Public health significance of outbreak research preparedness. Pragmatic approach to outbreak research preparedness

1. Public Health Significance of
Outbreak Research
Preparedness
Emmanuel Benyeogor BSc, MCSA, MScPH candidate
26th November, 2014
Global Health Trials One Workshop

2. Objective
By the end of this presentation participants will be able to:
• Define key terms in this discuss
• Explain the importance of topic
• Describe public health significance of outbreak research
preparedness
• List the major strategies for implementing outbreak
research preparedness

3. Definition of key terms
• Public Health
• Outbreak Research Preparedness

4. Definition of key terms
• What is Public Health?
• Public health is the science of protecting and improving the
health of families and communities through promotion of
healthy lifestyles, research for disease and injury prevention and
detection and control of infectious diseases.

5. Definition of key terms
• What is Public Health?
• Major concern is protecting the health of entire populations.
• These populations can be as small as a local neighborhood, or as
big as an entire country or region of the world.
• As Public health professionals the idea is to try to prevent
problems from happening or recurring

6. Definition of key terms
• What is Outbreak Research Preparedness?
An outbreak could be either a pandemic or
epidemic
• It affects a large number of people
• Occurrence of more cases of disease than the
expected in a given area among a specific group of
people over a particular period of time.
• Two or more linked cases of the same illness.

7. Definition of key terms

8. Definition of key terms
• Epidemic - a widespread outbreak of an infectious
disease where many people are infected at the same
time.
Epidemics usually spread very easily and
quickly, and cause severe and often life-
threatening symptoms.
• Pandemic - an epidemic that affects multiple
geographic areas at the same time

9. Definition of key terms
• Research?
• Research is the bedrock
of societal growth
and development
But ?

10. Definition of key terms
• “Researchers are focusing on
projects with a high probability
of results,
Faculty are doing safe things because they know they’ll
work.
But then the probability of discovering something
really new and exciting goes down

11. Definition of key terms
• Why is this?
• Those projects have better chance of
getting funded.

12. Definition of key terms
What is Preparedness?
• Preparedness is the range of deliberate, critical
tasks and activities necessary to build, sustain and
improve the operational capability to prevent,
protect against, respond to, and recover from
domestic incidents.
• It is a continuous process involving efforts at all level
to identify threats, determine vulnerabilities and identify
required resources

13. Definition of key terms
What is Preparedness?

14. Importance of topic
• Why bother

15. Why Bother?
Asides
• To control ongoing outbreaks ,
• To prevent future outbreaks,
• To advance knowledge about a disease.
• When the time available for decision-making and response
may be compressed from days or weeks to a matter of
hours

16. WE
OUGHT TO
PREPARE FOR
OUTBREAK RESEARCH

18. Public Health Significance
Individual
Stifled Health System
Economy

19. Individual

20. Individual
Cells are the basic unit of life
The individual is the basic unit of a population
Individual in the Nigerian Ebola outbreak:
• First case (Patrick Sawyer)
• Health worker - IDSR team (3 health Personnel died)
• Community leader (Family, clan, local government, state, federal)
• Nigerian populace and contacts (Exposed and Unexposed)

21. Individual: Nigerian Ebola First Case
• Inspite of Ebola confirmed in 5
West African Countries
• On the 25th July 2014 patrick
sawyer fainted at the Int’l airport
• Officials at the airport were not
properly trained on screening
and protecting themselves
• A lot of individuals came in
contact owing to lack of Rapid
Response team or
Emergency team
Contacts
Airport
Officers
Patrick
Sawyer

22. Individual: Health personnel
• In spite of Basic Precaution Practice
procedure for health worker in
handling Infection
• Poor case management
• Late diagnosis owing to accessibility
to laboratory result
• Lack of protection by health care
personnel exposing hospital
patients
• Resultant increase in contacts
Contacts
Hospital
patients
Hospital
staff

23. Individual: Leader (State and Federal)
• At state level
• Absconding quarantine and surveillance
lead to Enugu and Port Harcourt cases
and death
• Low turn up owing to poorly maintained
isolation unit
• Striking health institutions further
reduced health personnel and facility for
case management
• Over 8 deaths due to inadequate
preparedness of the state and
health personnel
Contacts
Federal
State

24. Individual: Leader (State and Federal)
• At federal level
• Poor allocation of funds and resources to
state
• Little or no funding for research and
trials to come up with drug and
preventive measures
• Poor laboratory funding as there is one
functioning virology laboratory in Lagos
• Information and port entry control and
outbreak preparedness
• Implementation of IDSR and
record keeping
Contacts
Federal
State

25. Stifled Health system
• Limited resources are diverted towards stopping the spread of Ebola
• A dire shortage of medical workers
• A generalized climate of fear surrounding the outbreak may be
preventing people from getting treatment for equally deadly, but
perhaps more readily treatable, diseases.

26. Stifled Health system
“Ebola’s ripple effects are extending to everything else, from
children unable to receive care for malaria to women unable
to deliver babies in a hospital,” said Andrew Maccalla, of the
medical aid organization Direct Relief, in a commentary for the
Huffington Post.
Preventable ailments like typhoid and dysentery, meanwhile, “might be
killing more West Africans than Ebola,” he added.

27. Stifled Health system
• Inpatient health services where severely affected by the Ebola
outbreak.

28. Stifled Health system
• The dramatic documented decline in facility inpatient admissions and major
surgery in Sierra-Leone is likely to be an underestimation.
• Reestablishing such care is urgent and must be a priority.

29. Stifled Health system
In the face of a scarce health work force in west Africa, Nigeria ebola response
leveraged on the response team that addressed a recent lead poising health issue
this metamorphosed to Ebola Outbreak Response team

30. Stifled Health system
Health care provision disproportionately impacted
by Ebola results in difficulty to establish isolation
wards.
Lack of information and
training about

31. Economy

32. Economy Human suffering Vs Economic toll

33. Economy
Human suffering Vs Economic toll

34. Economy
Human suffering Vs Economic toll

35. Economy
Mobility restrictions, trade and transport:
To halt the spread of the virus, the countries most affected by
Ebola have implemented quarantines in areas where risk
of infection is high while neighboring countries such as Cote
d’Ivoire and Senegal imposed restrictions on the
movement of people and goods, including border
closures.
These measures, in turn, have reduced internal and regional
trade, transport and, of course, tourism.
…the president of Sierra Leone has called them an
“economic blockade”

36. Economy
Agriculture
• Disruptions from the outbreak during the planting season
earlier this year (2014) are expected to diminish yields for
the staple crops of rice and maize during the harvest
season, between October and December
According to IMF estimates, in Liberia the inflation rate will
climb to 13.1 percent in 2014 from 7.7 percent before the
Ebola crisis first broke.

37. Economy
Fiscal challenges
• Fiscal revenues will decline as limited economic activity
reduces revenues from taxes, tariffs and customs duties.
• At the same time, to resolve the crisis and meet the greater
health and security needs of their people, government
expenditures will need to rise.
• Avoiding the impact on the poorest and most vulnerable
will also necessitate more transfers.

38. Economy
Fiscal challenges

39. Economy
The financial sector
Although the financial sector has largely been excluded from
the narrative of the outbreak,
• if large depositors withdraw funds, banks may face
serious liquidity problems.
• if some big creditors miss payments, the number of
nonperforming loans will increase, eventually leading to
some defaults.

40. Economy
The financial sector:
Loss of confidence in the financial system is the main risk
factor and should be avoided.
Capital flight is an additional risk to the financial system
especially as exchange rates have become more volatile.
The World Bank reports that many wealthier Guineans and
expatriates have already left the country and that
uncertainty and risk aversion in Sierra Leone has prompted
a rise in capital outflows.

41. Economy
Fear of Contagion Curbs Economic Activity
• Ebola outbreak’s effects on the economies of West Africa
has fear as most influential factor constraining economic
activity.
• As stressed by the World Bank, “the largest economic
effects of the crisis are not as a result of the direct costs
(mortality, morbidity, caregiving,
and associated losses to working
days) but rather those resulting
from aversion behavior driven
by fear of contagion

42. Submissions
“The emphasis so far has been on containing the Ebola
outbreak,” said Stakem, of Catholic Relief Services.
“But we’re hoping the international community is committed to
strengthening health care systems in the long term.”
“We need clearly to focus on Ebola response. We need clearly to
focus on rebuilding the general services, but we need also to
focus on making the system resilient, to making the system
stronger to resist the future epidemics or any disasters in the
future,” said Schmets

43. Conclusion
Outbreak preparedness thrives on a strengthened health
system
Efforts should be done at par with preparedness to
strengthen the health system.
Liquidity management must also be a priority and banks’
bad loans portfolio need to be monitored carefully

44. Reference
• Bolkan HA, Bash-Taqi DA, Samai M, Gerdin M, von Schreeb J. Ebola and
Indirect Effects on Health Service Function in Sierra Leone. PLOS
Currents Outbreaks. 2014 Dec 19. Edition 1. doi:
10.1371/currents.outbreaks.0307d588df619f9c9447f8ead5b72b2d.
• Michael Pizzi. Ebola outbreak exposes West Africa’s existing public health
woes. http://america.aljazeera.com/articles/2014/9/16/ebola-impact-
publichealth.html. Accessed 10/1/2014
• Amadou Sy. Understanding the Economic Effects of the 2014 Ebola
Outbreak in West Africa. http://www.brookings.edu/blogs/africa-in-
focus/posts/2014/10/01-ebola-outbreak-west-africa-sy-copley. Accessed
10/1/14
• http://www.healthmap.org/ebola/#

45. Thank you and Questions