologists who are vital for detecting and stopping zoonotic disease outbreaks that can spill over into human populations.

According to the World Health Organization’s (WHO) Joint External Evaluation (JEE) tool, which is part of the International Health Regulations of 2005 monitoring and evaluation framework, “the optimal target for surveillance is one trained field epidemiologist (or equivalent) per 200,000 population.”

This cadre target provides a measurable standard for the IHR (2005) human resource compliance and preparedness by countries.

Working with governments and development partners such the US Centers for Disease Control and Prevention the African Field Epidemiology Network (AFENET) which brings together Field Epidemiology and Laboratory Training Programs (FELTPs) on the continent, has trained over 2,000 field epidemiologists in sub-Saharan Africa out of the required number of 5,550.

With such a huge deficit, amidst emerging and re-emerging public health threats, our health systems are under the weight of complex challenges, making increased and sustained investment into the training of disease detectives more important than ever before, if we are to reach the one field epidemiologist per 200,000 population.

Evidence shows that field epidemiology training programs contribute to the strengthening of the public health system as a whole.

Monitoring data further shows that majority of alumni stay within their countries’ public health system, with a sizeable number in positions of leadership, increasing the possibility of using data for decision-making.

kkirunda@afenet.net

The author is a communications specialist with the African Field Epidemiology Network.

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