Ethiopia: Using Experiences From the Polio Programme in the Response to Covid-19 Pandemic in Ethiopia - the Story of a Dedicated Frontline Laboratory Professional

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Many frontline workers are putting their lives on-the-line in the response to COVID-19 Pandemic. They put their lives at risk daily, tasked with the critical mission of controlling the spread and mitigating the impact of this pandemic. Mrs. Berhane Beyene is one of those heroines with the mission-essential task of keeping laboratory surveillance and detection of COVID-19 in motion.

As a critical Staff in the Response to the COVID-19 Pandemic, Mrs. Beyene, despite the UN Circular information on the AWW (Alternative Ways of Working) and the "stay home" announcement from the government, Mrs. Beyene is working nonstop, including weekends, and not even getting enough sleep since the declaration of COVID-19 pandemic.

Every day at the Ethiopian Public Health Institute (EPHI), Mrs. Beyene works along with her National Lab Team to make sure COVID-19 testing is conducted accurately and continuously. The Ethiopian Public Health Institute (EPHI), the technical arm of the Ministry of Health (MoH) is tasked with managing public health emergencies. Mrs. Berhane Beyene is one of the many World Health Organization (WHO) Ethiopia workers who have been deployed to the COVID-19 outbreak preparedness and now response under WHO Incident Management System. She is assigned by WHO to coordinate the laboratory pillar, mainly supporting the establishment and expansion of COVID-19 testing laboratories at the national and regional levels throughout the country.

"I feel proud of being able to do my part to serve my country in fighting against COVID-19," Berhane says while asked about her thoughts about her task during this challenging period.

Reflecting on her 22 years' experience, Berhane expressed how her expertise from the national polio laboratory and the work on other viral pathogens in the Laboratory helped her to support the establishment of COVID-19 laboratory testing capacity during the current pandemic. "I was engaged in the establishment of the National Polio Laboratory in 1998 from the inception of EPHI. With continuous technical, logistic and financial support from WHO, the Laboratory managed to conduct testing using cell culture and molecular technology for more than 3500 Acute Flaccid paralysis (AFP) samples and contacts coming through the surveillance system from 9 regions and 2 city administrations. The laboratory expanded its activity and established Environmental surveillance in three regions since 2017. The Laboratory maintained accreditation for the past 18 years and integrated other vaccine-preventable diseases laboratory detection such as measles, rubella, Rotavirus and influenza laboratory surveillance throughout the country. After integrating the National Measles Laboratory which was founded in 2005, it expanded to sub-national measles laboratories in Amhara and SNNPR regions. The national and sub-national measles laboratories are accredited under the WHO to deliver on-time laboratory result for Public Health Emergency Management by processing more than 4000 samples from the case-based surveillance throughout the country. The National Polio Laboratory and other vaccine-preventable diseases surveillance is under Public Health Emergency Management at EPHI and supported by the WHO EPI and surveillance team at the National and regional level. As a virology research team leader for the past ten years at EPHI, I have been serving as a senior researcher and licensed chief public health expert and mainly engaged with heading the National Polio and Measles Laboratory and other Viral Hemorrhagic Fever Laboratory services."

The laboratory technical guidance for COVID-19, laboratory reagent and kit provision, technical support, External Quality Assurance, laboratory capacity-building through training and supportive supervisions were the major support of WHO through the overall leadership of the WR Ethiopia Dr Boureima Hama SAMBO and the well-organized coordination of the Incident Manager Dr. Emmanuel Musa and the EPR Team Lead Dr. Aggrey Bategereza. The success of the laboratory pillar was also dependent on the dedication and contribution of other COVID-19 response team pillars such as surveillance, point of entry, risk communication, case management, logistic and Infection prevention and control.

"I am a witness of the expansion of COVID-19 laboratory testing capacity at both the national level and regional public health institutes, regional laboratories and university molecular laboratories throughout the country to reach all communities has been a tremendous achievement of EPHI, with the strong support of WHO and collaboration with other partners," said Berhane.

The laboratory expansion started at the National Influenza laboratory at EPHI and progressed to capacitate the National Bacteriology molecular laboratory, the National malaria molecular laboratory and the National HIV molecular laboratory to test for COVID-19. There are a total of seven laboratories in Addis Ababa including four laboratories at EPHI and three others namely the Armauer Hansen Research Institute (AHRI), the National Animal Health Diagnostic Centre (NAHDIC) and the Ethiopian Biotechnology Institute. Currently, the COVID-19 testing laboratories have reached 45 throughout the country. The expansion of laboratories will continue in the country in all the 11 regions with different testing platforms to reach all communities. The expansion of testing capacity which started on 7th February 2020, then reaching few hundred tests per day following the detection of the first confirmed case on March 13th, 2020, has increased tremendously to more than six (6) thousands of tests per day. This makes the total tested samples 350,160 and a total of 11,524 confirmed cases as of 23, July 2020.

Regarding human resource development, Mrs. Beyene says she is proud of the job she has done in training other laboratory personnel to strengthen their capacity to conduct COVID-19 testing and perform laboratory coordination functions. To date, more than 500 health workers have been trained on sample management and laboratory functions at national and regional levels across the country. This capacity development enables regional and national laboratories to deliver accurate laboratory results on-time and contributes to the control of COVID-19transmission while keeping safe.

Mrs. Beyene is also very grateful to the Honorable Minister of Health Dr. Liya Taddese, Director General of EPHI, Dr. Ebba Abate, Deputy Director of EPHI and National Incident Manager Mr. Aschalew Abayneh, Deputy Director- Dr.Getachew Tollera and the laboratory colleagues at EPHI who walk the long journey of polio eradication with her, Professor Oyewale Tomori and Dr.Nicksy Gumede who contributed to the establishment of the National Polio Laboratory in Ethiopia as part of the WHO AFRO Polio laboratory network, and all the dedicated laboratory professionals working day and night to win the battle against COVID-19 and protect the community. Even though the pressure is high, she says the achievement from the laboratory pillar is beyond our expectation in COVID-19 public health management which will lay a legacy for the coming generation.

"I pray always that the Almighty God will have mercy upon us and lead us to zero case COVID-19 or a low number of positive results! I think this feeling is shared by all of us!" Mrs Beyene says finally and calls upon everyone to do their best in the fight against this pandemic. "Everybody has to be a warrior against this disease and all of us have to do our own part by adhering to the preventive measures which are very critical for developing countries with limited or fragile health systems."

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