Coordination of the GMRLN is carried out by WHO, based on the experience gained in establishing the Global Polio Laboratory Network. Each of the six WHO regions has a Regional Laboratory Coordinator (RLC) responsible for the laboratories within their region. The RLC works closely with the GSLs, RRLs and WHO HQ to coordinate training activities. Each of the regions works in partnership with the Global Laboratory Coordinator (GLC) based at WHO headquarters, Geneva, Switzerland. The GLC and RLCs share comments, requests and queries, and provide ongoing communication through summaries and regional meetings. Procurement and distribution of essential standardized laboratory equipment and reagents for selected countries is also coordinated through WHO.
An established system for monitoring indicators of laboratory performance, including external quality assurance for IgM detection, molecular detection and characterization, and laboratory accreditation has proven beneficial for the participating laboratories. The analysis of quality assessment activities helps to guide training needs and the data is valuable for tailoring recommendations intended to improve testing methods as well as to respond to changes in technology. For example, external quality assessment activities for molecular testing was established in 2014 following a comprehensive training programme to expand the number of laboratories routinely performing molecular techniques for measles and rubella surveillance.
Laboratory virologists and epidemiologists at all levels must establish mechanisms to exchange information on a regular basis to monitor and evaluate performance indicators of the surveillance system and to link laboratory and epidemiology data. Therefore, while responsibilities for measles and rubella testing (along with documentation and reporting requirements) increase the workload for laboratories in the GMRLN, the technical collaborations and collegial relationships are important benefits that member laboratories enjoy. The network laboratories interact closely with national immunization programmes and timely information exchange is critical for the integrated surveillance required to meet measles and rubella elimination goals and provide necessary data for verification of elimination [3].
The advantages of providing updates and reviewing aggregate data in a scheduled meeting format are now well established. Representatives of the GSLs and RRLs hold meetings on an annual basis and many participate more frequently through membership in one or more research working groups. Representatives from the NLs should hold meetings with their immunization programme counterparts at least once a month and participate in regional meetings every year.
An effective and efficient laboratory network depends on collaboration and information exchange within the network, with the disease control field staff, and colleagues in the immunization programme. Standard referral and reporting forms have been developed to ensure that all essential patient information is transmitted (see chapter 11 and annex 11.1 for example). Collection and dissemination of relevant information that guides both control activities and testing strategies is the cornerstone of effective surveillance.