EWARS-csd

EWARS falls into the Country preparedness and outbreak response scope of work. It was designed to predict effectively and, in a user, friendly manner epidemics of climate-sensitive diseases such as dengue, chikungunya, Zika, cholera, malaria, among others. EWARS’ conceptualization was based on the biological relationship between the change in a weather condition and the manifestation of a disease outbreak in a specific geographic area/population. EWARS is therefore perceived not only as a statistical but also as an information system designed to support decision-making for national and local level health institutions, enabling them to take action to mitigate the impact of an impending outbreak.

This predicting tool aims at: (i) strengthening surveillance systems for climate sensitive diseases; and ii) triggering early vector control by strengthening the coordination between all relevant stakeholders, such as local epidemiologists, meteorologists, entomologists, national and local management agencies that assess risk and develop response strategies, and the public communication channels used to disseminate warning information.

Climate sensitive infectious diseases are currently the fastest spreading illnesses in the world, with over half of the world’s population living in areas at risk of dengue, as one of many examples. With climate change, such diseases continue to spread and become a health burden for more communities. It is essential to have tools that can predict when and where outbreaks might occur, to better prepare communities and control programmes.
Usually, a country’s national vector control programme is guided by reported cases, which are often under estimated. EWARS works upstream by predicting in advance outbreak scenarios based on alarm predictors such as meteorological, epidemiological, and entomological data, which can guide an early structured response in time and space, prior to the disease manifestation.

EWARS builds a prediction algorithm that is data and area specific, using historical disease records, and analyses retrospectively their association with alarm indicators (which are the functions of dashboard 1 used at the country or central level). It further employs prospective (weekly) alarm information, e.g., mean temperature, humidity, rainfall, ovitrap index, among others, to predict a forthcoming outbreak (which is a function of dashboard 2 used at district level). EWARS uses a robust modelling system with a user-friendly interface to enable data understanding by frontline health care workers and data use for appropriate local response. It has the potential to improve collaboration at regional level (i.e., regional surveillance, data sourcing, joint response, etc.) for surveillance and response, applying a multisectoral approach.

EWARS employed a co-design and co-production approach led by the UNICEF/UNDP/World Bank/ WHO Special Programme for Research and Training in Tropical Diseases (TDR) and the World Health Organization’s Climate Change and Health Unit, together with endemic countries, the University of Freiburg (Germany) and the University of Gothenburg (Sweden), and engaging key stakeholders such as the World Meteorological Organization, IT experts, endemic partner countries (ministries of health, district health managers, local meteorological and entomological entities) in five WHO regions. Its development benefited from users’ feedback, including recommendations for improvements.

EWARS has been developed, used, and validated since 2012 in more than 17 countries in the WHO Regions of Africa, the Americas, the Eastern Mediterranean, South-East Asia and the Western Pacific, and is close to being fully implemented in the national surveillance platforms of Colombia, the Dominican Republic, Mexico and Thailand.

EWARS is a free open-access tool, based on free R software, created with the aim of granting countries full ownership of the tool and its processes.

Country ministries of health and district health managers.

All tropical and sub-tropical countries prone to climate sensitive diseases. EWARS is currently being used in five of the six WHO regions (see above).

A generic English version is offered, but typically once installed in the country’s local server, local language can be used. For instance, the Dominican Republic and Mexico have the tool in Spanish and Thailand in Thai.

Essentially, EWARS is designed in such a way that it can integrate within countries’ routine activities, i.e., not to add more work or effort on already overstretched national control programmes. It facilitates a user-friendly interface (only minimal calibration or application needed) and can be hosted by any local server so that ministry of health and districts/ municipalities are digitally connected for information exchange and monitoring.

It is designed in a flexible way so that countries can monitor alarm signals at the central and local level. Commonly, the ministry of health or the national institute of health is the central level overseeing the process, but the district level is usually the first to take action, in agreement with the central level. Larger countries such as India could see states acting as central levels to align with the large number of districts and localities. Interoperability with the surveillance system DHIS2 has also been achieved.

The WHO/Climate Change and Health Unit (CCH) and TDR are overseeing the administrative process, while the partner universities (Freiburg and Gothenburg) maintain the technical and operational aspects, as well as providing expertise on surveillance, training, and response. TDR supports implementation research for evaluating the feasibility, acceptability and impact of using EWARS and WHO/CCH is helping with access to meteorological data.

The tool is 100% owned by users and uploaded on local servers, so countries take control of their data, ensuring security and privacy. The tool is further designed to allow secured access and communication within and between districts, i.e., ministries of health have the administrative power to assign users and passwords.

Data management and reporting
• EWARS works as a subset of the national surveillance programme.
• While it requires simple time and area specific information (in Excel format), it can also act as a data hub/storage of prospective information.
• It organizes the data feeding in an automated way, automatically connecting, and feeding data between the surveillance programme and meteorological or entomological entities, which saves time and effort and improves consistency of data.

Availability and support
• The tool has a series of published reports (available on WHO’s website), video training (on YouTube and the EWARS GitHub) and pre-recorded PowerPoint presentations to guide users in the installation, calibration, and interpretation of the tool’s parameters.
• The EWARS team provides monthly follow-up and technical assistance.

Customization and flexibility
• The tool relies on the country’s local (often already existing) server.
• Country IT personnel are engaged to understand the tool’s features and to take part in the installation process.
• The tool is designed in such a way that additional or independent maintenance is not required as it aligns with the routine IT tasks of the country’s server.

Security and compliance
• Data are located in and owned by the country. Therefore, data security follows the country’s own protocol. The tool provides a means for increasing the security aspects for users, but it is entirely up to users how they control that.

User management
• There is no limitation to the number of users, depending on the server’s capacity. However, by virtue of the automated feature of data feeding, the central level (ministry of health) will do the semi-automatic calibration only once per year, otherwise, no specific management activities are needed

EWARS-csd- Fact Sheet