Enhancing global health security responses through greater inclusion of the global south in infectious disease modelling

SUMMARY BOX .

• Gaps continue to persist in global public health responses and greater inclusion of the Global South in infectious disease modelling is crucial for improving global health security.

• The inaugural Infectious Disease Modelling Conference 2024 fostered inclusivity by attracting diverse participants and offering equitable access. It also showcased the pivotal role of modelling in shaping policies during pandemics.

• This will inform future research, practice and policy that building local modelling capabilities and improving research policy-maker communication are keys to addressing health threats. Equitable resource distribution and stronger global collaborations are needed for sustainable epidemic responses.

As we mark 5 years since the emergence of the COVID-19 pandemic, the world continues to face numerous epidemics of emerging and re-emerging diseases, including mpox, cholera, avian influenza, chikungunya and dengue. Concurrently, long-standing diseases such as pneumonia, tuberculosis (TB) and malaria continue to account for millions of premature and preventable deaths globally. Despite the valuable lessons in disease prevention and control during both pandemic and non-pandemic periods, gaps remain in our responses to global public health challenges, including limits to our ability to consolidate, share and analyse data to generate the evidence that policy-makers need to make the best decisions possible, at both local and global levels. Addressing these gaps requires sustained investment, development and retention of modelling and analytical capabilities, and collaboration across jurisdictions, both within and across regions, with the aim of building a united and effective global health response system. Capacity is also strengthened from sharing knowledge about the state of the art in research, and on best practices, and learning in international fora such as conferences. Efforts to enhance modelling capabilities are particularly crucial for resource-constrained countries, many of which are located in the Global South, where the gaps in data collection and analytics training are most pronounced.¹

A major hurdle in such cooperation, as evidenced during the first year of the COVID-19 pandemic, is that jurisdictions often operate in isolation, lacking synergy—even among those sharing borders and infrastructure, such as food production, labour markets and supply chains.² The barriers hindering collaboration and knowledge exchange stem from heterogeneities in public health priorities, resource availability and national policies across different jurisdictions.^{3 4} Where global coordination efforts exist, researchers from the Global South were frequently underrepresented in influential global analyses, calling into question the validity of the underlying assumptions, objectives and data, hence undermining the reliability of the results.⁵ Consequently, these analyses often found low buy-in from the Global South, ultimately undermining their overall effectiveness and, in many cases, resulting in wasted investments and preventable morbidity and mortality.

In an effort to foster a more inclusive environment for regional and global collaboration, we convened modellers, researchers, public health practitioners and health decision-makers at the inaugural Infectious Disease Modelling Conference 2024 (IDM 2024). This event was held in Bangkok, Thailand, from 6 November to 8 November 2024 (https://idmconference.net/). The conference attracted 257 participants from 30 countries and regions spanning 6 continents, with more than half (148 participants) from the Global South. This conference was fully funded by the Hong Kong Jockey Club Global Health Institute. The funding enabled a 90% and 60% discount for registrants from lower-income and lower-middle-income countries (LMICs), respectively, making registration fees broadly proportional to per capita incomes (ie, more equitable) to offset the usual cost barrier of international conferences. Conferences hosted in the Global North often impose stringent visa requirements, creating disproportionate barriers for attendees from the Global South.6,8 As such, to promote inclusivity and equity and ensure broader representation from diverse regions, we hosted the conference in Bangkok, a major air travel hub with high-quality yet affordable conference facilities and visa-free or visa-on-arrival access for many citizens from the Global South.

This commentary reflects on the key discussions and insights from IDM 2024. It highlights critical lessons learnt from the conference speakers and panellists’ regarding policy modelling in infectious diseases, while also sharing practical recommendations and approaches employed to foster greater inclusivity of stakeholders from the Global South. IDM 2024 opened with a plenary session on the Lancet Commission for Strengthening the Use of Epidemiological Modelling of Emerging and Pandemic Infectious Diseases.⁹ Dr Kiesha Prem and Dr Mark Jit emphasised the pivotal role that modelling has played in shaping policies during pandemics, particularly in influential control measures such as travel restrictions, lockdowns and vaccination campaigns. However, concerns about the quality and communication of modelling outputs have prompted calls from both the scientific community and public health decision-makers for improved standardised reporting guidelines, consistent taxonomy of models and mutual understanding. During the conference, trust and effective communication were repeatedly emphasised as paramount to successful translation of epidemic research into policies and impact.

Keynote speakers repeatedly highlighted the importance of working with local experts and stakeholders in order for data analytics and the associated findings to be trusted and adopted locally. For example, Dr Sheetal Silal of the University of Cape Town highlighted that training in malaria biology, epidemiology and modelling was aligned with the priorities of the National Malaria Control Programme to ensure sustainability of such training and practicality of skills acquired.¹⁰ She also highlighted the importance of operations management and communication skills in research translation, for example, devising and implementing cost-effective approaches to enhance vaccine coverage and distribution. Resource-constrained jurisdictions often face formidable challenges in establishing robust surveillance systems for data collection, analytics and modelling. As shared by Dr Anne Cori of Imperial College London, in their work on Ebola and mpox responses, policymakers in Africa face continued challenges in interpreting surveillance data due to a lack of local expertise and analytic tools.

IDM 2024 prominently featured diverse contributions from researchers and practitioners across the Global South, encompassing both their expertise and research tailored to the Global South context. The conference included dedicated sessions such as ‘Advancements in Epidemiological Disease Modelling for Lower-Middle-Income Countries’ and ‘Networks of infectious disease modelling in LMICs—Lessons learnt and next steps’. The key and closing panel discussion, ‘Current developments in ID modelling: Implications for LMICs’, featured prominent voices such as Dr Gautam Menon (India) and Dr Thumbi Mwangi (Kenya), offering invaluable regional perspectives. Specific research showcased included modelling studies on mpox epidemics in Thailand by Dr Thitiya Theparod, dengue epidemiology in Bangladesh by Dr Kishor Paul and colleagues, malaria distribution in India and Africa, HIV and TB programmes in Malawi, cholera transmission in Bangladesh, and COVID-19 vaccine hesitancy in the Philippines, among many others. These contributions span a wide range of diseases and methodologies, demonstrating the growing expertise and urgent relevance of modelling efforts originating from the Global South.

It is crucial to establish and strengthen modelling-to-decision pathways during public health emergencies in a sustainable, trusted and collaborative manner.¹¹ In the closing panel discussion, Dr Thumbi Mwangi recounted his team’s experience during the COVID-19 pandemic, managing diverse requests ranging from data cleaning and visualisation to modelling and health technology assessment. His team served as a trusted intermediary between the field teams collecting data and the government decision-makers in Kenya. Building trust necessitates consistent transparency, open communication, reliable actions, mutual respect and the understanding and acknowledgement of each other’s perspectives. Consequently, the most effective strategy is to develop local modelling capabilities and promote collaboration with practitioners and decision-makers not only during epidemics but also in times of peace. This is especially vital for jurisdictions in the Global South where the COVID-19 pandemic revealed significant gaps in local support for evidence-based policy-making.

Sustainability of modelling efforts is important in our combat against epidemic emergencies but also long-established public health threats. One of the unique features of IDM 2024 was an open panel discussion arranged to encourage direct conversations between participants and representatives from funders and collaborating agencies. In addition to supporting technological innovations that can generate health impacts, there was also a call for continued support to sustain and institutionalise the surveillance infrastructure, data collection and modelling capabilities established during past and current epidemics. For example, despite the severe mpox outbreak, the Democratic Republic of the Congo is still facing significant challenges with limited access to surveillance, vaccines and medicines. Countries such as the Philippines and Brazil suffer from severe dengue epidemics but lack sufficient funding for comprehensive surveillance systems, timely diagnostics and adequate medical care.¹² The discussion also emphasised that support should include the allocation of domestic resources and the identification of regional and global funding mechanisms to maintain the networks and talent pools built among modellers, researchers, funders and decision-makers at different career stages. Building capacity requires empowering the future generation of modellers. The Scientific Committee of IDM 2024 sought to integrate early career researchers in the design and execution of the conference and explored several early career initiatives, for example, sessions to connect and share resources across networks formed during the COVID-19 pandemic and sessions to inform talents in the Global South of potential career paths, to help overcome these challenges.

There remains a call for more equitable distribution of funding and global resources to sustainably manage emerging epidemic threats. Antimicrobial resistance has emerged as a silent global health threat that has been neglected for decades. The problem is particularly pronounced in the Global South due to limited access to new antibiotics, lack of surveillance and diagnostic capability, and low awareness of antibiotic stewardship.¹³ Avian influenza A/H5N1 poses significant pandemic risks due to its potential to mutate and spread globally, though it is not currently causing widespread human infections.¹⁴ Unlike the Global North’s focus on technological innovation and development of new antimicrobials and vaccines, the priorities of the Global South are centred around more basic public health measures such as clean water and sanitation, vaccine access and coverage, and food preparation hygiene.¹⁵ As highlighted by Dr Zulma Cucunubá of the Xavierian Pontifical University (Pontificia Universidad Javeriana) in the closing panel discussion, harmonisation and sustainability can be improved through strengthened North-South and South-South networking and collaborations.¹⁶ Greater integration of global health leaders and local modelling experts in these processes is essential to fostering a sustained, vested interest in translating scientific knowledge into actionable health policy options, ultimately leading to better health outcomes.¹⁷

In response to the COVID-19 pandemic, a community of modellers, public health practitioners and decision-makers has emerged and thrived. The IDM 2024 conference sought to sustain this momentum with an emphasis on the importance of integrating local and global expertise and helping this community grow. More South-focused, empowering initiatives like IDM 2024 are needed to foster balanced, reciprocal collaboration given that we are all connected in several ways. By building on past lessons and ensuring more inclusive responses, particularly for the Global South, we can better address longstanding and emerging threats.

Data availability statement

No data are available.