Global Risk Informatics Microsoft / Gates Foundation

Debra Goldfarb
Sr. Director, Technical Computing Industry Strategy

The crisis information gap

When the global economic crisis hit in 2008, world leaders knew they needed to act quickly.

They knew that they needed to take immediate policy actions to protect communities from downstream impacts on health, nutrition, education, jobs, and the environment.
Agile, targeted responses required up-to-date evidence of how families were coping with shocks.

Sounds pretty straightforward, no?

Household-level stats take months to collect, and years to validate!

The information gap is real

First data becomes available

as are its consequences.

But what if?

Decision makers had access to real-time data and the tools to detect the early signals ? Policy-makers and field workers had models to help uncover the complexities of disease, economic crises, poverty, civil unrest? We could tailor interventions based on real data and analysis? We could broadly apply simulation and modelling to global risk to dramatically change outcomes?

Microsoft Gates Foundation Collaboration

What are we doing?

Why we care?
What will we learn? What are the impacts? How does it fit?

The Bill and Melinda Gates Foundation

Guided by the belief that every life has equal value, the Bill & Melinda Gates Foundation works to help all people lead healthy, productive lives. In developing countries, it focuses on improving peoples health and giving them the chance to lift themselves out of hunger and extreme poverty. In the United States, it seeks to ensure that all peopleespecially those with the fewest resourceshave access to the opportunities they need to succeed in school and life. The Foundation focuses primarily on the bottom 20

The Bill and Melinda Gates Foundation

Malaria today

Malaria Burden -2008 863 000 deaths 243 million cases Half of the world's population is at risk of malaria

Current solution
Tools
Current: LLINs, IRS, ACTs, accurate diagnostics Future: vaccine, vector compromise, surveillance tools Strategies for human behavior change Improve the health systems infrastructure Economic development Understand climate change impacts

What motivates the GF?

The Goal: Eradication
Removal/depletion of the last malaria parasite on the earth Its been done before: Smallpox, Rinderpest Guinea Worm, Polio, Measles Ambiguities/challenges Syndrome vs single disease Animal reservoirs? Latent infections

Malaria modeling: why technical and high performance computing?

To predict the impact of a particular intervention To explore the modes of action of specific tools To evaluate transmission patterns and efforts to reduce them To explore economic and public health arguments for particular eradication strategies To simulate approaches to eradication and explore options for achieving it

Malaria Models
Transmission models
Ross McDonald (transmission) R0: The number of new infections that arise from a single one

Within-host models
Immunity: partial protection in adult humans who survive infancy

Population models
Parasite drug resistance or insecticide resistance in mosquitoes

and then you add in all the parameters and sub models: biology, climate, human population models, environmental, technology, complex relationships, food, etc.

Modern Malaria Models

Modern range
Simple ODE models Multiparametric MCMC Simulations

Novel modeling approaches

Nested hierarchical models Computational/statistical innovations Network models of human movement

Different assumptions about underlying biology

Proposed analytical framework incorporates multiple information sets, enables assessment of vector control interventions
Integration of community inputs into unified framework

Analytical tools

Entomology
Biting VS Indoors Outdoors Dawn Night Dusk aconitus 1 1 tbd tbd tbd annularis 0 1 0 0 1 campestris 1 1 tbd tbd tbd dirus 1 0 0 1 0 fluviatilis tbd tbd 0 0 1 funestus 1 0 1 1 0 gabaldoni tdb tdb tdb tdb tdb jeyporiensis 1 0 0 1 0 lesteri 1 0 tbd tbd tbd maculatus 0 1 0 0 1

Local environments

Epidemiology

Assembly of regional vector ecology profiles

Identification of critical data gaps

Location-specific stratifications and data Malaria parasite locations, rates

Vector species ecology profiles and ranges

Second-wave input

Assessment of utility of potential VC interventions

Interventions
Pat. of use # AIs Resist. Target IRS 4 1 Adult Nets (LLIN/ITNs) 0 1 Adult Space spraying/fogging 2 0 All Topical Repellants 2 0 Adult Emanators/coils 0 1 Adult Larviciding 0 1 Larva Durable wall lining 1 Adult 2 Topical Repellants tbd 3 Adult

Policies and regulations

Identification of gaps in current intervention set as informant of TPPs

Second-wave output

Intervention profiles, incl. efficacy and resistance

Regulations, policies, financing

Supply, demand and financing assessment

Analytical framework will capture four key types of data

1
Entomology
Aggregate vector species information
Species
Anopheles aconitus

Local Environments
Consolidate multiple locationbased variables

Epidemiology
Map against malaria outbreak data (location, rate)

Interventions
Overlay intervention profiles, including efficacy info.
Target Paradigm # of AIs Vector age IRS 4 Adult Nets 0 Adult Space spray 2 All Topical 2 Adult Coils 0 Adult Larviciding 4 Larva Preventive efficacy 30-75% 40-64% tbd tbd tbd tbd Developme nt status Current tool Current tool Current tool Current tool Current tool Current tool

Larval Habitats

Feeding Behavior
Feeds on man and animals, indoors and outdoors. Generally zoophilic, feeding outdoors before midnight. Often anthropophilic, feeds indoors or outdoors, bites in shaded areas. Highly anthropophilic, feeds primarily between 2200-0400 hrs indoors and outdoors.

Rice fields, stream pools, shaded pools with grasses. Rice fields, permanent water with emergent vegetation. An. annularis Usually deep, brackish water, ditches, wells with some vegetation and An. campestris shade. Isolated stream pools, undisturbed ground pools, cisterns.

An. dirus

Primary data components

List of reproductively isolated vector groups Vector ecology profiles (biting, resting, breeding sites, sugar meal source) Vector presence coordinates Expert-derived vector ranges Parasite rates and coordinates Political map Expert-derived epidemiological Precipitation ranges Human density estimates Climate Topography Local resistance to active ingredients Availability of alternative interventions (e.g., drugs, vaccines) Impact of human migration patterns Actual disease burden Human and vector host resistance Classified list of interventions1 Efficacy and effectiveness

Secondary components (used to expand and/or refine framework)

Emergence of new species Mating and swarm behavior Species genomic data Climate change impact Human development impact Urban, rural, agriculture stratifications Cost constraints Infrastructure/accessibility Socio-political obstructions Relevant cultural mores Use patterns for alt. interventions WHO MAP CIA Factbook Koppen-Geiger Climate Classification SEDAC (GRUMP) Compliance Cost Impact of educational efforts Ecological influences on intervention efficacy

Key sources for data

Malaria Atlas Project (MAP) Disease Vector Database Swiss Tropical Institute / MARA Walter Reed Biosystematics Unit VectorBase / Anobase WHO AFPMB ANVR

Malaria Atlas Project (MAP) WHO Swiss Tropical Institute CDC

WHO Croplife IVM evidence committee STI Vestergaard-Frandsen Academic literature Expert input

1. Interventions to be classified by control paradigm, target vector age, active ingredient(s), number of active ingredients, safety, development status and robustness against pyrethroidresistant vectors

Multiple data sets to be combined and integrated

Framework inputs Intermediate outputs End-user tools
Vector ecology profiles
MAP, WRBU, STI

Comprehensive vector ecologies

Biting VS Indoors Outdoors Dawn Night Dusk aconitus 1 1 tbd tbd tbd annularis 0 1 0 0 1 campestris 1 1 tbd tbd tbd dirus 1 0 0 1 0 fluviatilis tbd tbd 0 0 1 funestus 1 0 1 1 0 gabaldoni tdb tdb tdb tdb tdb jeyporiensis 1 0 0 1 0 lesteri 1 0 tbd tbd tbd maculatus 0 1 0 0 1

Regional Vector Ecology Profiles MAP, WRBU, DVD, STI

Vector ecology profile for: Vector Ecology features Species aconitus crascens dirus minimus A minimus C scanloni Indoors Outdoors Dawn Night Dusk Human Animal Sugar meals No Sugar meals Resting Indoors Outdoors Thailand # Vectors 4 4 0 5 3 6 3 0 0 3 6

Entomology

List of reproduct. isolated groups

DVD, MAP., STI

Expert-derived vector ranges Political map

DVD, MAP , Academic lit.

Country Long Lat

Indonesia Greece Saudi Arabia China Brazil Ethiopia Ethiopia Ethiopia Brazil Brazil 97.2 26 50.2 109 -62.8 37.5 37.6 37.6 -62.8 -61.9 1.38 40.9 26.3 19.3 -8.7 5.88 6.03 6.03 -9.68 -10.7

Species
sundaicus superpictus superpictus aconitus albitarsis arabiensis arabiensis arabiensis albitarsis albitarsis

MAP, DVD , Academic lit., Expert ranges

Vector species datasets / maps

Integrated epidemiological & entomological datasets / maps

MAP, Expert input MAP

Local Environments

Precipitation
NASA; MAP

Climate Topography
NASA; MAP MAP

Location-specific boundaries & data

Country All Asia All Asia All Asia All Asia All Asia All Asia All Asia All Asia Bangladesh Bangladesh Bangladesh Bangladesh Bangladesh Bangladesh Bangladesh Bangladesh Bhutan Ecological stratifications All ecological stratifications Plains and valleys Forest and forest fringes Highland and desert fringes Wetland and coastal areas Urban and peri-urban areas Agricultural development Socio-political disturbances All ecological stratifications Plains and valleys Forest and forest fringes Highland and desert fringes Wetland and coastal areas Urban and peri-urban areas Agricultural development Socio-political disturbances All ecological stratifications

Stratification map MAP Searchable database and vector or locationspecific datasets Visual maps MAP Searchable database and vector or locationspecific datasets Visual maps MAP Searchable database and vector or locationspecific datasets Visual maps

Feeding

Vector presence coordinates

Vector locations

Integrated epidemiological & vector species datasets / maps

Biting

Data gaps
Data type Vector bionomics Vector bionomics Data gap Current efforts to fill gap?

Sugar feeding None Malaria Atlas Project- in progress Some local experiments

Hum. population Local resistance to AIs Altern. interven.

GRUMP

Western Pacific region Larvicide Interventions effectiveness Space spraying Interventions effectiveness p. ovale Epidemiology prevalence

None None

Academic lit., Vestergaard-Frandsen, WHO, Academic lit.

MAP, GRUMP WHO, Academic lit., VestergaardFrandsen Parasite epidemiology

b. Reported malaria deaths (annual) -> 2003

MAP

Intervention utility map

Epidemiology

Parasite rates and coordinates

MAP, Academic lit.

Epidemiological map

Expert-derived epidem. ranges

MAP, Expert input

Interventions

Cambodia Democratic Republic of the Congo Dominican Republic Ecuador Egypt El Salvador Eritrea Ethiopia

492

16,498 16

0 MAP, Academic lit., 0 n/a Expert input 78 n/a

MAP, WHO, STI Intervention effectiveness

Paradigm IRS Nets Space spray Topical Coils Larviciding Biting indoors Yes Yes Yes Yes Yes Yes Biting outdoors No No Yes Yes No Yes

List of interventions
WHO, STI, Expert input, academic literature

Profiles of current interventions

Target Paradigm # of AIs Vector age IRS 4 Adult Nets 0 Adult Space spray 2 All Topical 2 Adult Coils 0 Adult Larviciding 4 Larva

WHO, Academic lit., STI, Expert input

Intervention gap assessment

Vector ecology or land ecology feature Outdoor biting Outdoor biting Outdoor biting Outdoor biting Forest environment Forest environment Forest environment Current intervention option, if applicable Space spraying Space spraying Space spraying Space spraying None None None Region affected Ethiopia Thailand India Brazil Thailand India Brazil

Expert input

Intervention efficacy

WHO, STI, academic literature

What are we doing?

VCDN consortia member

Develop the cyber infrastructure, applications and tools to enable broad-based sharing of Malaria data and models; simulation and analysis to drive positive and predictive outcomes
Components: cloud-based large scale data integration, collaborative tools, extraction/ modeling/analytic tools, visualization, GISmapping, search, simulation and modeling

Challenges
Data: integrity, formats, ontologies, currency and curation, security.not to mention the politics of data Collaboration: data owners dont always play nice Technology + policy = impacts We are in unchartered territory.

Where do we go from here?

GF at scale
Extreme Scale Informatio n Exhaust

UN/Global Pulse Public Health

Global view for Health WHO

Data
UNSD NGO/IGO

Thank you!