Hacking for global health: Tackling wicked problems, like avian influenza, with creativity

December 17, 2016

Chiang Mai wasn't Annie Maxwell's (MPP '02) first introduction to the EpiHack. As president of the Skoll Global Threats Fund, which pioneered the "epidemiology hackathon" in 2013, Maxwell had heard a good deal about them. They were multi-day events that brought together diverse stakeholders and tasked them with designing a digital tool. The goal? To allow communities to detect, report, and verify disease outbreaks in real time.

But what happened in Chiang Mai, an historic city in northern Thailand, was special, says Maxwell. "It was a big, late-night conversation. We walked into the room with one view of the world, and we came out completely different, and totally for the better."

In December of 2003, avian influenza broke out in Thailand.

Birds, like people, often get the flu, which can result in large avian losses and, sometimes, spill over to infect the humans who care for them.

Prominent U-M alumni at the Skoll global Threats Fund include Dr. Larry Brilliant (MPH '77), chairman of the board of directors, and Dr. Mark Smolinski (BS '84, MD '89), chief medical officer and director of global health.

The most common of such flu strains, and one of the deadliest, is H5N1, with a human mortality rate of 60 percent. That's the strain that hit Thailand in '03, '04, and '05—resulting in the deaths of tens of millions of birds, as well as 17 of the 25 humans who were diagnosed.

To date, the H5N1 strain of avian influenza has been largely contained to the humans who come into close contact with sick birds. But there's always the concern that, like other influenza strains, it will adapt, enabling human-to-human infections of a disease so new, so deadly, that it will launch a global pandemic.

And in Thailand, where almost half of all residents rely on backyard animal production for their livelihoods and very few have knowledge of the symptoms, and threat, of zoonotic diseases, that possibility is even more troubling.

So when researchers at Chiang Mai University expressed an interest in preparing for the next possible outbreak, the Skoll Global Threats Fund got involved.

Since its founding in 2009, says Maxwell, the Skoll Global Threats Fund has tried to identify leverage points where a moderate philanthropic investment can make a big impact on complex challenges like climate change, water security, nuclear proliferation, and pandemics.

With pandemics in particular, the fund believes there's a crucial point—after the outbreak of a disease, but before it becomes an epidemic—when quick intervention can actually head off disaster.

So in 2014, the Skoll Global Threats Fund assembled key stakeholders—physicians, environmental health specialists, veterinarians, economists, anthropologists, engineers, local government officials, foundation representatives, and computer programmers—for a three-day EpiHack at Chiang Mai University.

Their task: To build a participatory reporting tool that would allow local citizens to inform government agencies of their symptoms as soon as they became ill.

Maxwell says she walked into the event expecting that the tool that emerged would report human health concerns. "It wasn't until working with the teams for a few days that we thought, no, we need to get at this sooner," she says. "We need to be thinking about this from the animal health side."

The Participatory One Health Disease Detection (PODD) team uses geospatial information systems (GIS) to map an outbreak of blackleg disease in southern Chiang Mai.

Mapping outbreak with PODDs

The new app, Participatory One Health Disease Detection (PODD), refers to a growing international "one health" movement focused on addressing human, animal, and environmental health in concert since all are interrelated.

In 2014, the app was rolled out to 300 volunteers, more than half of whom had never owned a cell phone before, including farmers, teachers, and government officials. They were shown how to take a photo of a sick animal, to answer a series of questions, and to hit a button to submit their findings to local government agencies.

Since then, the number of local users has grown to 4,600 and collectively they have reported 36 incidents of dangerous pathogens, zoonotic in nature, including multiple cases of rabies and avian influenza. "Within the first few months, volunteers were reporting more animal disease cases in Chiang Mai than Thailand had [reported] for the entire year," says Maxwell.

One farmer, she says, reported foot-and-mouth disease in one of his cows, launching an immediate community response that is estimated to have helped save his region $4 million in revenue.

The app, she says, is innovative, but what makes it useful and relevant is that it engages community members as disease detectives while producing a quick, credible response from government agencies.

Maxwell recently returned to the Ford School to deliver the 2016 Josh Rosenthal Education Fund Lecture. Her topic: "Wicked Problems: The Role of Imagination and Creativity."

Skoll Global Threats, Maxwell said, has spent a good deal of time looking for systemic ways to foster and encourage creativity to address wicked problems, and Maxwell sees two key ingredients. The first is technology, which Maxwell believes "allows us to iterate solutions at a speed unheard of before...and to scale at a fraction of the cost."

Shortening that timeframe is vital when responding to an infectious disease outbreak in a world where trade and travel have dramatically sped transmission rates. But it's important too, she believes, because it encourages more creative thinking as people begin to expand their understanding of the possible.

Still, at the end of the day, Maxwell says, "information technology is just a product, or it's a platform, and those things are agnostic to the process." The second ingredient, engaging diverse people and perspectives in that process, is critical, she says, "to make sure that we're engaging our collective imagination, creativity, and ultimately intelligence, [because] the end product will only be as good as those engaged in the process."

"I want the ability to be able to detect disease and respond to it in the far corners of the world. And I want a way to manage and plan around risk in our ever-changing climate. And I want it not just for the wealthiest, but for the world's most vulnerable, as well," says Maxwell. That can't happen, she says, without tapping into the intelligence and experience of diverse communities who know, and can speak to, these issues.

By Erin Spanier for State & Hill, the magazine of the Gerald R. Ford School of Public Policy

Below is a formatted version of this article from State & Hill, the magazine of the Ford School. View the entire Fall 2016 State & Hill here.