COVID-19 has affected populations and health systems around the world, whereby Event-based Surveillance (EBS) has increased in significance. Thus, EBS collects and analyzes unstructured, ad hoc information regarding health events that represent a risk to human health. Furthermore, it increases the sensitivity of the surveillance system and contributes efficiently to the rapid detection of acute public health events.

To shed light on this issue further, EMPHNET conducted a webinar titled “Event-based Surveillance in the Eastern Mediterranean Region: Progress and Best Practices” on Tuesday, October 27, 2020. The webinar highlighted the challenges faced by countries and the possible ways of bridging the gaps along with country-specific experiences from Libya and Sudan.

The webinar was led by four health experts, namely: Epidemiologist, US CDC, Ms. Sharifa Merali; Program Area Manager, Health Emergency Information and Risk Assessment (HIM), WHO Health Emergencies Program (WHE), Dr. Pierre Nabeth; and National Surveillance and Rapid Response Teams’ focal point, NCDC, Libya, Dr. Mohamed Al-Faqeh; and Deputy of Health Emergencies and Epidemic Control Directorate, Federal Ministry of Health, Sudan, Dr. Muntasir Mohammed Osman. The session was facilitated by Associate Director for Global Health Sciences, US CDC, Dr. Arun Balajee, and Public Health Specialist at GHD|EMPHNET, Dr. Mahmoud Kayed.

Dr. Kayed started the session by introducing the webinar’s focus and emphasizing the importance of EBS in countries to mitigate the health impacts of COVID-19. He then shared the results of a poll that had been sent by GHD|EMPHNET in collaboration with CDC Atlanta and WHO/EMRO to multiple EMR countries to understand the EBS landscape. He then presented the speakers and the second facilitator.

In her presentation, Dr. Merali stated that due to increasing rates of globalization, the emergence and re-emergence of diseases are more common, and that diseases spread effortlessly and more rapidly than before. She added that the International Health Regulations (IHR) require countries to develop an early warning system, which includes EBS as a component. She also explained that the Global Health Sciences team at CDC focuses on strengthening EBS in health facilities and communities and that it is working with partners to achieve this goal. She also discussed EBS in the context of COVID-19, where it can detect clusters, deaths, and cases among health workers. Ms. Merali concluded her presentation by emphasizing the importance of EBS as part of early warning and rapid response systems, which can help in the detection of COVID-19 cases.

The second presenter, Dr. Nabeth, briefly introduced the objectives of surveillance systems. Surveillance systems objectives are to monitor disease mortality and morbidity and to provide timely information on public health threats to guide control measures. He then shed light on some challenges that face surveillance systems such as fragmentation, no clear responsibilities, data sharing, high turn-over of staff, and lack of sustainability. He added that to solve these problems, surveillance systems integration is crucial. Furthermore, he stated that WHO/EMRO is working on the technical specifications that are required for an electronic surveillance platform, surveillance evaluation toolkit, building the District Health Information Software (DHIS2) capacity, and strengthening early warning and response (EWAR) in the EMR. He then finally discussed Epidemic Intelligence from Open Sources (EIOS), which is a tool that collates articles from multiple sources and provides a user interface.

The third presenter, Dr. Al-Faqeh began by explaining the difference between EBS and IBS. In EBS, the signal leads to a public health threat followed by an alert and then rapid response, which is accompanied by an on-going risk assessment. For IBS, it leads to a long-term structural response. He then moved on to present the surveillance system in Libya, which was interrupted due to conflict and political instability. Responding to this issue, Libya introduced the Early Warning, Alert, and Response Network (EWARN) in 2016 in collaboration with WHO. He further explained the structure of the EWARN system and highlighted the scaling up of the EWARN system in response to COVID-19.

Dr. Al-Faqeh then presented the main challenges faced were namely: the deficiency of resources, situational instability and sustainability, underreporting of COVID-19, cases not seeking treatment, limited testing capacity, lack of timeliness, and limited surveillance data. He concluded his presentation by listing the lessons learned, which include: enhancing COVID-19 surveillance aids in spread control, adoption of multiple surveillance systems can ensure broader coverage, need for regular evaluations, and having more laboratories involved to test.

The final presenter, Dr. Osman started by introducing the surveillance system that has been established in 1970 and how it has been improved through the years. He explained that in 2016, the EBS became one of the major tools of surveillance, and in 2017, focal points were selected and trained, and in 2018, the system started to function.

He highlighted that information sources in Sudan include community-based surveillance, incidents tracking system, PoE reporting, media, rumors, and relevant ministries and institutions. He also added that the flow of information in Sudan goes as follows: (formal/ informal) source area from the community to the health facility, localities, states, central level through mobile phones. He then shared one of Sudan’s monthly EBS reports and explained that there are daily reports during COVID-19. He concluded his presentation by highlighting the main challenges Sudan is facing regarding EBS, which are the high turnover of trained staff, inadequate communication tools, and irregularity of the inter-sectoral tool.

Dr. Balajee facilitated the webinar’s Q&A session which centered around important and relevant questions received from the attendees. The session was deemed a success as it drew 247 attendees.