Coordinating multidisciplinary, rapid support for outbreak response – a conversation with Dr Sharon Salmon, GOARN

Our guest this week is Dr Sharon Salmon, technical officer for the Global Outbreak Alert and Response Network (GOARN), hosted by the World Health Organization. GOARN is a network of over 250 technical institutions and networks globally that respond to acute public health events with the deployment of staff and resources to affected countries.

Dr. Salmon is based at the Western Pacific Regional Office of WHO working in the emergency management operations of the World Health Emergencies Programme. Prior to this, Dr Salmon worked for the Ministry of Health in Singapore and as a technical officer for WHO in Vietnam and Philippines. 

In this episode, we discuss: 

• Dr Salmon’s work with GOARN.
• How GOARN operates the importance of partnerships, particularly in the Western Pacific region. 
• Some of the challenges GOARN faced in the early days of the COVID-19 pandemic.
• Reflections on some of Dr Salmon’s deployments to Liberia during the 2014 Ebola outbreak.
• The key priorities for GOARN’s recently launched 2022 - 2026 Strategy. 

We encourage you to join the conversation on Twitter at @CentreHealthSec. You can also follow GOARN at @WHOGOARN and https://goarn.who.int/

Transcript

Please note: We provide transcripts for information purposes only. Anyone accessing our transcripts undertake responsibility for assessing the relevance and accuracy of the content. Before using the material contained in a transcript, the permission of the relevant presenter should be obtained.   

The views presented in this podcast are the views of the host and guests. They do not necessarily represent the views or the official position of the Australian Government. 

Dr Stephanie Williams 00:35

Hello, and welcome to Contain This. I'm Dr. Stephanie Williams, Australia's Ambassador for Regional Health Security. I'd like to acknowledge the Traditional Owners and Custodians of Country throughout Australia and the Indo Pacific region. We recognise the continuing connection to land, waters, and community and pay our respects to Elder's past, present and emerging. Today, I'm joined by Dr. Sharon Salmon, who is a technical officer for the Global Outbreak Alert and Response Network, or GOARN is the acronym for short. GOARN is a network of over 250 technical institutions and networks that responds to acute public health events through the deployment of staff and resources to affected countries. GOARN is hosted by the World Health Organization but is a collection of external institutions. To do her role, Dr. Salmon is based at the Western Pacific Regional Office of WHO, working in the emergency management operations of the World Health Emergencies Programme. In this episode, Dr. Salmon discusses her work with GOARN and how GOARN operates, the importance of partnerships, particularly in the Western Pacific region, some of the challenges GOARN faced in the early days of the COVID pandemic, and some reflections of her own deployments to Liberia during the Ebola outbreak of 2014. She also outlines the priorities for the recently launched GOARN 2022 to 2026 strategy. I hope you enjoy the conversation. Sharon, thanks for joining us today on Contain This, you work for GOARN. What does it actually stand for? And what are you doing there? 

Dr Sharon Salmon 02:22

Thanks very much for having me, Steph, and it's great to be able to have a chat with you. So GOARN stands for the Global Outbreak Alert and Response Network. It was established in the year 2000, in April 2000, and it's a global technical partnership coordinated by the World Health Organization. And it consists of about 290 different partners, technical institutions, and networks that are capable of providing technical support for member states that request for help for alert response and activities. And GOARN, as we call it, the Global Outbreak Alert and Response Network provides this coordination for multidisciplinary, rapid support for technical experts for outbreak response.

Dr Stephanie Williams 03:12

So what happened, what was happening in around the year 2000? Why did we need GOARN then?

Dr Sharon Salmon 03:20

There was more and more outbreaks that were occurring around the year 2000, and we realised that coordination within the field needed to be strengthened. And there needed to be a body around it because there were so many partners that were in the field, it seemed that we needed to have a mechanism to be able to bring partners together to talk about response so that we could better coordinate and utilise the different resources from different partners and different technical expertise from around the world to be able to provide a better response within the field, without causing more confusion and more different players doing, I guess, the same thing at once. So it was about enhancing response capacities during a, during an outbreak in a particular country. 

Dr Stephanie Williams 04:06

So when GOARN sends people to the field, are these WHO teams or WHO individuals? Can you explain, help us understand how the mechanism works.

Dr Sharon Salmon 04:19

So, there's usually an event that happens in a country and based on that event, the Ministry of Health or the national leader of that country will then be able to put out an alert to WHO, that alert is then graded. And depending on that grade, then there's a request for an assistance that would be initiated by that particular country. That request of assistance will then detail the types of technical expertise that is required to help with that response. Now, it can be one particular expertise, it can be several expertise, and it can be either one or several people or several teams of people that may be requested to support that activity. So, based on that request for assistance that has to come from the country, we then support what they're asking for. So you can be an individual, for example, a single epidemiologist being deployed from one of the 290 partner institutions to that country. Or it may be several epidemiologists from different partner organisations, maybe the request is for three epidemiologists to support country operations, three separate people from different partner organisations, deploying at the same time to go help the country support. So you can be single, you can be deployed from GOARN and then work within a WHO country office team. Or you can be a team of different experts from different organisations, or the same organisation going in to be able to support the country. So I guess there's different team dynamics and team compositions for support depending on what the country is asking for. 

Dr Stephanie Williams 06:10

So you talked about GOARN being a network have now 290 partner institutions, what are the types of institutions that are you know, broadly speaking, GOARN members, and, you know, you've been working with us at the Centre for Health Security, looking at the Western Pacific region, and increasing the number of partners, just tell us about who are the members of the network? 

Dr Sharon Salmon 06:32

Yeah, they come from all different types of organisations, and they have to be not not for profit is the number one key to be a GOARN partner institution. They can be Ministries of Health or specific departments, for example, the epidemiology branch can be a partner, different universities so from Australia, we've got the Australian National University, we've also got Griffith University. So they can be university academic institutions, or departments within universities. They can be hospitals, or health services. And they can also be NGOs as well that are a part of GOARN. And of course, some of the partners are UN organisations as well, that support GOARN also that can be also through WHO as well to be able to support rapid response as well.

Dr Stephanie Williams 07:23

And you've been very effective WPRO, Western Pacific Regional Office GOARN lead over the last few years looking at increasing the number of partner institutions from the Western Pacific region. In the GOARN network, how did you go about that? What were some of your approaches in the last couple of years to try and increase the membership in the Indo Pacific?

Dr Sharon Salmon 07:49

Yeah, I think that the key thing with partnerships is always being able to talk to as many people as possible to be able to advocate for what GOARN is I mean, it's a it's something that you and I can say quite, quite quickly off our tongue, GOARN, but to a lot of people, they don't understand what what GOARN actually stands for, and what it does in the field. So it's through having a lot of different advocacy sessions, talking to people, and being able to talk to them about the value of being involved in such a big network. GOARN is the largest global network for outbreak responders. And it's, I've reached out to different partners that have different capabilities. For example, one of our newer partners from Australia is the Sydney Infectious Diseases Unit, within the University of Sydney. They've joined on board because they have capacities to be able to deliver training, they've got capacities to be able to link into their hospitals and other networks as well, to be able to help deploy staff that may be able to support outbreak, international outbreak response. So it's talking a lot, it's about communications and, and a two-way conversation. What's the benefit to the partners being part of a global organisation, then having further collaborations for the work that they're already doing. And and being part of that response to be able to help and better public health response. 

Dr Stephanie Williams 09:23

So what happened during COVID for GOARN? What was the activity like when around the world there was simultaneous demand for support for infectious disease outbreak response?

Dr Sharon Salmon 09:37

I do have to say it was it was a challenge. It was an absolute challenge, not only with the competing domestic priorities of countries trying to be able to do their own preparedness and response activities, but we had international border closures. There was different vaccine requirements and quarantine requirements for individuals going into countries, and there was there was no flights, there was a limited amount of flights to be able to deploy people physically into into a country, regardless of all the other constraints, like I mentioned, visas and, and vaccinations, quarantine. Despite all of those challenges, we were still able to deploy approximately about 200 experts into the field globally. For the Western Pacific region, which has 37 member states, countries, and territories, we were able to deploy 84 individuals throughout the COVID-19 response. So this was reflects about 30% of all global deployments for COVID-19. So I think that we persevered to be able to break down some of those barriers in terms of, for example, for international flights, to get to the Pacific Islands and the Pacific Islands was closed off for flights and being able to enter. But we were able to do things like do charter flights to be able to bring in specific experts that required that were required into the field. So we had to navigate a lot of the, I guess the said, process for for deployments to be able to manage how we could get international experts into the field. So logistics was one of our being able to work very closely with the Ministries of Health to be able to get those permissions to get into countries. And a key thing is that GOARN and likes to do rapid deployments and we always will say, we want to get between 24 hours to 72 hours someone in the field, to be honest, Steph, that was virtually impossible. Our quickest deployment to the field happened over about a week period. But some of our deployments took as long as about six months to be able to tailor to get that into the field. So how did we navigate that? Instead of short GOARN deployments of up to two weeks or three weeks that we would usually do outside of COVID-19, we extended it. It didn't make sense to be able to deploy people to the field for two weeks when administratively we've spent three months trying to get them into the field. So we had to work a lot with partners to be able to negotiate and see if they would be able to support at least eight weeks, preferably 12 weeks in the field to support COVID-19 operations, which was welcomed by our member states. And we had 14 of our member states within the 37 within WPRO receiving our support through GOARN. 

Dr Stephanie Williams 12:47

You're being very modest in how much of our hand you had in making WPRO, the most active region for GOARN deployments, I know that you personally facilitated and very proactively managed a lot of that load. It's an interesting reflection about the types of deployments and the change, both in the length that you were talking that came about by logistic necessity but ended up being welcomed by some partner countries. And then when we think about the simultaneous need during a respiratory pandemic, like COVID, the importance of national capacity and, and self-reliance and localisation in terms of how we think about I guess a 'yesterday's model' of fly in fly out outbreak investigation and response to what our model is over the next 5, 10, 15 years. This week, the GOARN strategy 2022 to 2026 was launched. Tell me about what is going to change for GOARN, when GOARN talks about community at the centre of what they do and national capacity building. How does GOARN actually do that?

Dr Sharon Salmon 13:57

So the launch of the GOARN 2022 - 2026 strategy, actually just documents the work that we've been doing for the past 20 23 years and for GOARN, the community has always been at the centre because they're the ones that or that we need to be able to work with to be able to make any response effective. So I think that the GOARN 2022 - 2026 strategy is just the documentation for it. How do we continue to want to be able to do that is is to continue to work with our partners even more closely. Hence, we're reaching out, we're doing more advocacy to be able to reach out to the partners that are working closer with these with with the communities to be able to understand how better we can do activities that are tailored to specific communities, specific contexts within regions, as well, to be able to deliver better capacity building, better training, working with national authorities to be able to support domestic response. So taking it away from relying on international experts to be able to fly in, and working at the national capacity to be able to build that. COVID-19 definitely surfaced the fact that domestic response needs to be built up, because we were unable to get in experts timely, we still got experts in, but it was delayed. So we need to be able to build up those layers within national capacity so that we can then supplement it with further international support from different partner institutions. So going back to the strategy, it's giving partners, an idea, a better idea of what our capacities are, who we're putting at the centre, and how they can then better contribute. And that's exactly what the strategy launch was yesterday, how can partners better contribute to the work that is ongoing and always ongoing with with GOARN? Because we can't do it alone. And we need partners involved.

Dr Stephanie Williams 16:05

And you're talking about partners, as in the GOARN member institutions, be that any infectious disease hospital in Japan, or a public health organisation in Kenya, I mean, it's it's you have a broad church of partners, do you think you're talking about the partners in the countries themselves, potentially, in lower income or lower middle-income countries doing in country development, or working closely with their ministries? How does the ongoing link to national capacity work for GOARN?

Dr Sharon Salmon 16:41

So I guess there's different ways that the different partner institutions can link up and there's some partner institutions that are already linked very closely to the government, so to leverage on that relationship, to be able to continue to influence, you know, training and capacity building for preparedness, because that's what we need, we need to keep strengthening preparedness at the national level. Other organisations that may be involved in, for example, in hospital, hospital work, it's about getting those, those particular individuals that are working in these clinical settings, better connected to the global work so that they understand that their work can not only have an impact that acute clinical needs, but also at global level as well, because they understand the context, they understand how the people work, and how the communities interact with each other. We we knew from COVID-19 that we needed to be better connected with with communities to understand how infectious diseases spread within communities, and how they communicate so that messages can be able to go through for risk communications and, and just community engagement in general. So we need to be able to better leverage on these relationships existing in countries to be able to support that national preparedness, and in effect, helping global preparedness as well. 

Dr Stephanie Williams 18:08

I want to switch now to asking you about you and how you got to where you are today professionally. Tell us a bit about your career path to this point.

Dr Sharon Salmon 18:17

My journey started with the I'm registered nurse coming from Sydney, Australia. I spent a lot of my time within acute facilities in Sydney and moved on to infection prevention and control. I ended up at the New South Wales Department of Health as a communicable diseases surveillance officer and after completing my Master of Public Health, I was led to an opportunity to apply for the Australian Youth Ambassador for Development Programme, which was held by then AusAID. And I went overseas to a post in a place called Vinh in a province Nghệ An in Vietnam. And I was there for eight months, ended up extending for 12 months because I enjoyed it so much, working on a child health development project at provincial level and district and commune level, it was an amazing amount of work that shifted my whole mindset on how to be able to support low to middle income countries. So from from there, I went back to Sydney, and I told my boss, I think I need to go back, and she said, I knew it. So I ended up going back to Vietnam and this was in 2005 and I've never come back to Australia since 2005. That's led me on to from from doing that there was avian influenza outbreak and that led me into WHO where I worked doing avian influenza work and infection prevention control at a much larger regional level. I ended up leaving WHO to pursue my PhD which was in hand hygiene barriers and facilitators for Vietnam. So I did my fieldwork within Vietnam and, and did my PhD while working, I moved to Singapore and was working there for about 10 years with the Ministry of Health and with the National University of Singapore, as the Assistant Director of Nursing, so leading infection prevention and control programme. I ended up leaving there after 10 years, and it was December 2019, and I left my infection prevention and control team to be able to come back to WPRO and I still apologise to my team, who if they listen, I apologise that I left them at the brink of the biggest pandemic ever. But in I guess, in true nature, they survived it. And they did absolutely fantastic in terms of their, their work to be able to get through the pandemic. But it led me back into the Western Pacific Regional Office, where I started in 2007, to be able to do things like incident manager for the COVID-19 response for the region.

Dr Stephanie Williams 21:01

As an Australian graduate of a master’s in public health and a surveillance officer and a registered nurse, what was the actual pathway to WHO and that's of high interest to many Australians and and our counterparts across the region, in how you find those opportunities, what was specifically the opportunity to you in 2007?

Dr Sharon Salmon 21:23

In 2007, I was attending a meeting, talking about safe injection practices, and WHO was at this meeting as well. And they were very interested in having the portfolio of skill sets for infection prevention and control, also communicable diseases, and also experience within developing countries to be able to have someone with these specific skill sets, technical skill sets in the regional office to be able to support much broader for member states. And the opportunity came up through discussions with people at this particular meeting. To be able to say, we actually need this particular expertise of infection prevention and control, because it fits into the Asia Pacific strategy for emerging diseases, which was just launched around the same time as the International Health Regulations had come out. So there was a big push to be able to get key experts in the field to drive these programmes forward. So I guess the stars aligned, technical expertise aligned as well. And at that particular point, there wasn't that many infection prevention and control experts that happened to be floating around in Vietnam doing global health. So I would always say that for opportunity, it's always making yourself available and talking to as many people as possible about your, your particular skill set.

Dr Stephanie Williams 22:56

When you look back at the last couple of years, not only were you coordinating GOARN deployments from Manila, so COVID response, you deployed yourself. Can you tell us a bit about what was your most professionally satisfying deployment, and why? What were the kinds of things that you did when you were deployed, for example, as an incident manager or in whatever capacity you were in your most satisfying deployment? 

Dr Sharon Salmon 23:25

Yeah, so I've been so when I first went to WPRO, I was also deploying through GOARN so I think I've been affiliated with GOARN since about 2008. So even during my time when I was in Singapore, I was deploying also, for responses. And I would have to say that leading teams as an incident manager recently for COVID-19 response, really memorable, really hard working, you know, setting the heart racing as well, because you're you're really having to direct the response. But my most memorable deployment is actually to during the Ebola virus disease outbreak in West Africa, where I was deployed to Monrovia, Liberia. I deployed there three times, at the very beginning of the outbreak when there was only six cases, when there was about 700 cases per week in Liberia, and then at the end, when there was it was tapering off in Liberia. But at the peak of the Ebola outbreak, that was probably the most intense response I've attended. And why that was so impactful was because I've come from an acute hospital background for infection prevention control and always thinking about infection prevention control in healthcare facilities, but this required community-based interventions, working with the community and understanding community needs, and translating what we would use in high resource settings to then resource settings that have never seen things like gloves, never seen things like hand sanitiser bottles, how you could make it safe to take care of the volume of people that were affected by Ebola in communities was probably the most rewarding part of any response that I've I've gone to because with the communities, they were able to share with me what they could possibly do in a very resource limited environment, such as, you know, wearing bags, shopping bags, on your hands, instead of gloves to be able to take care of dying relatives, or a friend, family safely in the in the in the home. So it's through these interactions with people that are really humble, and understand context, and that then understand how disease spreads. And to make those adaptations in the field. That's the rewarding part of being able to do outbreak response.

Dr Stephanie Williams 25:58

What you see the role of Australia, in the region, in infectious disease and public health and development for health broadly, I mean, you're an Australian, but you're really an internationalist, sitting with WHO and, and have a view across multiple ministries. I'm interested in where you think Australia is doing well, and where we could do better as we work in partnership to promote health in the Indo Pacific. 

Dr Sharon Salmon 26:29

I think Australia is in a, in a really good position to be able to, especially for our Pacific Island countries, to be able to be the convener or facilitator to get these different, I guess, different technical experts to be able to come together to be able to collaborate, know each other, so that when there is an outbreak, they know who they're talking to. So this connectedness between leaders, I think, Australia is in a really good position to be able to convene all of these leaders to be able to come together, and including technical experts, but also, Australia has the capacity to be able to host trainings, host and deliver a training throughout the region, whether it's held in Australia or within another in another country, to be able to keep promoting what GOARN does in terms of operational capacity to be able to respond, work with the field epidemiology training teams, so that we've got rapid responders that are able to identify when there is events, to be able to alert quickly. So I think Australia is in a really good position to continue to convene, and share the lessons learned. I know that for Australia, domestic capacity came up as well. So sharing the lessons about what we've identified in Australia for how to strengthen domestic capacity, and perhaps share those lessons also with neighbouring countries. But that convening part for Australia because there's so many great relationships between Australia and our neighbours, we can be a lead in terms of bringing technical experts and leaders together to continue to build this capacity together.

Dr Stephanie Williams 28:10

It's been such a pleasure to talk with you, Sharon, and to hear not only about what you're doing now with GOARN and the new strategy, but also on how you got there. And it's terrific for us on this podcast to be able to profile, while we would say an Australian woman leading infectious diseases and regional and global health, even if you left 2005 and haven't been back since. I'm not sure how long you'll be able to last in an office or how much longer this stint in the office will be, but thanks for making the time to talk with us today, and it's been a real pleasure.

Dr Sharon Salmon 28:47

My pleasure, Steph it was great to have a chat with you as well.

Dr Stephanie Williams 28:52

You've been listening to Dr. Sharon Salmon, technical officer with the Global Outbreak Alert and Response Network. Sharon spoke about her work, her approach to increasing the number of partner institutions within the Western Pacific region over the past couple of years, as well as the recently launched GOARN 2022 to 2026 strategy. We'll put the hyperlink on our show notes. And that strategy is focused on putting community at the centre of what we do and delivering stronger national capacity building in outbreak response. I hope you have enjoyed the conversation. I'm Dr. Stephanie Williams, Australia's Ambassador for Regional Health Security. Our podcast, Contain This, aims to bring you fresh insights, analysis, and updates on what is shaping our region in health. We look forward to having your company on the next episode.

Contain This is produced by the Indo Pacific Centre for Health Security. We acknowledge the Traditional Owners and Custodians of Country throughout Australia and the Indo Pacific region. We recognise their continuing connection to land, waters, and community and pay our respects to Elders past and present. You can follow us on Twitter @CenterHealthSec.