LabNet, a key operational arm of the PPHSN, had its origins at the Inaugural Meeting of the PPHSN Public Health Laboratory Network, in Noumea in April 2000. At that meeting it was proposed to establish a three-tiered system of public health laboratory support services in the Pacific, and to focus initially on six outbreak-prone diseases: measles (and rubella), dengue, leptospirosis, influenza, cholera and typhoid.
The three tiers of laboratories were designated L1 (Level 1), L2 and L3, and intended to provide a system for all countries to draw on existing laboratory expertise in and around the Pacific. The tiers, or levels, are functional designations. That is, they indicate the role that each laboratory plays in Pacific LabNet services, not its technical capacity. Thus, L1 indicates a laboratory that provides services only to its own constituency or jurisdiction. L2 is a laboratory within the Pacific Islands that has agreed to provide selected public health laboratory services to any L1 laboratory in the region (determined largely by geography and ease of transport). L3 is a laboratory that will accept specimens for selected conditions from an L2 laboratory, for reference work, quality assurance, or more sophisticated testing.
Four Pacific laboratories initially agreed to an L2 role: Institut Pasteur New Caledonia (IPNC), Institut Malardé Tahiti, Mataika House Fiji and the Guam Public Health Laboratory. To oversee the administrative and technical aspects of LabNet, a Technical Working Body (TWB) was formed, with three member agencies: WHO, SPC and IPNC, with IPNC serving a leadership role. TWB reports to its parent network, PPHSN, through the PPHSN Coordinating Body, for which SPC is the focal point. As most readers know, PPHSN is a voluntary network of 22 Pacific Island countries and territories, supported by allied bodies including regional agencies, laboratories, academic institutions, donors and others. The structure, function and activities of PPHSN have been fully described elsewhere, especially in previous issues of Inform’ACTION and in Pacific Health Dialog.
The Guam Public Health Laboratory (GPHL) is the L2 laboratory for the north Pacific, and is most accessible to the American-affiliated Pacific Island (AAPI) jurisdictions of the Micronesian subregion: Guam, Commonwealth of the Northern Mariana Islands, Federated States of Micronesia, and the Republics of Palau and the Marshall Islands. There has been a concerted effort recently to take substantive steps forward at GPHL, to increase its capacity for providing regional services for the target diseases, and to formalize the agreements and arrangements with the L1 laboratories in the north Pacific. This has been assisted by provision of funds to all AAPIs by the US Centres for Disease Control and Prevention (CDC) for surveillance and response to agents of bioterrorism, under 2003 bioterrorism cooperative agreements. The AAPIs agreed to pool some of their resources under the umbrella of the Pacific Islands Health Officers Association (PIHOA) to improve regional laboratory services.
With this support, and following on discussions at the LabNet 2003 regional workshop in Suva in September 2003, a subregional consultation and review was convened 9–13 February 2004 in the north Pacific. This consultation brought together technical representatives from laboratories in each of the AAPI jurisdictions, and public health laboratory experts from IPNC, CDC, the US states of Hawaii and California, WHO, and the Pacific Paramedical Training Centre of New Zealand. Additional funds for the consultation were provided by the Hawaii Department of Health and WHO (through its agreement with the Global Fund to Fight AIDS, Tuberculosis, and Malaria, administered by SPC). The consultation began in Guam and included visits by two or three team members to Saipan, Pohnpei and Majuro; and concluded at the Hawaii Department of Health laboratory.
The scope of services addressed in this north Pacific LabNet initiative is somewhat broader than the six outbreak-prone diseases targeted Pacificwide, and includes agents of bioterrorism, tuberculosis, HIV and selected sexually transmissible infections. Participants in the consultation came to consensus on important points and strategies for implementation. A Regional Laboratory Advisory Board was established by the end of the consultation, and there was agreement to collaborate in preparing a final proposal for the PIHOA Directors of Health at their meeting in April 2004.
Some key elements addressed at the consultation (with examples) include:
- regional laboratory infrastructure (facilities, staffing, supervision, management);
- scope of services (primarily confirmatory testing for PPHSN priority outbreak-prone diseases, agents of bioterrorism, tuberculosis, HIV and STIs);
- inter-laboratory agreements (memoranda of understanding between L1 and L2 laboratories);
- supplies and equipment (new purchases required, stockpiles of reagents and shipping supplies, regional collaboration on biosafety cabinet maintenance and standardisation of equipment);
- training (pre-service and in-service, onsite and overseas, at both L1 and L2 laboratories);
- quality assurance (coordinated regionally);
- communications (rapid, confidential and reliable); and
- sustainable support (external funding sources, and a revolving fund to ensure ready access to funds for urgent needs).
A complete report of the February consultation is available on the PPHSN website at: http://www.spc.int/phs/PPHSN/Services/LabNet/Report_lab_review_AAPI_Feb04.pdf
Michael J. O’Leary, MD, MPH
Regional Epidemiologist (PIHOA countries)
US Centers for Disease Control and Prevention (CDC)