Why do we need outbreak preparedness?

CHIKWE IHEKWEAZU: Preparedness is fundamentally the difference between having a small number of cases of a disease versus a large outbreak.

When we fail to prepare, the consequences are that more people get ill. More people will die. The impact is more on the economy, on the health of the people, on the community cohesion that existed in that environment. So ultimately, preparedness is the difference between a small cluster of cases, our ability to manage an outbreak, versus an outbreak that gets out of hand, and we lose control, and we lose lives and property and money.

If you’re prepared, you know what to do. You know how to respond to that single case or two cases or small cluster of cases. You prevent further cases from happening. You prevent the adverse health impacts of that disease. You prevent people from dying. You prevent people from losing days at work or losing days at school. And you prevent a huge incident.

Surveillance is the work that we do in monitoring events in public health in order to take public health action. The most common form of surveillance that we would work with on a day-to-day basis is infectious disease surveillance. That means reporting new cases of any disease that you have from the health care facility, through the different levels of government to the very top. Stay on the ball, not drop the ball. Investigate every single case picked up by our surveillance system.

Investigate, and make sure that the laboratory reagents are in place to make the necessary diagnosis, that we understand that everyone in the system understands who to refer to, how to take a sample, how to send that sample to the lab, who pays for the sample getting to the lab, who sends the results, how quickly is the result sent, how well we understand disease burden in one area versus the other, how well we understand the threats that a specific area is facing. All these are the concepts that we have to think about that are part of preparedness before an event happens.

Research is not the primary function in public health. But almost everything we know about the infectious diseases that we deal with is research that has been done in the context of a response. As you are responding to the outbreak, you’re collecting data on distribution of risk factors that you will eventually analyse. And that then forms the basis of the research, through which we gain more knowledge about the infections that we deal with. In outbreak situations, it’s very difficult to plan for research after the outbreak has already started. So you have to have the protocols in place, the thinking, and all that you then require to do the research, before the outbreak happens.

Most of the work that we do in public health, in a well-functioning system, should be focused on preparedness. And then, we’ll be better placed to respond in the rare occasion where a response is absolutely necessary. I spend most of my time on working on preparedness, even though the response path gets most attention. The hardest part of the work we do, as well, sometimes the most boring, the most diligent part, is on preparedness. But if you do it, well, you sleep better at night. The whole system is much more confident to respond to any incident that it may face.

For all the things I listed, you need people that are skilled, that are trained, that are well-prepared mentally and physically, that understand the issues at stake, the science, and the art is bringing them together. Think about preparedness in terms of a system’s ability to cope and respond to whatever it faces in terms of public health threats.