Cross Border Public Health Emergency Dashboard

Cross Border Public Health Emergency Dashboard

    1. Introduction
         1.1 Background
This is a project proposal for the Horizon call on pandemic preparedness. Deadline 21 April 2022,
budget €10,000,000, action research and innovation.

The COVID-19 pandemic has revealed the weakness and vulnerability of the current system in the EU
and its Member States in taking timely and effective actions in response to a large-scale health
emergency. Moreover, as demonstrated by the pandemic, no single country alone can address all the
challenges associated with cross-border health threats. On the other hand, the risk of another
pandemic is real and imminent, given the increasing risks of climate change and environmental
pollution, biological threats to human health are emerging. Therefore, the reactive approach will not
be sufficient in case of a health emergency. A more proactive approach shall be adopted, aiming at
anticipating and preparedness.

The EU has already undertaken key initiatives to build a European Health Union by reinforcing the
collective health security framework. On 16 September 2021, the European Commission proposed to
establish a European Health Emergency Preparedness and Response Authority (HERA).1 In line with
the EU policy to strengthen the European Health Union, this project is designed to use the experience
of cross-border collaboration in the border region of the Netherlands, Belgium and Germany, build up
a pilot case study, which can be used as a model for pandemic preparedness in the border region, and
more broadly for other regions of Europe. This case study aims to establish a dashboard with health
risk monitoring and early warning system, with reaction measures corresponding with the risk levels.

        1.2 Innovation, output and methodology

Up to now, a lot of comparative researches have been carried out in Europe and internationally, but no
study focused on the effect of the pandemic in a border region, whereas these border regions are the
best illustration of the consequences of different national health systems and their regulations.
Therefore, the innovation of this proposal is to use the Euregional experience as a breakthrough point.
This provides an interesting scope for mutual learning (best practices and worst-case scenarios) to reach
the goal of better preparedness for another pandemic. Once the euregional framework for pandemic
preparedness is established and tested, the experience can be more broadly used in Europe and even
worldwide.

Another innovation of this proposed project is to bridge scientific research and decision/policy making
process into one course. Many researches have been carried out, however, the process of translating the
research result/evidence into policy takes a long time. Therefore, this project brings the scientific
community and health authorities together jointly achieving the goal of pandemic preparedness, so that
the needs of the health authorities can be quickly integrated into the design of the tool, and the scientific
insights can be immediately put into practice. The policy makers will be involved in the consortium so
that

This project employs a multi-disciplinary approach. The problems revealed by the pandemic are multi-
facets and thus require a multi-disciplinary approach when tackling: cross-border data will be collected
applying standardized definition, indicators and data collection forma, so that the data will be
compatible for the purpose of the study; qualitative research that is often used in social science will be
1
  Proposal for a COUNCIL REGULATION on a framework of measures for ensuring the supply of crisis-
relevant medical countermeasures in the event of a public health emergency at Union level, COM(2021) 577
final.

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employed to explore the deeper social-cultural insights of the COVID-19 pandemic; quantitative
research will also be employed in surveys and questionnaires to acquire more insight on the relevant
issues; based on the data analysis and findings of the social science study, an integrated online
dashboard will be established to support authorities in case of a health emergency. On a whole, the
project is impact oriented, meaning to learn from successes and failures, to continuously improve the
outcomes and impacts of the cooperation with partners and target groups.

The main output of the project will be a dashboard with harmonized/clearly-defined cross-border data
which covers comprehensive information that would be needed in case that a health emergency realises.
The dashboard will be accessible to civil protection authorities, public health authorities and other
relevant stakeholders who need to monitor data on public health risks. The project will start with
available data on COVID-19, SARS and influenza, and then expand the dashboard to other health
emergencies. This dashboard will equip the health authorities with the data to make informed decisions
and to respond as quick as possible to health risks. By supporting decision-making and harmonising the
assessment and communication of public health risks (through harmonization of data collection,
standardized indicators for risks, implementation and evaluation), the dashboard will contribute to better
preparedness for future crises.

    2. Work packages

WP1: Project management and coordination
A workable management to coordinate among all partners is crucial. The proposal from euPrevent is
to set up a management board (MB) and project group (PG). The MB supports partners in the
administration of the project including financial management (administrative management), whereas
PG works on the content of the project (scientific management). The structure of the PG shall take
into account the capacity of each partner to make optimal use of existing resources and knowledge of
all partners.

A secured internal work platform will be used (ViaDesk) where all partners can share information and
documents without delay and avoid repetition. The financial management system shall also be
included on ViaDesk to ensure open and timely communication in a secured manner.

WP2: Review of current situation (preparation phase)

Many similar studies and research have been carried out or are ongoing. To initiate another project
without applying the acquired knowledge from the previous efforts would be a waste of resources.
Therefore, it is essential to avoid repetition and to build the proposed project on what has been
achieved and what can be used as a basis for further exploration. In WP2, a literature review shall be
carried out to explore existing data and projects at different levels that might be relevant for the
current project, including national studies, regional and international projects.

(Just to name a few relevant researches at the European level:

Under the PF7 program, PREPARE (Platform for European Preparedness Against (Re-)emerging
Epidemics) was carried out between 2014 and 2021. The goal of this project is to build up a network
for harmonized large-scale clinical research studies on infectious diseases, prepared to rapidly respond
to any severe infectious disease outbreak, providing real-time evidence for clinical management of
patients and for informing public health responses.

In Horizon 2020 programme, the first call granted 6 projects on pandemic preparedness and response,
the second call financed another 5 projects on the social and economic impacts of the outbreak
responses.)

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The objective of WP 2 is to take the fragmented studies as a starting point, to seek possibility of
pooling current knowledge to leverage into a comprehensive monitoring and response strategy.

WP3: Social science
The use of social science research on epidemics and pandemics can make great contribution to the
understanding of human experiences and its relation to the disease. All qualitative methods shall be
used focusing on various groups including policy/decision makers, health professionals, database
users and citizens. Quantitive method shall be used e.g. in questionnaire surveys. WP3 compliments
the literature review in WP2 which provides an in-depth view on the current situation.

WP3 consists of two parts: the first part consists of semi-structured interviews with policy makers,
health authorities, professionals and experts on their experiences with the pandemic. The goal of this
part of the project is to find out from the policy and professionals’ perspective what has been done
sufficiently well during the past (pan-)endemic and where are the scopes of improvement. It is also an
opportunity to collect good practices. (One example is the so-called “Sentinel Praxen” in Germany,
which is a group of general practitioners collecting data through their daily work, and one group
"Influenza Sentinel" collects the number of influenza patients and different kinds of influenza
variants. This good practice can be used to build an early warning system. Another example is the
monitoring of sewage water where the virus is detected, and this can be used as an indicator for the
spread of the virus. RIVM in the Netherlands has carried out some research on this approach of virus
monitoring.)

The second part of WP3 is citizens’ summits. Different than the previous researches carried out by
e.g. RECOVER project under Horizon 2020 program, where the focus of citizens’ experience is on
primary care (so the citizens as patients), in this project, the citizens share their experiences more
broadly or generally as a person. The stress on health care caused by one disease may adversely
impact the care for other needs. Therefore, taking a more general view of the citizens will provide a
more comprehensive understanding of the dynamics between the disease and human behavior, and
with certain countermeasures such as national response/prevention policies as implemented at a local
level. It also contributes to a better understanding of the social consequences of a health emergency,
taking into account the cultural differences. In addition to the citizens’ summits, the opinions of the
citizens shall also be investigated through online questionnaires and analyzing social media.

WP4: Data collection and processing

The first step of WP4 is identification of risk factors and relevant data: to identify what are the major
risks of a health emergency for the border region, and hence what are the relevant data that would be
needed for the risk control. Although a lot of research works have been done, knowledge gaps still
exist. Therefore, in addition to a set of infectious diseases that are already known, the data collection
shall make use of existing datasets such as:
Local population from national statistic bureaus: e.g. Population of North Rhine Westphalia
Hospital infrastructure in North Rhine Westphalia
Cross border movement, Pendler Aachen NL, BE
Sciensano (Belgium): COVID-19 data
The World Bank Covid-19 data collection
INFORM COVID-19 Risk Index
OECD COVID-19 tax policy responses
ACLED COVID-19 direct disorders
COVID-19 Open Research Dataset (CORD-19)
ESOC COVID-19 Misinformation dataset

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WHO Coronavirus Disease Dashboard
Euregional Health Atlas

An important element of the data is that they bear cross-border nature, such as the cross-border traffic
which may have direct influence on the spread of the disease. It is possible that a national profile is
well established, but the effective regional data are still lacking. The regional data provide the solid
basis for coordinated actions of health authorities in case of a large-scale (often cross-border) health
crisis. Lacking such data makes swift reaction and decision-making difficult, as witnessed during the
COVID pandemic.

Moreover, different countries adopted different approaches in the collection and classification of data,
which makes the data incompatible. Therefore, the data to be collected shall be done in a standardized
manner, in preparation for data harmonization process.

WP5: Data harmonization
Based on the data collected and processed in WP4, a set of standardized indicators shall be developed
through harmonizing definition and taking into account the context situation. The data included in the
dashboard covers important demographic information of the local population (especially the
vulnerable groups), infection rates, the biology/pathogen of various diseases in the border region, the
emergency contact lists across the border and their respective competences, etc.

The scientific team (including epidemiologists and data analysists) shall bring the collected data into a
model that reflects the real-time spread of the disease. What is experienced during the current COVID
pandemic is that there is often a time lapse between the infection and the inclusion of the infection in
national dataset, which results in a delayed depiction of the spread of the disease. Therefore, the
prediction based on it might be inaccurate or delayed. Hence, this project tries to overcome this delay
by combining the use of other instruments (such as social science findings on the dynamics of disease
spread with human relations) in order to acquire a timely reflection of the local spread of a disease.

WP6: Dashboard design, development and testing
In WP6, a dashboard for euregional health emergency and related tools will be established and
implemented.

First, a web-based dashboard will be developed, integrating the harmonized data collected in WP5
and the results of social science study of WP3. This dashboard shows the state of affairs of the crisis
indicators in the participating regions. The dashboard is connected to existing national databases e.g.
the database of the RIVM (NL), Surfnet (DE) and Sciensano (BE). The dashboard will be integrated
with an already existing portal called the Euregional Health Atlas.

For the user of the dashboard, a toolkit will be created. In this toolkit all mechanisms needed for crisis
management will be included, inter alia, an up-to-date contact list of the cross-border crisis
management team, the way to integrate new and necessary indicators quickly on the dashboard. Other
information that shall be included in the toolkit shall include e.g. number of hospital/intensive
care beds, free hospital/intensive beds, number of ambulances, resources of emergency services, all
structure data of the ambulant and stationary health care sector. A barometer scheme shall be included
to indicate which actions to be taken related to different levels of risks. In addition, extra (backup)
capacity that can be motivated in case of need (such as the emergency service providers who have
medical training) shall also be fully explored and included in the toolkit. This is crucial as it concerns
the scale up of the regional healthcare capacity in case of need. In order to implement the emergency
actions at regional level, different structures of political governances of bordering countries shall be
taken into account, and a flow chart of the decision making process in cross border crisis management
shall be included in the toolkit. In addition, a check-and-balance mechanism shall be put into place to

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avoid delays in taking action, such as a time limit with particular action.

Second, for implementation of the dashboard, the dashboard shall be tested and experimented with at
least three cases in selected countries.

A special part of the dashboard shall also be available for the public. It can contain specific
Information dealing with the border situation like cross border traffic rules, relevant measures in
the bordering countries, local situations and advices and general information.

WP 7: Dashboard sustainability and transferability
It is crucial that the dashboard is transferrable and sustainable in the sense that the capacity of the
dashboard can be expanded to include other regions than the participating parties, and it shall be
maintained and updated even after the project ends. Therefore, the partners shall develop a
sustainability plan on how to continuously maintain and update the current dashboard in the future. In
addition, all partners shall work together to develop a guideline (a step-by-step plan) on how other
border regions can use the experience of the dashboard with data necessary for cross-border crisis
management. This is supported with an infographic, an animation movie and EU training. As for the
development of transferability plan: the transferability toolkit will be developed in multiple languages.
The languages of the countries that surround the participating countries and including EN for usage in
the EU. So, in total: EN, DE, FR, NL, CZ, DK, PL.

WP 8: Scientific/policy advisory board (Interaction: science with policy)
Translating research and evidence into policy is a time-consuming process. Involving policy makers
in the process of the project will speed up this whole process. Therefore, an advisory board consisting
of policy makers and scientists shall be established so that the policy makers will be not only
informed of the progress of the project, but also will be able to give their advices on the design and
implementation of the dashboard. The use of the advisory board shall ensure good communication
with policy/decision makers and to ensure translation of evidence into policy in real time (on time).

WP9: Dissemination and communication
The objective of WP 9 is to promote the project throughout the lifespan of the project, and clear
communication with the general public on the progress and result of the project.

The result of the dashboard will be disseminated through the project website, the kick-off event, final
conference, news feeds, banners, social media and press releases. Guidelines and toolkit will be
developed for the user of the dashboard. Training will be provided to the health authorities.

In addition, the partners shall also disseminate the results of the project through their own network
respectively: website, social media, contacts and administrations at local level.

    3. Limitations and risks
This project aims to collect data cross border, however, due to the privacy protection under GDPR
and various national legal restrictions, when data concern private information, they will not be
allowed to transcend the border. This poses difficulty for collecting data which are necessary for
pandemic response but not infringing on privacy.

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