In 1976 in Yambuku, Zaire, now the Republic of Congo, a schoolteacher appeared at the local hospital with a severe fever, which was soon followed by endless fits of vomiting. Within days, the man was bleeding uncontrollably from his nose, mouth and rectum, and before the rest of the world knew it, the first Ebola outbreak quietly began claiming lives.
When it subsided, 280 of the 318 people infected had died.
Thirty years later, containing highly contagious viruses, such as Ebola, appears more difficult than ever. Business travelers frequently rub elbows with aficionados of exotic destinations aboard airplanes traveling to and fro, and faster and further than before.
While these conditions seem to spell a pandemic scenario, advanced means of communication have also made it nearly impossible for viruses to go unnoticed. With the Internet, news organizations worldwide can report on outbreaks virtually anytime, anywhere, and effectively serve as a warning system for public health agencies. These agencies can, in turn, convert the information into solid infection containment plans -- which save lives in the long run.
But sifting through tens of thousands of news releases daily raises logistical questions: Do agencies have the resources to constantly peruse the Internet for relevant news, identify duplicates and separate trustworthy from dubious sources?
The Public Health Agency of Canada's (PHAC) Global Public Health Intelligence Network (GPHIN), using linguistic and data mining technology, simplifies the process, and enables its users worldwide to take advantage of health-related media reports.
Multiple-Point Conversion
The GPHIN was designed internally by the PHAC's IT department in 1998. Although the network could scan hundreds of news releases daily, it was limited to those in English only. Conscious that outbreaks transcend language barriers, PHAC officials sought to broaden the GPHIN's scope.
In November 2004, the Canadian government joined the U.S. Nuclear Threat Initiative and launched GPHIN II. This new version, designed in collaboration with Quebec-based Nstein Technologies, allows the network to incorporate Arabic, French, Russian, simplified and traditional Chinese, and Spanish, using translation technology.
News alerts and translating Web programs are common fixtures of the Internet browsing experience. However, the GPHIN's automated analysis component, which allows the network to send relevant real-time alerts to its users, is what sets the network apart from regular search engines.
"The intelligence is the ability for the system to detect, in what journalists are saying, potential outbreaks, and tying those events together," said Laurent Proulx, senior vice president and chief technology officer of Nstein.
For instance, Proulx explained, some journalists may report on deaths in a particular Chinese village, and others report on other similar casualties in different areas of the country. Separately the journalists may not realize the potential for an outbreak, however, the GPHIN II automatically analyzes these events jointly and determines the value of the threat to public health.
"If the news has a high potential outbreak, or let's say 90 percent, it will automatically send an e-mail to a health agency or a subscriber to the GPHIN health platform," Proulx said. "If it's under, let's say, 90 percent health outbreak trigger, it will be sent to [an] analyst; and if it's under 30 percent, it will automatically be garbage, because it doesn't have potential health outbreak."
Users range from universities to large health organizations, and the annual fee varies from CAN $30,000 to CAN $250,000, depending on the organization's size.
Today, Abla Mawudeku, manager of the GPHIN, said the network counts users in North America, Europe and Asia, including the World Health Organization (WHO). Additionally once the WHO investigates and verifies information retrieved by the network, it sends messages to participating health agencies worldwide, which indirectly benefit from the GPHIN.
The Human Element
"The GPHIN system has two components: There's an automated component and a human analysis component," said Mawudeku. "[The] GPHIN team, which is multidisciplinary and multilingual, reviews the articles that are of public health concern and determines whether the article is relevant or not."
The GPHIN's other critical human component is the media. Mawudeku said that although the information mostly comes from reliable sources, such as the BBC and Reuters, it remains unverified until users conduct their own investigation. The GPHIN does, however, provide some indication of the media sources' reliability.
"We ensure that this newspaper, for example, does not have a political agenda, which could then distort the information," Mawudeku said. "We don't remove the information, but we flag it for the user to say, 'Be aware,' that they need to verify that information."
At a press conference announcing the launch of GPHIN II, Dr. Ron St. John, director of the PHAC's Center for Preparedness and Response, which oversees the GPHIN II, said the media's role should not be underestimated.
"We have looked at your reports. We have tried to look at how well they're verified. We think we have a 96 percent or better accuracy," said St. John, warning the attending journalists not to sell themselves short. "You're important in public health too."
More Than an Alarm System
In addition to disease outbreaks, the GPHIN monitors a wide variety of public health-related topics, such as bio-terrorism, the quality of water and food supplies, man-made and natural disasters, as well as exposure to nuclear and chemical elements. It also watches for nations' responses to health-threatening events.
"We also monitor what countries are doing to implement preventive measures, control measures -- and it's a broad spectrum," Mawudeku said. "What kind of measures, including prophylaxes, in the case of another event would they be recommending or including?"
During the severe acute respiratory syndrome outbreak in the late 1990s, this dimension of GPHIN proved valuable to its users. "We were then also providing information about what airport screening measures were being implemented in different countries," she said. When airlines began canceling flights and were unable to field the ensuing large number of phone calls from travelers and public health officials, the GPHIN provided news reports indicating different flight options and other important travel information.
Another important facet of the GPHIN -- one that may become more important in light of new health threats such as the avian flu -- is that the network doesn't solely watch for human disease outbreaks.
"When we talk about public health, it's not just the agencies looking at human diseases, but also animal diseases. It's of main concern now, with the avian flu," Mawudeku said, explaining that some infectious animal diseases not only have the potential to spread to humans, but they can also destabilize a country's economy by affecting its food production.
"With avian flu," Mawudeku added, "we've been monitoring, aside from [outbreaks], the debate on Tamiflu -- and other antivirals that could be used -- vaccine production; we monitor new proposals by pharmaceutical companies that may be producing new vaccines for poultry and so forth."
Recognition
In early 2006, the GPHIN garnered much attention when Dr. Larry Brilliant, the recently appointed executive director of Google's philanthropic arm, made it a central part of his Technology Entertainment Design prize speech.
Brilliant expressed the desire to expand the GPHIN by adding sources and broadening the language base. "It's one of [Brilliant's] wishes to bring the GPHIN platform to an international -- almost democratic -- level," Proulx said, "and by having it so any individual around the world could see what's happening on a real-time basis about health issues."