Public Health’s Role in Large-Scale Events: How Guam Prepared for the 2016 Festival of Pacific Arts

April 03, 2018|3:00 p.m.| Health Security Team

As evident in last month’s Winter Olympics, public health plays a vital role to ensure the safety of all attendees, prevent dangerous infectious disease outbreaks, and prepare for any potential threats. Public health and governmental agencies must work together to prepare prior to and during large-scale international events to help ensure the health and well-being of all attendees.

Similar to the Winter Olympics, the Festival of Pacific Arts (FestPac) is held every four years and brings together a large global audience of 10,000 daily visitors to acknowledge and celebrate various cultures. The 2016 FestPac was held in Guam, and the Guam Department of Public Health and Social Services (DPHSS) worked closely with the Pacific Community (SPC) to protect attendees and residents against public health threats, such as the Zika and influenza viruses. To learn more about these preparedness efforts, ASTHO spoke with Josephine O’Mallan, administrator for the Bureau of Communicable Disease Control at Guam DPHSS.

How was Guam DPHSS involved in preparing for this event?

Over a year in advance, Guam DPHSS requested technical assistance from SPC to enhance Guam’s disease surveillance system in preparation for FestPac. Guam DPHSS, in collaboration with SPC, conducted an initial assessment, created an enhancement plan, and developed an epidemiological and surveillance planning team to focus on security and safety prior to and during the event.

During the event, Guam partially activated its emergency operations center and put Guam DPHSS’ epidemiology and surveillance operations in action. Epidemiology and surveillance operations consisted of a surveillance unit, an epidemiology response unit, an analysis and reporting unit, and the event and community health outreach (ECHO) team.

What were your key areas of focus when preparing for this event?

To prevent disease outbreaks and protect the health of residents and visitors, Guam DPHSS focused on identifying health promotion and risk communication messaging to allay fears around the importation of arboviral and other infectious diseases of international public health concern into Guam. The ECHO team used successful strategies from the 2009 H1N1 response to develop and disseminate messaging materials before and during the event for participants and the community. Partnership and technical assistance from SPC were also key in the development and translation of health risk communication messages for delegates. Additionally, Guam DPHSS intensified its vector control measures by spraying ports of entry and festival facilities at least three weeks before FestPac, and mobilized the community for source reduction and village beautification.

The department used data from the Pacific Public Health Surveillance Network (PacNet) to identify the communicable diseases affecting the Pacific Region and enhance its laboratory services accordingly. Collaboration and guidance from CDC, the Pacific Island Health Officer’s Association, and SPC’s public health programs helped augment Guam’s laboratory testing capacity for STDs and HIV, tuberculosis, influenza, dengue, Zika, and chikungunya. CDC’s Epidemiology and Laboratory Capacity grant and Trioplex test kits for the three arboviruses – dengue, Zika, and chikungunya – were instrumental in providing 24 to 48 hours turnaround time for lab results. The Guam DPHSS public health laboratory performed a total of 23 laboratory tests for diseases under syndromic surveillance during FestPac for arboviral diseases, influenza, and leptospirosis.

What do you anticipate being principal areas of concern for the 2020 FestPac in Hawaii?

Based on our experience, we encourage those planning for a large event to have the following: attaining support from leadership at the Governor’s level and within the health department for preparedness activities; completing advance assessments, planning, and preparedness materials that address safety, health surveillance, risk communications and logistics; and maintaining effective communication channels with participating countries, partners, and stakeholders. These three areas are the foundation to ensuring a coordinated approach for the prevention of disease outbreaks during the event. The lessons learned, and recommendations included in Guam’s after action will serve as a guide for Hawaii as it prepares to host FestPac in 2020. 

What advice would you share with health agencies interested in hosting a large-scale event in their jurisdiction?

It is vital that you review and test existing plans, use the incident command system for planning and preparedness, engage key partners early, and develop communication strategies. If possible, partner with neighboring jurisdictions for their support and expertise, which will in turn serve as a hands-on learning experience for their staff. For example, the Commonwealth of the Northern Mariana Islands’ (CNMI) health department sent a support team consisting of health department employees to assist with planning and participation during Guam’s FestPac. This mutually beneficial partnership increased Guam’s skilled personnel, while also providing CNMI’s team with valuable experience.

Despite the mass influx of visitors into its small island, Guam successfully hosted FestPac 2016. With support from leadership at the Governor’s office and the health department, and assistance from international, federal, and regional partners, Guam DPHSS ensured the mechanisms and systems were in place to mitigate and address public health risks. There was no known spread of notifiable diseases to the local population due to its effective use of risk communication strategies from past responses, disease prevention efforts, and enhanced surveillance and laboratory systems. Taking appropriate measures before and during large-scale events can be the key to controlling and preventing public health outbreaks from occurring.


Neyling Fajardo, Preparedness Analyst, assists in promoting public health preparedness efforts in the states and territories. Fajardo contributed to this article.

Alexandra Seifert, Senior Analyst of Epi Preparedness, coordinates ASTHO’s support for territorial and freely associated state public health preparedness programs. Seifert contributed to this article.