East Africa Public Health Laboratory
The establishment of an East African Public Health Laboratory (EAPHL) has a number of objectives and impacts on the region. In this article, we will examine the regional coordination process, project objectives, and impacts, as well as the need for rapid BSL3/4 pathogen diagnostics. This project aims to develop the capacity of laboratories in the region to respond to emerging public health needs. We will also outline the needs identified in this region and the challenges faced.
The EAC is a regional network that promotes laboratory services and training in East Africa. The network comprises nine mobile laboratory units that are dispersed across the region through national public health laboratories. The EAC mobile laboratories are used for BSL 3/4 infectious pathogens and response to outbreaks of viral haemorrhagic fevers. These units have also supported SARS-CoV-2 diagnostics in East Africa.
The network aims to strengthen national disease surveillance systems in the region. It should also develop standardized guidelines on building staff and institutional capacities. The network should enhance national disease surveillance networks, develop a unified electronic data platform and conduct regular simulation exercises. This will help countries identify potential outbreaks and contain them in their early stages. It will also provide early warning of disease outbreaks and allow countries to take timely and appropriate action to stop the rapid transmission of diseases across borders.
The East Africa Public Health Laboratory project has three key components. The first component will help countries increase their diagnostic capacities for communicable diseases. The second component will help create a subregional network of public health laboratories that will help countries better diagnose diseases and monitor drug resistance. All three components will be implemented through an implementing agreement between the donor and the participating countries. The project also includes joint training for laboratory personnel. The third component is knowledge sharing.
The EAC mobile laboratories are based on the European Mobile Laboratories and comprise a network of nine specialised portable laboratory units. The mobile laboratories have the capacity to diagnose infectious pathogens (BSL 3/4) and respond to viral haemorrhagic fever outbreaks in East Africa. The project’s mobile laboratories have already been used to support SARS-CoV-2 diagnostics in the region. These mobile laboratories are equipped with state-of-the-art diagnostic equipment.
Impact of project on region
The project has already made significant contributions to the health sector in the region. It has installed mobile laboratories in six countries, reducing sample turnaround time from more than 16 hours to less than 8 hours. This has been a game changer in reducing the time required for isolation of patients and breaking the transmission chain, among other benefits. The mobile laboratories have already assisted in eleven outbreak response missions, including COVID-19 and dengue fever. A thirteenth mission is planned for Tanzania and one is being prepared for Zanzibar, to support SARS-CoV-2 diagnostics.
The US$56 million East Africa Public Health Laboratory Networking Project will build a subregional network of laboratories to better monitor, diagnose, and track communicable diseases. In particular, the project will improve access to diagnostic services in four countries: Kenya, Rwanda, Tanzania, and Uganda. Component #1 will strengthen laboratory based disease surveillance and conduct drug resistance monitoring. Component #2 will strengthen the surveillance system for infectious diseases.
Need for rapid diagnostics of BSL3/4 pathogens
The need for rapid diagnostics of Biosecurity Level 3 and 4 (BSL3) pathogens is pressing in East Africa, where an estimated 170 million people live. These regions are prone to epidemics of viral haemorrhagic fevers and other bacterial diseases. These outbreaks occur mostly in rural areas without public health laboratory infrastructure and high levels of biosecurity. The samples that are collected in these areas must be transported to National Public Health Laboratories or even flown to international reference centers. This delays diagnosis and leads to epidemics.
The implementation of rapid diagnostics in EAC laboratories has faced a number of challenges. The logistics of transferring lab equipment across borders have been difficult. The need for additional laboratory equipment has also been identified. Additional gloves, PPE, and centrifuges were required to accommodate the increased volume of samples. Additionally, additional centrifuges and RNA extraction are required to support the rapid sample throughput in mobile laboratories.
Integration of laboratory network into host institutions
EAC, the regional association of countries in East Africa, is the project implementer and overall project coordinator. The Bernhard Nocht Institute for Tropical Medicine (BITM) provided technical support and seconded a team of laboratory consultants permanently stationed in Arusha, Tanzania. The institute is also a WHO Collaborating Centre. The project also included the participation of EAC country representatives, regional steering committees, and an expert working group to guide decision-making and ensure political buy-in at the highest level.
EAC is composed of the national public health laboratories and ministries of health in each country. The project partners include: the National Public Health Laboratory in Nairobi, Kenya; the Central Public Health Laboratories in Kampala, Uganda; the National Health Laboratories, Quality Assurance and Training Centre in Dar Es Salaam, Tanzania; the Institute National de Sante Publique in Bujumbura, Burundi; the Public Sector – Blood Transfusion Services in Kigali, Rwanda; and the Public Health Lab and National Reference Laboratory in Juba, South Sudan. Each member country is responsible for selecting laboratories for implementation.
Training of laboratory personnel
The Training of East Africa public health laboratory personnel (FELTP) program trains epidemiologists for a two-year program in public health leadership. In addition to the basic epidemiology and laboratory science curriculum, the program offers a range of short-course trainings for frontline staff. Graduates of the FELTP program work to develop public health laboratory systems in their countries, providing a pool of frontline implementers and capacity for the lower tiers of health systems. They also act as surge capacity at national and regional levels.
The program has already deployed mobile laboratory units in eleven emergency outbreak missions, including the recent COVID-19 outbreak in Tanzania. It is currently preparing for its thirteenth mission, where it will deploy one laboratory in Zanzibar to support SARS-CoV-2 diagnostics. In addition, the program will train emergency and health personnel in other aspects of the public health laboratory in East Africa. Using these mobile laboratories in response to outbreaks is a valuable way to ensure rapid diagnosis and prevention of disease epidemics.