What is an outbreak response?

IBRAHIMA SOCE FALL: An outbreak response is a set of public-health measures aiming to contain a disease outbreak in a short period of time. The short-term action is important to prevent further transmission to other areas of the country. This is all different you can have response, and this is a national programme. These are longer-term objectives.

And it is important, really, to look at some key elements to outbreak response, and the first one is the coordination. And this is the first responsibility of the country. It is important to show leadership at country level to be able to coordinate partners and actors who are responding to the outbreak. But in developing countries, most of the time, they need WHO support to be able to coordinate partners, actors. And now, we use what we call “incident management system” in WHO. It’s the kind of command and control structure, putting together various actors, but also all intervention aiming to stop the transmission. And this is really something valued at all levels right now.

Our coordination is not only at national level because we want the operation to be at the ground. We need at district level, at country level to make sure that we have the coordination mechanism for rapid action.

Bringing together, selecting the appropriate public health response because depending on the type of outbreak, it’s important to really have the right expertise and right intervention to stop the transmission. It goes from the epidemiological side for case management, for vaccination– preventing further transmission. You also have some specific intervention, like infection prevention and control. For example, if you look at Ebola, you have lot of transmissions sometimes in health facilities because of poor infection prevention– condition. So it is important to make sure that we have the right intervention put together in a well articulated manner. And this calls for a very upgraded response plan.

That’s why my next point, the third one, is really to mobilise the response team for immediate action– to make sure that this team is skilled and able to rapidly elaborate or develop a response plan with clear responsibilities, and knowing who will do what, and how we are going to coordinate our joint action. We are going to be accountable together and making sure that we also plan to mobilise the resources. This is something I will talk about later on. And so mobilising the outbreak response resources is number 4. This is really critical. We need all type of resources in an outbreak. We talked about the human resources, depending on what we need to do because of the specific outbreak.

But it is not only about specific health expertise. You need expertise for logistics, you need expertise for planning. If you look at what is happening now in Congo, to be projected to [happen in] Butembo. You need to take it and plan. You need helicopters. So we need to make sure that we have all these resources together and the right people to manage the response. And the funding aspect is extremely important. So when we start to respond, most of the time, we don’t have the fund at the level– ready at the level.

So alerting the international community – mobilising domestic and international resources is critical in continuing assessing the gaps to make sure that we are not delayed because we don’t have the resources to respond to an outbreak. And if you look at Africa, most of the time, the logistic aspect is so crucial. If you don’t have a team able to project your expertise on the ground, you will get stuck. So it’s important, like planning, to not neglect all the support functions we need. And, of course, since day one, we start implementing the activities. This is my number 5.

But it’s important to adjust activity based on the plan we have developed, based on the reality on the ground, based on the challenges we are facing. And this is really something very dynamic. You cannot be static when you do outbreak response. You need to take into account how the community is perceiving the outbreak, how the community is contributing, what are the obstacles you have on the ground, and how you want to fix them.

To provide a regular update on the situation. Where are we in terms of cases, in terms of deaths? Are we really rounding the curve of the outbreak, or are we seeing more cases? And in this situation, we need to have some kind of analytical report to know exactly where are we having challenges? And what can we do to fix the challenges and to stop the outbreak? So it’s important when responding to the outbreak– this is my number 7– to monitor effectiveness of the response because many of the actors– they will be so busy responding. And you need a proper team to be able to monitor where we are going. Are we going to the right direction? Are we having problems?

So this needs to be done on a regular basis, almost on a daily basis. Do the operational meeting to fix any problem we may face in the response. And number 8 is about the documentation of outbreak. You know, during the outbreak, we do a regular review. But at the end of the outbreak, what you do is called “after action review,” a kind of lessons-learned exercise to be able to improve the way we are responding to outbreak in a given country, but also, at a global level.

And, of course, at the end of the outbreak, we need a more broad evaluation also, to document success stories, best practices, but also, lessons learned in terms of challenges, and how we can improve the way we are dealing with the outbreak. So in conclusion, I think outbreak response is a comprehensive set of complex activities and intervention, including public health intervention, but also, support intervention for the response. And this needs to be well coordinated first by the country, but also, with support from WHO and partners when it comes to developing countries.

This needs, really, to be well articulated to make sure that the operation will not be stopped because of major critical gaps, and making sure that coordination is done at the country level. And we need to make sure that all these interventions are well articulated, funding will not be an obstacle. And this is the only way we can stop an outbreak in a reasonable time.