FETP - Thriving in Ethiopia
CAPT David Sugerman, MD, MPH
David Sugerman serves as the Resident Advisor (RA) for the Ethiopia Field Epidemiology Training Program (EFETP). A 2007 graduate of CDC’s Epidemic Intelligence Service (EIS), David is trained in disease surveillance and outbreak response. Over the past 13 years, he has used his skills and training to lead and support FETPs around the world.
David was introduced to FETP in 2009, when his global immunization rotation provided the chance to work on the ongoing wild-type poliovirus transmission in northern Nigeria with Saheed Gidado, an FETP resident in the country. David’s experience seeing the devastating effects of polio on children drove him to pivot towards a career in global health. However, it was a 2011 assignment that led to his interest in working with FETP more permanently. While working on injury prevention, David led U.S. EIS Officer Dr. Ben Levy and India EIS Officer Dr. Somashekar to create a national burn injury surveillance system. The data revealed an ongoing tragedy of young brides in India dying by self-immolation, or setting themselves on fire, due to unpaid dowries. David saw the FETP residents’ dedication, passion, and commitment to field epidemiology. The experience reinforced the need to build a workforce that has strong epidemiologic knowledge and appropriate cultural context to truly be effective. These experiences increased David’s interest in FETP, so he began to seek more opportunities.
In August 2014, David became the FETP Acting Team Lead for a new global Noncommunicable Disease (NCD) Team. In this role, David developed standardized training materials for FETPs and managed a mini-grant program, exploring country-specific burden and risk factors for chronic diseases, injury, and environmental health conditions. The milestone event of his tenure was the 2015 FETP NCD workshop, which trained residents and graduates from more than 30 countries to establish systems that analyze chronic disease and injury surveillance data. Many of these trainees now lead chronic disease offices within their Ministries of Health.
From this role, David then transitioned to work as Acting Team Lead for FETP, building infectious and non-infectious epidemiology capacity across regional networks. During this time, David was able to get a more expansive view of FETP all over the world, as well as provide support and advisement to a host of outbreak response activities. Most notably, David provided leadership for FETP during the Zika response in the Americas.
The Field Epidemiology Training Program Resident Advisor (FETP-RA) is an in-country teacher, mentor, role-model, and confidant for residents and graduates. The FETP-RA is often an FETP or EIS graduate, with expertise and experience in field epidemiology, field investigations, disease clusters, and scientific communication. RAs also coordinate program activities with the national public health authorities until the time when the program is integrated with a national public health institution.
FETPs in Action – Rising to the Challenge
Since 2018, David has served as the Resident Advisor (RA) for the Ethiopia Field Epidemiology Training Program (EFETP), one of the largest FETP programs in Africa. David wears many hats as the RA, including mentoring and supervising over 600 residents. He also provides leadership and guidance to residents in training, who play critical roles in many outbreak responses, including vaccine-preventable diseases (vaccine-derived poliovirus, measles, pertussis), yellow fever, and vectorborne diseases (malaria, dengue, and chikungunya).
David Sugerman (left) mentoring India EIS Officer Dundaiah Somashekar at the 2015 Global FETP NCD Workshop.
Since the program began, EFETP has led more than 290 outbreak responses in Ethiopia. EFETP graduates and residents staff the Emergency Operations Center, which coordinates national outbreak responses, including COVID-19. “Working with FETP residents has entirely changed my outlook on public health and training,” David said. “I’ve learned an incredible amount from residents and graduates at different points in their careers. They have a fresh perspective and invaluable knowledge. When you investigate outbreaks with FETP residents, you gain a lot of local knowledge and community perceptions of diseases that you couldn’t understand from CDC headquarters.”
Growth and Success of Ethiopia FETP
The EFETP program began in 2009 at Addis Ababa University (AAU) as an advanced two-year program, and it expanded to seven additional universities in 2015. An NCD track began in 2019, with eight residents supported by Resolve to Save Lives, the CDC Foundation, and CDC’s Global NCD Branch.
EFETP-Frontline, established in 2017, has trained over 545 district surveillance officers, covering nearly half of all districts, as well as 110 national military and police surveillance officers. This expansion has reduced detection times from weeks to days and even hours. The advanced FETP has graduated close to 500 people, achieving 89% of the Global Health Security Agenda goal of having one advanced epidemiologist for every 200,000 people. In short, EFETP has become an invaluable part of the country’s public health infrastructure.
EFETP graduates are playing critical roles in the country’s COVID-19 preparedness and response efforts. FETP residents and graduates are supporting enhanced surveillance within facilities and the community, which includes house to house surveys, mortality surveillance, and hospital-based pneumonia surveillance. Residents are leading data analysis and visualization, drafting protocols and guidelines, and building sub-national capacity through virtual trainings. Currently, more than 100 residents and 40 graduates are working on active case search, contact tracing, point of entry screening, and laboratory testing at the national and regional level. Ethiopia’s COVID-19 Deputy Incident Manager, Zewdu Assefa, is a 2017 graduate; other recent FETP graduates are managing COVID-19 by providing medical management and infection prevention and control in their roles as medical officers.
The Future of FETP
David has a grand vision for the next five years. “I see more FETPs accredited through the Training Programs in Epidemiology and Public Health Interventions Networkexternal icon (TEPHINET), whose graduates are in demand to fill outbreak response roles. FETP will be a model for capacity building within Ministries of Health, which can then employ fewer hired contractors and consultants. I also see graduates continuing the learning tradition and helping to lead FETPs, ultimately replacing CDC RAs.”
“In my future positions, I hope to help improve support for the continued growth and expansion of FETP.”