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Digital Health Global Good from Germany

The SORMAS Foundation supports countries in combating pandemics and epidemics. Copyright: HZI/Verena Meier

The digital software SORMAS is already used in numerous countries to manage epidemics. With the newly founded SORMAS Foundation, Pilar Hernandez and Jan Böhme want to develop the open-source project into the world's leading digital system.

Ms. Hernandez, Mr. Böhme; a foundation has just been spun off from the Helmholtz Centre for Infection Research (HZI), which you will lead. With it, you want to sustainably promote public health. What is the idea behind SORMAS?

Jan Böhme: SORMAS was developed at the Helmholtz Centre for Infection Research in 2016. At its core, SORMAS is software for process management of epidemics and pandemics. This means that we map the entire process in our software, from the detection of a possible disease to the implementation of all necessary activities, and finally to the management of the epidemic or pandemic.

Pilar Hernandez: So far, we have integrated modules for over 40 diseases into our open-source software. SORMAS is now used in about 10 countries. These are countries on the African continent, but also in Europe and Asia.

Pilar Hernandez, Executive Director of the SORMARS Foundation. Copyright: Verena Meier

Mr. Böhme, how exactly does your system work?

Jan Böhme: It usually starts with a coordinating body such as a health department receiving a tip. A positive test result, for example. A case is then created in SORMAS, i.e., a confirmed or unconfirmed suspicion of a corresponding disease. Various bits of information can be recorded there such as what disease it is; where the case occurred; where the person is currently located, and the like. Then we can assign various tasks to this case via the system, which are sent directly to the appropriate teams. Then, for example, someone on site checks if it is really the disease and if there has been contact with other people. These contacts are then also recorded in SORMAS. In this way, chains of infection can be traced. And all further measures, such as isolation, are also mapped and coordinated in SORMAS and then statistically evaluated.

Ms. Hernandez, you are an expert in the field of public health. What advantages does your system offer over previous approaches?

Pilar Hernandez: It's important to understand that SORMAS is much more than just a website or an app. It is a platform that connects everyone involved in early outbreak detection and pandemic response. Not only health department personnel, but also those working in airports, in hospitals, in laboratories; they are all able to enter information. In SORMAS, the data is collected and shared, which is unique. You can distribute the information not only vertically, for example, from the municipality to the Ministry of Health, but in different directions. On the platform, the information is always available in real time. As a result, you can react very quickly. You can of courseuse other tools that only collect information. This is called a data warehouse. For example, a data warehouse may store the number of people who have fallen ill or have been vaccinated. But these tools usually don't allow you to manage and analyze the information. It's just collected but not analyzed, and as a result you can't make decisions."

What connects you both to the topics of communicable diseases and epidemics on the one hand and digital systems on the other?

Jan Böhme: I have been a computer scientist since the beginning of my professional career and have always been involved in software development. The concrete bridge to SORMAS was built for me when I worked as an application administrator in a health department. That was at the beginning of the Covid 19 pandemic and I was involved in the introduction of SORMAS. That was the first time I experienced first-hand how much added value the system brings. I immediately had the feeling that SORMAS had a lot of potential. And because I would like to be part of increasing that potential in the future, I then joined the Helmholtz Centre for Infection Research."

Pilar Hernandez: "I came to SORMAS from a different direction. I specialized in infectious diseases and did my PhD in this field, but mainly in international contexts. Before I came to SORMAS Foundation, I was traveling in different countries. Especially in Africa. I was in Nigeria for two years. I was the team leader of a project that dealt with pandemic prevention, which was funded by GIZ [German Society for International Cooperation]. One of the components in that was SORMAS. That's how I came into contact with it. And since infectious diseases are my subject, I was naturally interested, so when the project in Nigeria ended, I decided to work in the SORMAS team."

The HZI project has now evolved into the Foundation. Why did you decide on a foundation to advance SORMAS?

Jan Böhme: We thought about what structure would be right for SORMAS in the future with everyone involved. The decision to establish a foundation was an active one, because for the long-term success of SORMAS as a Digital Health Global Good, it is very relevant to avoid being subject to any form of monetary interest. That's why we chose a non-profit. In our case, just a foundation."

Pilar Hernandez: To do that, you have to know that there are different Digital Health Global Goods. One category of them is software, and there, in most cases, it's open-source software. That means the software doesn't belong to any company. And anyone can contribute to its further development. SORMAS is no exception. And many of the open-source projects like the Firefox internet browser are supported by a foundation. Like the Mozilla Foundation for Firefox or the Wikimedia Foundation for Wikipedia. That's where we got our inspiration from.

Ms. Hernandez, you worked in Nigeria for two years. How do they deal with infectious diseases and epidemics there , in comparison to Germany, for example?

Pilar Hernandez: Nigeria is an extremely good example because there, SORMAS is the national system responsible for epidemiological surveillance and for combating epidemics and pandemics. This was also seen during the Covid pandemic. They were much better equipped with the system there than Germany, for example. Of course, countries like Nigeria are much more sensitive to outbreaks because diseases occur there all the time, and not just the ones we know here, but also Ebola. People there are aware that catastrophic outbreaks can occur. That's why people are much more proactive. To be better prepared, the Nigeria Center for Disease Control contacted the Helmholtz Centre for Infection Research back in 2016. SORMAS was then developed together. As a result of Covid, the population in Germany is now also aware of the topic of epidemics and pandemics.

Jan Böhme is the executive director of the SORMARS Foundation together with Pilar Hernandez. Copyright: Verena Meier

And in the meantime, SORMAS has also become a household name in Germany, at least among experts?

Jan Böhme: That's right. Germany introduced SORMAS 2020 to better manage the Covid pandemic. The deployment was previously financed centrally by the Federal Ministry of Health via the HZI. That has now changed as of the first of January, as the project has come to an end as planned. Fortunately, the Federal State of Bavaria decided to continue to tender the central deployment of SORMAS for the entire state. Now, we are working with the service provider from the free market to continue to provide and improve SORMAS in Bavaria.

Luxembourg, Nigeria and Bavaria probably differ a lot in the needs of their respective healthcare systems. How does SORMAS respond to this?

Pilar Hernandez: SORMAS is adapted to the country and its epidemiology. Each country's Ministry of Health has a list of notifiable diseases. And we adapt SORMAS to that. Also, not all countries want to use SORMAS the same way for all their reportable diseases because they already have their own systems. During Covid, some countries saw that their own systems were not sufficient to deal with the pandemic efficiently. That's why they used SORMAS for Covid. That was the case in Côte d'Ivoire, for example, where they implemented SORMAS for Covid as part of a European project and are now interested in using it for other diseases.

What are the main tasks ahead for the Foundation?

Jan Böhme: From a technical point of view, of course, the further development of the platform by the community is an important task. Through moderation, for example, we ensure that no two parties develop the same thing. We coordinate the collaboration, and that speeds up development. And we have an overview of what is currently happening so we can point out to developers early on that their ideas may not be compatible with what someone else is developing. Then we establish communication within the community. That's also one of our big areas of responsibility."

Pilar Hernandez: "And we have to help ensure that more and more countries use SORMAS and also operate it independently. It is important to understand that we are mainly helping to establish SORMAS. Our main task is to adapt the system to the needs of the country., so configuration, support, training in the first months. But then the countries should take over themselves to be independent of us and if possible independent of external funding sources."

Let's take a look into the future. What is your big vision for SORMAS?

Jan Böhme: Our big vision is that we will have established SORMAS worldwide at some point. That it will be the leading and most sustainable epidemic management system in the world. And we can only achieve that if we all work together in the open-source community.

Pilar Hernandez: For me, our vision has two important points. We want the SORMAS software to be high quality and at the same time sustainable. That's why the role of the SORMAS Foundation is so important. Because if there is no one in an open-source project to moderate the community's contributions and thus take care of the quality, no leading software can develop from it. And that's what we are here for.

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