The Importance of Networks and Relationships: Leveraging the Biocontainment Unit Leadership Workgroup for Special Pathogen Outbreak Response

Abstract

Developing and sustaining relationships and networks before an emergency occurs is crucial. The Biocontainment Unit Leadership Workgroup is a consortium of the 13 Regional Emerging Special Pathogen Treatment Centers in the United States. Established in 2017, the volunteer-based workgroup is composed of operational leaders dedicated to maintaining readiness for special pathogen care. Monthly meetings focus on addressing operational challenges, sharing best practices, and brainstorming solutions to common problems. Task forces are leveraged to tackle more complex issues that are identified as priorities. In 2022, members of the workgroup were harnessed for response efforts related to mpox, Sudan ebolavirus, and Marburg virus disease. The weekly Outbreak Readiness call is a shared effort between the Biocontainment Unit Leadership Workgroup and the Special Pathogens Research Network of the National Emerging Special Pathogens Training and Education Center. Call participants included leaders of the Regional Emerging Special Pathogen Treatment Centers and federal partners who shared weekly updates on operational readiness of units, case counts, laboratory capacity, available medical countermeasures, and other pertinent information. The routine exchange of real-time information enabled learning and collegial sharing of experiences, highlighted the experience of the network to federal partners, and provided situational awareness of special pathogen outbreaks across the country. The consortium enabled this rapid convening of partners to meet an urgent need for special pathogen response. The weekly Outbreak Readiness call is a communication model and scalable framework that serves both domestic preparedness efforts and international efforts should the need for a collaborative global response arise. In this case study, we describe the framework and experience of this partnership, along with the structure of rapid deployment for group convening.

Introduction

Healthcare emergencies necessitate collaboration among colleagues and networks. In special pathogen outbreaks, there is limited capacity among healthcare workers caring for patients with pathogens requiring biocontainment unit level care. Harnessing networks of partners with a common purpose and passion is therefore crucial to success. Programs are learning what, if any, therapeutics are available, as well as identifying specific guidance and approaches to care for patients with a special pathogen. These partnerships are developed before a healthcare emergency, not during, and they are established over months and years of capacity and trust building. While the importance of developing and sustaining relationships before an emergency has been well described,^1-4 this case study focuses on the experience of a special pathogen network in the United States. In it, we describe the relationships and structures of the National Emerging Special Pathogens Training and Education Center (NETEC), which was leveraged to respond to real-world outbreaks of national and international concern.

Biocontainment Unit Leadership Workgroup

NETEC is a consortium dedicated to special pathogen preparedness and response across US healthcare systems. NETEC has 4 major activities: (1) consultation and assessment, (2) education and training, (3) research, and (4) international partnerships. The consortium’s activities are supported by the 13 Regional Emerging Special Pathogen Treatment Centers (RESPTCs) and other special pathogen experts.⁵

The BCU Leadership Workgroup is a consortium of the RESPTCs in the United States. Established in 2017, the volunteer-based group is composed of operational leaders dedicated to maintaining readiness for special pathogen care. It holds monthly meetings focused on addressing operational challenges, sharing best practices, and brainstorming solutions to common problems. It leverages task forces to tackle more complex issues requiring prompt action and prioritization, including operational infrastructures for managing a BCU and category A waste management protocols.

Over the past 8 years, the workgroup has served as a sounding board for open, honest, and transparent discussion for operational leaders working to maintain BCU readiness while managing increasing programmatic requirements. In 2022 and 2023, 5 major outbreaks had the potential for BCU-level care (mpox, Lassa virus, Zaire ebolavirus, Sudan ebolavirus, Marburg virus). Although mpox, formerly monkeypox, was eventually identified as the West African clade of mpox and therefore a non-BCU pathogen, the need for a rapid convening of BCU leaders was evident.

Special Pathogens Research Network

The Special Pathogens Research Network (SPRN) is an activity within NETEC that was developed in 2016 when NETEC’s charge was expanded to include developing infrastructure to support clinical research readiness for future epidemics. The need was identified to create a sustainable infrastructure for research capabilities regarding special pathogens. The mission of SPRN is to create and sustain the infrastructure to conduct multicenter clinical research to improve patient care and outcomes, reduce nosocomial transmission, and further knowledge of existing and emerging special pathogens. This infrastructure was established by launching workgroups whose activities include participation from the RESPTCs and multiple federal partners.⁶

The network conducts activities through 4 workgroups that address and develop the capabilities needed to create and sustain research infrastructure across the network. The workgroups are as follows:

Ethical Conduct of Special Pathogens Human Subjects Research

Basic and Translational State of the Science

Clinical State of the Science

Special Pathogens Research Operations Implementation

The workgroups meet on a regular schedule and have the ability to pivot their scope of work in a just-in-time fashion during an outbreak to address operational and research needs. The subject matter expertise across the network and in the workgroups can be leveraged to support an operational response to any outbreak and can provide the interpretation of the evidence base necessary to ensure a scientifically and operationally sound response across the network.

The success of the Outbreak Readiness calls, as described next, grew from a collaboration between the BCU Leadership Workgroup and the SPRN in tandem with support from essential federal partners. The established relationships, trust, and commitment to working together to advance preparedness and response has led to a sustained collaboration that can continue to flourish during a response and in times between.

Outbreak Readiness

Need for Network-Wide Situational Awareness

The ever-growing requests for visibility of healthcare capacity and capabilities in the United States prompted the need for a collaboration on readiness of the RESPTCs during outbreaks. The Outbreak Readiness call was established in March 2022 to maintain situational awareness of the capacities and capabilities, challenges, and lessons learned of the 10 specialized BCUs across the United States. Representatives from all RESPTCs were invited, with national and federal partners joining ad hoc for real-time needs (Table).

Table.

Roles and Expectations of Outbreak Readiness Call Participants

Role	Expectations
Chair/cochair	Possess knowledge and expertise of special pathogens and outbreak news o Be familiar with the entire partner network and its structure Develop and finalize agenda o Integrate time-relevant outbreak news o Share operationally relevant information Facilitate meeting discussion o Keep discussion on topic and on time Determine next steps and follow-up items o Identify the need, if any, for task forces (eg, short term, task-oriented group) o Follow up with key stakeholders and knowledge partners for information and guidance Maintain secure and confidential content of meeting
Administrator	Coordinate agenda development and share agenda prior to meeting Coordinate development of supporting materials o Update outbreak news and case reports Identify and invite presenters Collect meeting minutes and share following the meeting Upload minutes and supporting materials to shared drive Manage shared drive access Manage meeting invitation, cadence, and attendees o Invite special guests to specific meetings Collate and coordinate next steps and needs Maintain secure and confidential content of meeting
Agency representatives	Attend standing meetings Share agenda items for inclusion Report out during meetings o Provide updates on operational readiness and local/state/regional status o Highlight operational barriers and concerns o Share, when applicable, experience with special pathogen response/activations Maintain secure and confidential content of meeting
Ad hoc members	Maintain secure and confidential content of meeting Report out during meetings o Provide updates on federal/international readiness o Highlight operational barriers and concerns o Share, when applicable, experience with special pathogen response/activations

These calls began on a biweekly cadence during the 2022 Lassa fever outbreak in Nigeria, which quickly scaled up to a weekly call as other outbreaks, such as Ebola and mpox, began. These calls were structured with agendas to facilitate outbreak updates relevant to US preparedness and report outs by each center. Flexibility was integrated to support the addition of special guests and debriefs for real-world events. To maximize knowledge sharing and situational awareness, meeting minutes and additional resources were provided to everyone on the calls and archived for future reference.

To date, these calls have been used as a platform to discuss US preparedness and response for Lassa fever, mpox, Sudan ebolavirus, and Marburg virus disease outbreaks. The calls enabled partners to voice common challenges experienced at the local and regional levels, and to elevate shared experiences and challenges to key decisionmakers for help in problem solving and resolution finding. Additionally, the Outbreak Readiness calls provided situational awareness on other potential threats, including the impact of highly pathogenic avian influenza on wildlife and potentially humans, Nipah virus, and Crimean-Congo hemorrhagic fever. The Outbreak Readiness calls continue with a flexible cadence, which varies based on real-world outbreaks.

Gaps in Capability

When Sudan ebolavirus began to spread in Uganda, the participants of the Outbreak Readiness calls quickly identified a major gap in US presumptive laboratory testing capability for this particular strain of ebolavirus. The RESPTCs were asked to onboard this laboratory testing capability in collaboration with federal partners to address that gap. Using the Outbreak Readiness call as a platform for discussion, leadership identified the need for a laboratory task force to address the rapid onboarding of this testing capability. Key stakeholders were identified from each RESPTC and other agencies to be involved in this task force. Implementation calls were quickly established on a regular cadence. Once the objectives of developing this capability were met and the challenges addressed, this task force was discontinued.

Scalability

Having a platform to quickly identify a need during an outbreak and address needs with key players and subject matter experts was essential to rapidly expanding preparedness and capabilities across the United States. As the major outbreaks of concern slowed down and ultimately were declared over, the Outbreak Readiness calls were transitioned to occur every other week, although they could be scaled down or scaled up as needed. Maintaining a regular call provides an ongoing administrative benefit should this large group of players need to be convened rapidly in the future.

Successes

The Outbreak Readiness calls have successfully acted as a platform to communicate challenges, concerns, operational needs, and opportunities for collaboration across institutions with a common purpose during outbreaks of concern. Call participants represented key stakeholders and decisionmakers for their respective RESPTCs, enabling efficient and timely discussion of critical information. This increased communication transparency and situational awareness fostered trust and confidence among colleagues. Subsequently, attendees felt more comfortable sharing questions and information, resulting in more cohesive preparedness and response phases. This ultimately led to more effective consensus building at critical and urgent decision points.

In leveraging the strong network of partners to meet real-time needs, the Outbreak Readiness calls served as a conduit for resolution of common challenges and for communication of concerns to federal partners. These shared challenges could be addressed quickly, and where needed, task forces and ad hoc meetings were convened for resolution. Ultimately, this response framework allowed for a rapid increase of capabilities and capacities across the network for special pathogen preparedness.

Recommendations for Replicability and Scalability

As outbreaks continue to pose greater and greater threats to the global health system, it is critical for all players to maintain situational awareness and allow room for rapid scale-up of communication and collaboration efforts.⁷ The time to engage with partners and networks is now. The organization and participation of the Outbreak Readiness calls involved networks and institutions from the United States; however, implementing a recurring meeting cadence for situational awareness on global outbreaks is encouraged in any national or regional context to bolster readiness anywhere in the world. In addition, should multiple countries or regions implement something similar to the Outbreak Readiness calls, a consortium of these special pathogens-focused groups could also scale up collaboration to a multinational level, should an outbreak warrant such international operational collaboration.

Key components for establishing regular meetings and scaling up for specific task forces include identifying the lead agency and organization responsible for convening the group, designating a facilitator, and establishing an administrative structure and schedule. The structure can include a project manager or similar administrative team member dedicated to managing the meeting invitation, meeting agenda and notes, membership, and the central repository for information sharing. Developing a focused agenda based on the prioritized needs at the time of each convening of the group allows for a productive discussion and the determination of next steps to advance preparedness. The group must have a shared understanding of, and agreement on, the scope and intent of the meeting, as this determines where a task force is necessary to address parallel needs. This can be done in a variety of ways, including through a formal charter or during the initial kickoff meeting. Where possible, members should be program leaders with decisionmaking power and a broad understanding of the program. If confidentiality or security of the content shared during the meeting is of concern, security measures should be implemented at the onset and new members must agree to adhere to the standards upon joining.

Conclusion

Leveraging existing collaboratives for special pathogen preparedness proved to be successful in the United States. The key components to success included partnering with existing strong networks built on trust and cooperation, identifying key leaders with critical information and decisionmaking ability, and ensuring flexibility to meet the needs of constantly changing incidents. The experience in the United States can be shared and replicated by others to enhance special pathogen preparedness.

Footnotes

Acknowledgments

Thank you to the wonderful RESPTC BCU Leadership Workgroup members for their ongoing partnership and collaboration. NETEC is funded by the Administration for Strategic Preparedness and Response and US Centers for Disease Control and Prevention (U3REP150549-0549A).

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