Caribbean Public Health Agency (CARPHA) Works to Provide an All-Inclusive Response to Health Threats

December 4, 2018

In May of 2012, a luxury hotel in the Caribbean received a visitor they weren’t expecting. The dangerous viral illness, norovirus, found its way to the white sand beaches of a Caribbean island. The outbreak began with one hotel visitor who had contracted norovirus before arriving in the country; by mid-week, more than 300 people–most of them tourists–had been infected by the severe illness. After breaching the resort’s gates, the virus spread to the local community and infected hundreds of locals, including schoolchildren. It was the first outbreak of norovirus that this Caribbean island had ever seen. Before it was under control by local authorities, over 800 people had been infected.

That summer, as news of the outbreak spread on TripAdvisor and throughout tourist networks, many visitors cancelled or delayed their trips, seriously impacting the Caribbean’s summer tourist economy.

The Caribbean, which consists of 26 island countries and territories, is the most tourist-dependent region in the world–with over 50 million visitors each year. At the time of the norovirus outbreak, there was no disease early-warning surveillance system in the region that could have prevented or contained the spread of outbreaks like this. The Caribbean Public Health Agency (CARPHA), the sole public health agency in the region with responsibility for protecting and promoting health, did not find out about the outbreak until it was too late.

“That event was really an important impetus for us,” said Dr. Lisa Indar of CARPHA. “It was clear that the situation could have been prevented with an early warning and response system. And with emerging threats like Zika and H1N1, combined with the Caribbean’s unique geography and tourism-focused economy, we knew we needed a regional response.”

The result was the CARPHA Tourism and Health Program (THP), a Caribbean-wide effort that bridges the tourism and health sectors to detect and prevent health threats to visitors and local communities. A major component of the THP is a web-based, tourism health information, monitoring and early alert and response system that allows real-time detection of illnesses especially those common among travellers. It provides thresholds for reporting on various illnesses and gives cruise ship operators and owners of hotels, guesthouses,  Airbnbs and other established accommodations a clear way to provide information and seek assistance before outbreaks spiral beyond their control.

“The program is really a first of its kind in the world, because it bridges the health and tourism sectors,” Dr. Indar says. “We are pleased because we’ve seen that, when used correctly, the surveillance system works and is successful at deterring outbreaks.”

Recently, the proprietor of a small hotel used the system to prevent an outbreak of a communicable disease by reporting an illness in his establishment. Within a few hours, the Ministry of Health had been alerted, a quarantine was implemented, and the threat contained. In another large hotel, a few guests reported a gastrointestinal illness, but the swift actions of the hotel management and staff meant that a sickness that could have easily spread to hundreds was contained to a handful of cases.

The THP also supports the tourism industry by providing training and certification in advanced food safety and environmental sanitation, hospitality standards and certification schemes, and acts as a conduit to international groups. CARPHA develops and maintains partnerships with international public and private agencies–including the US Centers for Disease Control and the Public Health Agency of Canada.

Now that the system is operational and demonstrating success, Dr. Indar says that the vision for THP is to become fully integrated within each country’s system. “Our hope is that the THP is valuable enough to individual countries that it becomes part of their country surveillance plans and budgets,” she says.

The THP and CARPHA’s efforts to provide surveillance signal important steps towards readiness for health threats or epidemics. However, to date only one country (Grenada) in the region has completed a Joint External Evaluation (JEE)–a comprehensive, standardized and transparent assessment of a country’s ability to find, stop and prevent disease threats. This ‘report card’ for preparedness assesses and scores 19 areas of epidemic preparedness and response, first by a group of domestic experts and then by an external group of international experts.

The JEE may be a future step for Caribbean countries to ensure they are even better prepared in the event of health crisis. Within the Caribbean, individual countries are currently discussing potential plans for conducting a JEE with PAHO, and CARPHA has funding from the International Development Bank to complete the JEE in three countries over the next year. “It would be ideal for these systems to be linked,” said Dr. Indar, of the THP and individual countries’ JEEs. “We need to all be working together to build capacity in both our regional and country systems. That’s the best way to ensure the health and safety of locals and tourists alike.” And a key way for CARPHA and the THP to continue strengthening regional health security.

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