Testing early warning and response systems through a full-scale exercise in Vietnam

Abstract

Background: Simulation exercises can functionally validate World Health Organization (WHO) International Health Regulations (IHR 2005) core capacities. In 2018, the Vietnam Ministry of Health (MOH) conducted a full-scale exercise (FSX) in response to cases of severe viral pneumonia with subsequent laboratory confirmation for Middle East Respiratory Syndrome Coronavirus (MERS-CoV) to evaluate the country's early warning and response capabilities for high-risk events.

Methods: An exercise planning team designed a complex fictitious scenario beginning with one case of severe viral pneumonia presenting at the hospital level and developed all the materials required for the exercise. Actors, controllers and evaluators were trained. In August 2018, a 3-day exercise was conducted in Quang Ninh province and Hanoi city, with participation of public health partners at the community, district, province, regional and national levels. Immediate debriefings and an after-action review were conducted after all exercise activities. Participants assessed overall exercise design, conduction and usefulness.

Results: FSX findings demonstrated that the event-based surveillance component of the MOH surveillance system worked optimally at different administrative levels. Detection and reporting of signals at the community and health facility levels were appropriate. Triage, verification and risk assessment were successfully implemented to identify a high-risk event and trigger timely response. The FSX identified infection control, coordination with internal and external response partners and process documentation as response challenges. Participants positively evaluated the exercise training and design.

Conclusions: This exercise documents the value of exercising surveillance capabilities as part of a real-time operational scenario before facing a true emergency. The timing of this exercise and choice of disease scenario was particularly fortuitous given the subsequent appearance of COVID-19. As a result of this exercise and subsequent improvements made by the MOH, the country may have been better able to deal with the emergence of SARS-CoV-2 and contain it.

Keywords: Early warning and response; Full scale exercise; Vietnam.

Fig. 1

Locations for the 2018 full-scale exercise in Vietnam. The exercise was conducted in Quang Ninh province and Hanoi city (both in red). Source: Wikimedia Commons (https://commons.wikimedia.org/wiki/File:Vietnam_location_map.svg). The original figure was slightly modified by the authors of this manuscript

Fig. 2

The 2018 Vietnam public health full-scale exercise scenario and process flow. The diagram provides an overview the process flow of the full-scale exercise at every administrative level. Administrative levels are shown in boxes. Solid black arrows represent interactions and flow of information/laboratory samples among different administrative levels. Dashed black arrows represent some of the main activities conducted by the administrative levels. The colored dots represent the type of players involved in each level