Since the beginning of the COVID-19 outbreak, RKI has been actively supporting international crisis response. The RKI is a valued partner for public health institutions worldwide when it comes to the exchange of experience regarding the management of the COVID-19 outbreak. RKI’s Centre for International Health Protection (ZIG) has been continuously analyzing the international epidemiological situation through its public health intelligence team and is regularly in contact with health ministries and public health institutions in numerous countries. As of mid-March 2021, ZIG has provided assistance and advice on all public health aspects of outbreak response to over 70 countries in Africa, Asia, Europe and Latin America.
Field missions
Requests for COVID-19-related field missions arrived at RKI either via the WHO Emergency Medical Team Secretariat, via the GOARN mechanism, through GIZ, the German development cooperation agency, in the form of SEEG missions or via bilateral requests. ZIG staff, in cooperation with other RKI units and partners outside RKI, supported the following field missions:
2020
2021
2022
Ecuador (19 November to 03 December 2020)
Uzbekistan (29 October to 12 November 2020)
Namibia (18 October to 01 November 2020)
Kosovo (21 September to 03 October 2020)Uzbekistan (21 to 28 August 2020)
Tajikistan (26 July to 19 August 2020)
Cameroon (22 June to 30 July 2020)
Tajikistan (11 to 27 June 2020)
Armenia (29 April to 05 May 2020) (virtual WHO mission)
Iran (02 to 12 March 2020) (WHO mission)
Namibia (01 to 07 March 2020)
Rwanda (09 to 15 February 2020)
Iran (November and December 2021)
Nigeria (December 2021)
Kosovo and North Macedonia (October and November 2021)
Uzbekistan (20 to 30 September 2021)
Namibia (12 to 26 August 2021)
Uzbekistan (19 to 25 March and 27 May to 3 June 2021)
Namibia (December 2020 and May 2021)
Guinea (15 to 19 March 2021)
Kosovo (17 to 29 January 2021)
Nigeria, Madagascar, Democratic Republic of the Congo und Ivory Coast (February 2022)
Guinea (7 to 17 February 2022)
In addition, support was provided through the EMT National Focal Point (NFP) for the international deployment of German Emergency Medical Teams (EMTs) to assist local health facilities and ministries of health, e.g. in Armenia, Cameroon and Mongolia.
During the early phase of the epidemic, ZIG prepared a series of bilateral on-site trainings in partner countries, as well as regional trainings on SARS-CoV-2 diagnostics in cooperation with WHO and the African CDC (Africa-CDC). In parallel, ZIG received requests for material support for diagnostics. With the travel restrictions imposed in March 2020, and in close collaboration with the Africa-CDC and WHO AFRO, the planned trainings were eventually transformed into web-based trainings available in 4 languages (https://zenodo.org/record/4058349). As part of these trainings, ZIG facilitated more than 20 deliveries of diagnostic materials to participants of the online trainings. The first deliveries were sent to the Democratic Republic of Congo, Mali and Zimbabwe on 15 April. As part of the international cooperation, Africa-CDC selected the participating countries and facilitated the contact.
In total, ZIG has received nearly 100 requests from almost 50 countries for public health laboratory support since January 2020. Requests have included training on SARS-CoV-2 diagnostics, including typing of emerging variants, diagnostic materials and laboratory equipment. In this context, ZIG facilitated more than 50 shipments of diagnostic materials and consumables, as well as two shipments of laboratory equipment to bilateral partner laboratories.
Field missions, which could not take place or were very limited due to travel restrictions caused by the pandemic, were replaced by virtual exchanges with over 60 countries on technical issues. In spring 2020, this exchange was particularly intensive; at least five virtual exchange meetings took place per week at that time, including with foreign embassies in Germany, ministries of health and national health institutions. Together with numerous public health experts from all over the world, ZIG has carried out many other activities on the COVID-19 exchange of experience.
Research and other projects
The existing international health projects coordinated at RKI have used their resources and personnel to prepare for and support outbreak response in partner countries. Public health capacities that have been built up in recent years are making a visible contribution in many places to a more timely and successful crisis management. In addition to strengthening diagnostics, these capacities focus primarily on improved infection prevention and control.
In addition, ZIG has initiated a number of specific COVID-related research and other projects to answer urgent response-relevant questions.
In February of 2020, the Public Health Laboratory Support unit (ZIG 4) of the Centre for International Health Protection (ZIG) at the Robert Koch Institute received funding from the Federal Ministry of Health to train African partner countries on SARS-COV-2 specific diagnostics. Initially, the training was to be delivered in three distinct African sites as regional trainings including participants from neighboring countries. In each site, the training was to last one or two weeks, and train up to eight laboratory technicians in SARS-COV-2 diagnostics per week.
During the preparation of this project, and with the evolving COVID-19 situation, travel restrictions were imposed, prohibiting trainers as well as participants from reaching the training sites and delivering the training. With the new situation, ZIG 4 modified the training to be delivered online. Despite the pandemic, ZIG 4 managed to partner with WHO AFRO/EMRO and Africa CDC to engage a large number of laboratory technicians from several countries in Africa to participate in the training. Laboratory technicians from Afghanistan and Saudi Arabia also participated in the training. A SARS-CoV-2 PCR diagnostic online training was assumed to have a large impact on the readiness to fight and control COVID-19 as well as future similar pandemics.
To assess the extent to which this training has had the desired effect, especially given that the delivery mode changed from its initial concept and that the demand has exceeded the original expectations vis-à-vis the size of the target audience, the Evidence-based Public Health unit (ZIG 2) designed a triangulated mixed methods research strategy to study the SARS-CoV-2 PCR diagnostic online training designed and delivered by RKI’s ZIG 4.
Using key informant interviews, social network analysis, and an online survey, ZIG 2 researchers assessed the perceived usefulness and efficiency of the online training. Data was obtained from partners in Afghanistan, the Central African Republic, Comoros, Gabon, Madagascar, Mali, and Zambia.
ZIG 2 completed a systematic review of the comparative effect of different contact tracing interventions on COVID-19 morbidity and mortality. The review analysed 78 relevant studies, of which 12 were observational studies and 66 were mathematical modelling studies. While limited, the evidence from observational studies shows a role for manual and digital contact tracing in controlling the COVID-19 epidemic. Based on the results from the mathematical modelling studies, some of the policies that were found to be highly effective include: (1) Joint manual and digital contact tracing with high contact tracing app adoption by the public, along with high levels of isolation/ quarantine and social distancing (2) tracing contacts of contacts of COVID-19 cases, (3) eliminating delays in contact tracing.
ZIG 2 completed a systematic review of de-escalation strategies of non-pharmaceutical interventions following infectious disease outbreaks.
The severity of COVID-19, as well as the speed and scale of its spread, has posed a global challenge. Countries around the world have implemented stringent non-pharmaceutical interventions to control transmission and prevent health systems being overwhelmed. A literature review focusing on literature published since 2000 relating to pandemics and infectious disease outbreaks was conducted. The review identified 27 de-escalation criteria including information-based criteria such as consistent decreases in the number of confirmed cases, as well as capacity-based criteria such as the ability of health systems to treat all patients within normal capacity and capacity to test all suspected cases. A dynamic de-escalation framework was proposed based on the reviewed literature.
ZIG 2 has analyzed the effect of different OECD countries' responses to the COVID-19 epidemic on epidemiological metrics. Specifically, researchers explored the association between the variation in the level and timing of the implementation of non-pharmaceutical interventions and the effect of this variation on the rate of growth in the number of COVID-19 cases over time. The analysis was undertaken for two time periods: the first wave of the epidemic (i.e. from the start of the epidemic until July 2020) and between October and December of 2020.
Risk communication and community engagement (RCCE) are one of the key pillars of health emergency response and fundamental for the successful implementation of response measures. Strategies to communicate risks and mobilize communities to engage in controlling an outbreak and protecting the population are therefore crucial aspects of health emergency response strategies, including those developed and implemented in the context of COVID-19.
Nevertheless, little is known about the design, implementation, and effectiveness of the RCCE strategies that have been employed in the context of the COVID-19 pandemic. In order to optimize the learning from this pandemic and prepare for future public health emergencies, there is an urgent need to assess the design, implementation and effectiveness of RCCE strategies at different levels.
To assess the design and implementation of RCCE strategies, as well as their perceived effectiveness among the general public and populations that might experience language or participation barriers, e.g. due to age, language or geographical location, we interviewed 155 key informants, and 419 individuals in 73 focus group discussions in Germany, Nigeria, Singapore, and Guinea. We used qualitative research methods within an innovative, multi-disciplinary approach, drawing on communication, social, political, and anthropological sciences.
Data from the four countries have been analyzed. Two peer-reviewed manuscripts have been published:
The global spread and dynamic of the COVID-19 pandemic created a demand to generate, analyse, manage and present the rapidly growing body of data and information in an actionable and timely manner. At the same time, there was considerable uncertainty and disagreement globally regarding the effectiveness of different response measures (public health and social measures) for managing the COVID-19 pandemic.
In this project, we analysed data to provide German decision-makers with timely, actionable and relevant information for pandemic response and management. This involved in particular international data and analyses of the situation abroad in order to further improve the evidence base for corresponding recommendations by German authorities.
The project aimed to 1) improve the generation and analysis of global epidemiological data and global data on response measures, and 2) increase knowledge and analysis of response measures and contextualizing them with epidemiological developments of the pandemic.
To meet our goals, we developed a COVID-19 policy analysis framework that combined analysis of epidemiological data and response measures. Published reports provided insights into the changing dynamics of the pandemic in the relevant response measures policy context. Reports focused on some of the most pressing topics in the control of the pandemic, and presented a number of exemplar countries for which data on the topic could be informative. Archived reports can be downloaded below.
The Centre for International Health Protection (ZIG) conducted several SARS-CoV-2 seroprevalence studies worldwide. A cluster-based, risk-stratified sero-epidemiological study on SARS-CoV-2 infections of health care workers was conducted in collaboration with Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) at Kamuzu Central Hospital, Lilongwe, in Malawi. Other sero-epidemiological studies were implemented in Burkina Faso, Ivory Coast, Guinea, Madagascar, Namibia and South Africa.
From May 2021 to December 2022, the study on "Burden of COVID-19 among health care workers, assessing infection, risk factors, working experiences and one-health implications: a mixed methodology, multisite international study" was implemented in Democratic Republic of Congo, Ivory Coast, Madagascar, Nigeria and Germany. The German Federal Ministry of Health funded this study within the Global Health Protection Programme (GHPP).
All studies and protocols were continuously adapted the dynamic situation of the pandemic, e.g. in terms of vaccine deployment.
