Welcome back to the lecture. Let's talk now about identifying stakeholders. So who was on your list for important stakeholders in the JE surveillance in Bangladesh? Well, you can compare it to this list. Which is who we identified as important stakeholders from our perspective when we were thinking about who would be interested in knowing the results from our surveillance and also, who would be responsible for taking action based on the data. First and foremost, we thought about the Ministry of Health and Family Welfare at the Government of Bangladesh. They are the organization with the mandate and responsibility for the public health well being for people of Bangladesh. In particular there are two groups within The Ministry of Health and Family Welfare that we thought about and included in discussions and dissemination programs of these surveillance data. The first was the Institute for Epidemiology for Disease Control and Research. They were also a collaborator on the surveillance project. And were responsible for getting data out and publicly disseminated. Next was the Expanded Program for Immunization. Our data suggested that Japanese Encephalitis was an important contributor to poor health in Bangladesh If we're interested in including JE vaccine Into the vaccine program in Bangladesh, then of course we have to be in conversation with the group that's responsible for deciding on new vaccines and for including new vaccines in the public health program. The hospitals and clinicians treating in encephalitis patients in Bangladesh are another important stakeholder. So, of course the clinicians and the hospitals who participated in the surveillance knew about what we were doing and were very interested in knowing which of the patients that we included in surveillance actually had Japanese Encephalitis. They had suspected that Japanese Encephalitis could be causing disease in the patients that they saw. But for the first time, we were able to give them real evidence that this was true. Even beyond, the hospitals that were in the surveillance program, hospitals treat encephalitis patients all over the country, and so our data showing that JE was an important cause was important for all of them to hear about. And we worked with the government to disseminate the data to these hospitals and clinicians who were treating patients. Unfortunately, JE doesn't really have a good treatment. So there is nothing that we could recommend to these stakeholders to improve clinical care. But it is important for them to know what's causing disease in their patients. Leading pediatricians in Bangladesh were an important stakeholder for us. In Asia, Japanese Encephalitis is seen as a pediatric disease, primarily. Now I showed you data from our surveillance system that suggest that that's not true in Bangladesh, that there are many adults who also have JE. But pediatricians as a group were more interested in JE and they needed to be brought into the discussion about surveillance data and what to do with it, particularly around the idea of immunization. Again, most of the considerations around vaccine were in including the vaccine in the childhood immunization program. So the pediatricians, the thought leaders, and pediatrics in the country were an important stakeholder for the surveillance program. The communities at risk were another important stakeholder. They're the ones who need to understand the risk. Most of them had never heard of Japanese Encephalitis Virus. There's no place to get the vaccine in Bangladesh, even if they wanted to buy it themselves. And so engaging them and understanding the risk was also important. Most of the time, communities at risk hear about findings from a surveillance program through the media. The media can be an important collaborator on communicating and disseminating results from surveillance and they are particularly efficient at getting the information back to communities who need to hear about it. Now finally, there were two external groups to Bangladesh who are also important stakeholders in JE surveillance. The first is PATH. They're a nonprofit organization that works to bring new technologies to improve health to low and middle income countries. And they were working with, Gavi, also known as The Vaccine Alliance, to improve access to JE vaccines throughout south and southeast Asia. So, they were supporting vaccination campaigns, and providing financing for countries that wanted to introduce JE vaccine into their expanded programs for immunization. So we had a number of meetings with those groups, largely facilitated by the World Health Organization, to discuss possibilities for Bangladesh, to introduce vaccine and what that vaccine would cost. Well, I'm sorry to say that JE vaccine has not been introduced to Bangladesh yet. The conversation is still ongoing but decisions whether to use vaccines are complex. All of our stakeholders are convinced of the utility of a JE vaccine, but there are other competing interests about which vaccines to include in the expanded program for immunization. So for now it remains under discussion. What about other interested parties? Let’s think a bit more broadly about stakeholders for other diseases. Sometimes, for some diseases, stakeholders can also be neighboring countries. Think about, for example, Ebola outbreaks that may happen in the Democratic Republic of Congo on the border with another country. Neighboring countries might be a stakeholder in their surveillance findings because they may need to take action based on those data. Stakeholders could also be our trade partners. Some diseases are spread through livestock, through our contact with agricultural animals. Think about avian influenza. Sometimes even our trading partners are stakeholders in a surveillance program. Certainly the World Health Organization can also be an important stakeholder. And next we're going to talk about an international reporting framework where the World Health Organization is a key stakeholder, and responsible for collating data from around the globe.
