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Introduction
As part of a multiyear project1 to promote a cooperative relationship between U.S. and Pakistani human and animal health and infectious disease experts, the Pakistan Academy of Sciences (PAS), together with the U.S. National Academies of Sciences, Engineering, and Medicine (the National Academies), convened a bilateral workshop in Islamabad, Pakistan, to promote best practices in and improved communications, cooperation, and coordination among public, private, military, and animal health clinical laboratories in Pakistan.
The workshop, “Strengthening and Sustaining a Network of Public and Animal Health Clinical Laboratories in Pakistan,” was held on September 27-29, 2016, at PAS headquarters. It was the first major bilateral PAS-National Academies workshop. The principal hosts were Anwar Nasim (PAS President), Zabta Shinwari (PAS Secretary General), and Brigadier General Aamer Ikram (Armed Forces Institute of Pathology and Pakistan Biological Safety Association).2 PAS invited life science, public health,
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1 Subsequent to this workshop, the National Academies and PAS conducted two additional workshops. One in February 2018, which led to the Handbook on Good Clinical Laboratory Practices in Pakistan (2019), and one in October 2019, which led to a roadmap for implementation of good clinical laboratory practices contained in Implementation of Good Laboratory Practices: A Joint Pakistan–U.S. Workshop, Proceedings of a Workshop—in Brief (2020) and a virtual workshop, “Sharing Pakistani Experiences in Developing and Implementing Good Clinical Laboratory Practices for Human and Animal Health.”
2 At the time of publication, Major General Aamer Ikram was serving as the Executive Director of the National Institute of Health, Pakistan.
veterinary, and clinical laboratory experts from across Pakistan to attend, as well as approximately 30 graduate students from Pakistani institutions of higher learning. The National Academies brought six distinguished U.S. scientists/clinicians to speak at the workshop and interact with participants (see Appendix A for biosketches of U.S. speakers and National Academies planning committee members).
WORKSHOP GOALS AND ORGANIZATION
The goals of the workshop were to explore initial answers to three critical questions facing human and animal health policy makers in Pakistan:
- What information does the Pakistan central government need from the country’s clinical laboratories to promote the health and welfare of people and animals?
- What information do the laboratories need from the central government to reach the same aim?
- How can that information be communicated between and among laboratories and experts most efficiently?
The workshop featured individual presentations by Pakistani and U.S. experts, and breakout group discussions (see Appendix B for the full workshop agenda). Plenary sessions centered on six themes: (1) the current situation related to Pakistan’s clinical laboratories, (2) key elements of effective labs and lab networks, (3) communications among different stakeholders (including public health officials, healthcare providers, and the public, as well as among the labs themselves), (4) implications of clinical lab data for compliance with International Health Regulations, (5) lab leadership and culture, and (6) opportunities for collaboration and next steps within Pakistan and with international partners. The three breakout groups focused on (1) information and capability needs of labs; (2) information needs of the Ministry of National Health Services, Regulations and Coordination of Pakistan; and (3) efforts needed to develop and implement an electronic Morbidity and Mortality Weekly Report model.3
Throughout the three days of the workshop, U.S. and Pakistani attendees had the opportunity to discuss issues related to public and animal health, information management systems, emerging infectious disease including zoonotic
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3 See Appendixes B and C for breakout group questions.
diseases, and other issues that arose through the presentations, discussions, and breakout sessions. Participants also had the opportunity to build connections and collaborations through informal encounters and conversations.
ORGANIZATION OF THIS PROCEEDINGS
The workshop was organized by an independent planning committee in accordance with the procedures of the National Academies in collaboration with PAS. This proceedings provides an overview of the discussions that occurred throughout the workshop, and highlights the key points raised during the presentations, moderated panel discussions, breakout groups, and open discussions among the workshop participants.
In accordance with National Academies procedures, this proceedings has been prepared by workshop rapporteurs as a factual summary of what occurred at the workshop. The workshop did not attempt to establish any conclusions or recommendations, focusing instead on issues identified by the speakers and workshop participants. Statements, recommendations, and opinions expressed are those of individual presenters and participants and do not necessarily represent the views of all workshop participants or the planning committee, and are not necessarily endorsed or verified by the National Academies or PAS. They should not be construed as reflecting any group consensus. The planning committee’s role was limited to setting the agenda and convening the workshop.
OPENING REMARKS
The workshop opened on the morning of September 27, 2016, with introductions by workshop co-chairs Nasim (PAS) and Franz (the National Academies).
Nasim provided background on how the workshop was conceived and developed. Conversations about the desire to collaborate on a joint National Academies-PAS workshop began several years earlier, with intense preparation taking place throughout 2016. He lauded the role of science academies in promoting science and technology within and between countries. The U.S. and Pakistani academies have collaborated in several areas, and in each case the foundation of personal and professional trust has been critical to success. He underscored the importance of the current endeavor and the scope, including both human and animal health, given that a number of human health problems result from interaction with animals. “A function-
ing network of public and animal health clinical laboratories in Pakistan is very important,” he stressed.
Franz welcomed the government, industry, and academic leaders who attended the workshop, as well as other participants, especially the students who are the future. He recalled that the workshop began with a vision from Nasim who wanted to strengthen Pakistan’s clinical labs, especially labs in geographically remote areas. There are exceptional human resources in Pakistan, but geography can be challenging. He thanked the organizers and speakers and said that the workshop goals, in simplest terms, were to explore challenges and opportunities facing clinical labs in Pakistan. Franz understood these challenges and opportunities to be synthesized through three questions: (1) what data are most important for the central government to receive and how can it be transmitted more efficiently from the laboratories to the central government?; (2) is there a need for more information to flow from the central and/or provincial government to local clinical labs that may feel isolated?; and (3) how can data help labs be more efficient?
Infectious diseases are a challenge throughout the world. At the time of the workshop, the United States was dealing with Zika virus, for example. Infectious diseases know no boundaries, and no country has all of the wisdom or expertise. Together, through relationships of trust, we can make a difference in Pakistan, in the United States, and regionally and globally.
TOWARD A ONE HEALTH REALITY IN PAKISTAN
Muhammad Baligh Ur Rehman, Minister for Federal Education and Professional Training, was invited by PAS as Chief Guest at the workshop. He began by thanking the organizers and acknowledging the role of PAS in addressing issues of great international importance. Picking up on Nasim’s remarks and giving impetus to the workshop, he noted the role of the One Health concept, which recognizes the importance of the interrelationship between human health, animal health, and the environment.4
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4 One Health is defined as “a collaborative, multisectoral, and transdisciplinary approach—working at the local, regional, national, and global levels—with the goal of achieving optimal health outcomes recognizing the interconnection between people, animals, plants, and their shared environment.” For more information, see https://www.cdc.gov/onehealth/basics/index.html.
For more information about ongoing One Health initiatives in Pakistan, see the One Health Hub Pakistan at http://www.onehealthnetwork.asia/node/76 and the Pak One Health Alliance at http://www.pakonehealth.org/about.php.
Many infectious diseases are zoonotic in nature, and Pakistan’s large population of farmers and others living in close proximity with animals makes this topic particularly salient as made evident by the recent emergence of Crimean-Congo hemorrhagic fever. Rehman was gratified to know that the workshop covered a wide spectrum of issues related to human and animal health safety and security. Biosafety and biosecurity at Pakistan’s laboratories are also of concern. He noted that including these concepts at all labs around the world will contribute to better global control of infectious disease, improved disease surveillance and effective communication, and hence provide better healthcare and health security.
There are also concerns about the misuse of biological research. Recent advances in biological sciences and biotechnology have brought scientists together to address issues of potential misuse. No national effort alone is sufficient, and more cooperation is needed. In the spirit of true cooperation, those in the regions of Pakistan need to nurture a society that is responsible in its conduct and informed about trends in life sciences. We must join hands in action-oriented efforts to increase awareness about biosafety and biosecurity issues worldwide, Rehman said. It is an opportune time to revive contacts and discuss issues of mutual interest. This workshop augmented efforts to strengthen and sustain clinical lab effectiveness in Pakistan. In a broader context, this workshop contributed to better global control of infectious disease, to improved disease surveillance and effective communications, and hence to the provision of better healthcare and health security.
The Ministry for Federal Education and Professional Training is striving to cope with the challenges of education in Pakistan, including ensuring that all children attend school and have a quality education. Despite hopelessness, millions of children are now in school because of the efforts of the government since 2013. The quality of public schools is improving, and some children are shifting from private to public schools. This is a clear indication of the improvement in the quality of education, he said, and as a result, Pakistan has substantially increased the funding for higher eduction. Funding for higher education grants to public-sector institutes is greater than it has ever been. Rehman said that the government is striving for better integration among three pillars of the country: policy makers, scientists, and civil society. The high-quality of scientific research in Pakistan is appreciated, and at the same time, there are efforts under way to increase the number of research projects in the area of applied sciences to address the needs of the country. At the government level, there is increasing recognition of the role and contributions of PAS.
Although there are budget limitations, over time investment in science has increased, and this trend will continue.
It is always inspiring to see Pakistani scientists making contributions in the international arena, Rehman said. In the context of increased concern about pathogenic and epidemic infectious disease, scientists are using biotechnology to develop new diagnostic tools for rapid and sensitive detection of pathogens. Biotechnology is also used extensively in the study of emerging infectious diseases. The situation is also improving on the animal side. Previously, Pakistan had only one veterinary university, and now the government of Punjab province is establishing a state-of-the-art veterinary and livestock university.
