Global Health Security Agenda: GHSA National Laboratory System Action Package (GHSA Action Package Detect-1)

Five-Year Target: Real-time biosurveillance with a national laboratory system and effective modern point-of-care and laboratory-based diagnostics.

As Measured by: A nationwide laboratory system able to reliably conduct³ at least five of the 10 core tests⁴on appropriately identified and collected outbreak specimens transported safely and securely to accredited laboratories⁵ from at least 80 percent of districts in the country.

Desired National Impact: Effective use of a nationwide laboratory system capable of safely and accurately detecting and characterizing pathogens causing epidemic disease, including both known and novel threats, from all parts of the country. Expanded deployment, utilization, and sustainment of modern, safe, secure, affordable and appropriate diagnostic tests or devices.

Country Commitments to Action Package:

• Leading countries: South Africa, Thailand, United States
• Contributing countries: Canada, China, Ethiopia, Finland, Georgia, Israel, Japan, Malaysia, Mexico, Peru, Switzerland, United Kingdom, Yemen
• Contributing international organizations: FAO, OIE, WHO

Five-Year Action Items:
Actions will be coordinated, as appropriate, with relevant international organizations including FAO, OIE and WHO.

1. Evaluate capacity needed at national reference, provincial, and district laboratories and implement a five-year approach based on experience with Integrated Disease Surveillance and Response (IDSR) and other ongoing platforms to build capacity at each level.
2. Integrate or increase collaboration among human and animal laboratory systems for a One Health approach.
3. Field-test novel point-of-collection diagnostics appropriate for screening outbreak specimens.
4. Train biomedical engineers in-country to certify biosafety cabinets and repair/maintain general laboratory equipment (centrifuges, fridges, freezers, incubators).
5. Systematically submit microbial samples or isolates to the public health reference laboratory/ies at the regional or national level.

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³ The laboratory results must be as accurate as possible, all aspects of the laboratory operations must be reliable, and reporting must be timely in order to be useful in a clinical or public health setting. Laboratory quality can be defined as accuracy, reliability and timeliness of reported test results.

⁴ The list of 10 core tests in each country includes six testing methods selected according to the IHR immediately notifiable list and the WHO Top Ten Causes of Death in low-income countries: polymerase chain reaction (PCR) testing for Influenza virus; virus culture for poliovirus; serology for HIV; microscopy for mycobacterium tuberculosis; rapid diagnostic testing for plasmodium spp.; and bacterial culture for Salmonella enteritidis serotype Typhi. These six methods are critical to the detection of epidemic-prone and emerging diseases, and competency in these methods is indicated by the successful testing for the specific pathogens listed. The remaining four tests should be selected by the country on the basis of major national public health concerns (see Ijaz et al., “What gets measured gets done. Emerging Infectious Diseases July 2012;18:1054-7).

⁵ For example, accredited laboratories could be those that have completed appropriate activities according to the Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA) checklist; the Strengthening Laboratory Management Towards Accreditation (SLMTA) accreditation process; International Organization for Standardization (ISO) standards (e.g., 9001, 15189, and 17025); and/or WHO disease-specific programs (e.g., measles and polio).