Epidemics that didn't happen
An early warning system in the Caribbean stops outbreaks before they start
During the Cricket World Cup, the Caribbean Public Health Agency’s new surveillance system protected residents, visitors and health systems.
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This case study was developed in partnership with the Caribbean Public Health Agency
What Happened
At packed stadiums across six Caribbean nations, tens of thousands of fans gathered at the 2024 Men’s T20 Cricket World Cup. One of the largest mass gathering events in the region, the World Cup offered unparalleled opportunities for celebration and for local economies as visitors from across the globe hopped across islands to catch 55 matches featuring the best cricket players in the world. But it also created ideal conditions for infectious diseases to spread rapidly and overwhelm local facilities.
One night, at the Kensington Oval in Barbados, when a game was in full swing, a woman started vomiting in the stands. Public health officials were on patrol and immediately stepped in to help—taking the woman to a sick bay for treatment while members of their team went back to the stand to clear the area, where a young boy was also vomiting and in need of help. Meanwhile, at the Sir Vivian Richards Stadium in Antigua, a staff member who was feeling unwell checked into a health tent inside the venue, where they were diagnosed with gastrointestinal illness.
Both of these situations triggered swift response actions. As well as treating both individuals, on site medical teams took samples for testing and passed them to mobile laboratories set up just outside the stadiums. Meanwhile, surveillance teams went back to where the individuals had been sitting to screen other spectators for similar symptoms. The next day, public health officials visited the hotels in Barbados where the sick spectators were staying to conduct food safety spot checks, identify any additional cases and identify the source of the spectators’ illnesses.
The Response
The elegant response that took place was not happenstance. It was part of a rigorous early warning system developed by the Caribbean Public Health Agency (CARPHA). “We serve 26 small-island member states across the Caribbean with interconnected borders and economies dependent on tourism,” explained CARPHA’s Executive Director, Dr. Lisa Indar. “In an outbreak response, minutes can make all the difference. A rapid, coordinated response is vital to protect the safety of residents and visitors.”
“Dealing with two and three cases at the earliest point in time is much easier for us to manage, given our fragile health systems and resource constraints,” added Keston Daniel, a tourism and health coordinator at CARPHA. “Some countries have very small hospitals, even just one hospital.” Under these conditions, even a few cases can quickly multiply into a few hundred and soon overwhelm smaller health systems, putting residents at risk and damaging the island nations’ tourism-dependent economies.
Ahead of the World Cup, CARPHA began developing a surveillance system. The team was able to fast-track development by using a tried-and-tested surveillance platform developed to capture health and tourism information, modifying the existing system for mass gathering events like the World Cup. While creating the module was simple enough, the team had to equip every event space with mobile hotspots to make sure officials could input and share data and receive alerts.
By the time the first cricket ball was bowled, the system was in place and internet hotspots were installed—with testing completed at smaller events. With support from the Pandemic Fund and Inter-American Development Bank, key staff were trained to use the system, including participating countries’ Ministry of Health surveillance officers, medical officers national epidemiologists and nurses. During the games, on-the-ground teams used tablets provided by the Public Health Agency of Canada to enter data at the stadium health sites.
That data fed into dashboards monitored by each country’s chief medical officer and national epidemiologists, as well as by CARPHA. Dr. Sastee Kissoondan, a senior technical officer at CARPHA, supported daily regional reports using this data, combined with information from other sources including tourism organizations, disaster management and security systems and collaborating health organizations from the U.K. and U.S.
Ultimately, CARPHA’s early warning system got the right information to the right people fast enough to act on it. From a surveillance officer in the stands to a chief medical officer watching a real-time dashboard, every link in the chain supported decision-makers to respond before small problems became large ones, keeping spectators safe, the World Cup running and island economies protected.
Across 55 games in six host nations, CARPHA’s surveillance system captured a total of 146 cases of potential infectious disease and identified 17 of potential concern. Not one resulted in documented spread of disease at the 2024 Men’s T20 Cricket World Cup.
Enablers
Early warning system for rapid detection and response
Strong collaboration between local teams, national leaders and regional agencies
Mobile testing facilities for rapidly processing samples
Leveraging the 7-1-7 Approach for Small Island Nations
Based on the success at the 2024 Men’s T20 Cricket World Cup, CARPHA and Caribbean national leaders have been using their surveillance system at other mass gatherings, including Carnival, music festivals and sporting events. In Belize, CARPHA trained public health teams to use the system during a two-day agricultural trade show that brought tens of thousands of visitors and live animals into the country from neighboring Guatemala and Mexico; they successfully used to it track animal, as well as human, health.
Dr. Brian Armour, technical advisor for CARPHA’s Pandemic Fund project, has also been adapting the system to handle routine national public health surveillance—not just large events. “It’s so efficient,” Dr. Armour said. “It all happens on the backend while the frontend political, economic and tourism needs of the patrons and participants go unbothered.”
All these tools are unique, and they form part of our overall early warning and response surveillance armory for the Caribbean region
Dr. Brian Armour, Technical Advisor, CARPHA Pandemic Fund
After participating in a training with Resolve to Save Lives at the end of 2024, CARPHA has leveraged the 7-1-7 approach to develop their own rapid detection and response targets, suitable for a Caribbean context. Speaking about these response targets, Dr. Indar noted that “faster response targets are both desirable and achievable” given the smaller capacity of Caribbean health systems. Dr. Indar’s team has also created disease-specific timelines to quickly curb outbreaks and minimize the risk of overloading local health systems.
“All these tools are unique, and they form part of our overall early warning and response surveillance armory for the Caribbean region,” said Dr. Armour, speaking about CARPHA’s use of tools like the surveillance system and leveraging the 7-1-7 target. “Everything combines to form a timelier surveillance picture. Thanks to these tools, we have a better and faster idea of what is happening across the region, and we’re best prepared to keep our local communities and visitors safe.”
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