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Integrating Clinical Research into Epidemic Response: The Ebola Experience
Gerald Keusch, Keith McAdam, Patricia Cuff, Michelle Mancher, and Emily R. Busta
National Academies of Sciences, Engineering, and Medicine
(2017)
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The 2014–2015 Ebola epidemic in western Africa was the longest and most deadly Ebola epidemic in history, resulting in 28,616 cases and 11,310 deaths in Guinea, Liberia, and Sierra Leone. The Ebola virus has been known since 1976, when two separate outbreaks were identified in the Democratic Repub
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lic of Congo (then Zaire) and South Sudan (then Sudan). However, because all Ebola outbreaks prior to that in West Africa in 2014–2015 were relatively isolated and of short duration, little was known about how to best manage patients to improve survival, and there were no approved therapeutics or vaccines. When the World Heath Organization declared the 2014-2015 epidemic a public health emergency of international concern in August 2014, several teams began conducting formal clinical trials in the Ebola affected countries during the outbreak.
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Accessed: 27.04.2020
Leaving no one behind in the Covid-19 Pandemic: a call for urgent global action to include migrants & refugees in the Covid-19 response
People on the move, whether they are economic migrants or forcibly displaced persons such asylum seekers, refugees, and internally displa
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ced persons (hereafter called migrants & refugees), should be explicitly included in the responses to the coronavirus disease 2019 pandemic. This global public health emergency brings into focus, and may exacerbate, the barriers to healthcare these populations face. Many migrant & refugee populations live in conditions where physical distancing and recommended hygiene measures are particularly challenging. The Covid-19 pandemic reveals the extent of marginalisation migrant & refugee populations face. From an enlightened self-interest perspective, the Covid-19 disease outbreak control measures will only be successful if all populations are included in the response. It is counter- productive to exclude migrant & refugee populations from the preparedness and response to the Covid-19 pandemic.
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Integrated Outbreak Analytics (IOA) applies a multidisciplinary approach to understanding outbreak dynamics and to inform outbreak response. It aims to drive comprehensive, accountable, and effective public health and clinical strategies by enabling
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communities, and national and subnational health authorities to use data for operational decision-making. IOA embraces a holistic perspective of outbreak dynamics throughout: from the trigger questions to the data that are collected or accessed, to the interpretation of results and the recommendations that follow. In addition, IOA promotes co-development and monitoring of evidence informed actions.
The IOA toolkit aims to provide a clear understanding of IOA and highlight the importance of using an integrated, holistic approach to manage outbreak responses. It provides step-by-step guidance for setting up IOA and putting IOA principles into action. Finally, this toolkit provides guidance on applying IOA in humanitarian and emergency contexts, offering a practical and adaptable approach to informing public health emergency responses.
Developed based on the model from the Democratic Republic of the Congo (DRC), its creation involved extensive consultation with experts experienced in IOA applications. The toolkit was piloted in Tanganyika Province, DRC, as well as Somalia and Sudan, demonstrating its adaptability to diverse emergency scenarios. It builds upon an existing array of tools, templates, reports, case studies, animations, and publications used by stakeholders in diverse contexts.
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The Haiti & Dominican Republic Cholera Operation Plan of Action outlines the Red Cross's strategy to combat cholera on the island of Hispaniola following the 2010 outbreak in Haiti. As part of a 10-year national strategy, the plan includes an initial two-year
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emergency response (2014-2016) with a budget of 9.9 million Swiss francs. The approach focuses on three key areas: improving water and sanitation by repairing and expanding water systems and constructing sanitation facilities, prevention and hygiene promotion through community education and hygiene training, and preparedness and response by strengthening disease monitoring, training Red Cross volunteers, and prepositioning medical supplies. This initiative, led by the Haitian and Dominican Red Cross in collaboration with international partners and local governments, aims to reduce cholera infections and improve public health on the island.
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Available in English and Spanish, Hesperian’s comprehensive app on pregnancy and birth contains a wealth of information on:
how to stay healthy during pregnancy
how to recognize danger signs during pregnancy, birth, and
after birth
what to do when a danger sign arises
whe
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n to refer a woman to emergency care
instructions for community health workers with step-by-step explanations such as “How to take blood pressure,” “How to treat someone in shock,” “How to stop bleeding.”
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The document is a UNICEF cholera toolkit designed to support prevention, preparedness, and response to cholera outbreaks. It provides guidance on water sanitation, hygiene, and health education, along with practical tools and resources for managing
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outbreaks. It is intended for use by UNICEF teams, governments, and partners to integrate cholera prevention into development programs and emergency response strategies.
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How should humanitarian organisations prepare and respond to COVID-19 in humanitarian settings in low- and middle-income countries?
This Rapid Learning Review outlines 14 actions, insights and ideas for humanitarian actors to consider in their COVID-19 responses. It summarises and synthesises the
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best available knowledge and guidance for developing a health response to COVID-19 in low- and middle-income settings as at April 2020
The paper, supported by the UN Under-Secretary-General for Humanitarian Affairs and Emergency Relief Coordinator Mark Lowcock, will be updated throughout 2020 to reflect emerging knowledge and evidence on the most effective approaches to respond to the COVID-19 Pandemic.
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This guidance document is meant to support practitioners working in disaster prone contexts to develop and implement more effective integrated resilience programming. It promotes programming that cuts across different fields of work like rights awareness, food security,
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emergency preparedness, livelihoods, education, health etc. whilst at the same time encouraging us to work simultaneously at the individual, household, community and national level. It includes specific recommendations for developing resilience programming for communities prone to floods, cyclone, drought and earthquakes. It also includes recommendations to develop safe school programming to help reduce the impact of disasters on school infrastructure, ensure education continuity and build the resilience of students, teachers and their families.
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Nurses are critical to deliver on the promise of “leaving no one behind” and the global effort to achieve the Sustainable Development Goals (SDGs). They make a central contribution to national and global targets related to a range of health prio
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rities, including universal health coverage, mental health and noncommunicable diseases, emergency preparedness and
response, patient safety, and the delivery of integrated, people-centred care.
No global health agenda can be realized without concerted and sustained efforts to maximize the contributions of the nursing workforce and their roles within interprofessional health teams. To do so requires policy interventions that enable them to have maximum impact and effectiveness by optimizing nurses’ scope and leadership, alongside accelerated investment
in their education, skills and jobs. Such investments will also contribute to the SDG targets related to education, gender, decent work and inclusive economic growth.
This State of the world’s nursing 2020 report, developed by the World Health Organization (WHO) in partnership with the International Council of Nurses and the global Nursing Now campaign, and with the support of governments and wider partners, provides a compelling case on the value of the nursing workforce globally.
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Pandemic Preparedness and Response – Lessons from the H1N1 Influenza of 2009
Harvey V. Fineberg
(2014)
New England Journal of Medicine 2014; 370:1335-1342. Please download the pdf-file from the nejm Website!
A number of viruses have pandemic potential. The most recent global pandemic was caused by the influenza A (H1N1) strain, which was first detected in North America in 2009. The 2009 H1N1 pande
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mic presented a public health emergency of uncertain scope, duration, and effect. At the request of the WHO, an international committee reviewed the experience of the pandemic, with special attention given to the function of the 2005 International Health Regulations (IHR) and the performance of the WHO. The most fundamental conclusion of the committee, which applies today, is not reassuring: “The world is ill prepared to respond to a severe influenza pandemic or to any similarly global, sustained and threatening public-health emergency
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In April 2018, Refugees International (RI) conducted a mission to Bangladesh, to research the GBV (gender-based violence) response for Rohingya women and girls. RI found that the entire humanitarian system is struggling under tremendous constraints in Bangladesh, and protection and
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health actors do deliver lifesaving services to survivors in an incredibly challenging environment. This report, however, focuses on key gaps and challenges in GBV programming, as communicated by practitioners deployed to Bangladesh at various stages of the emergency, by local organizations, and by the affected women and girls themselves.
In the analyses and recommendations provided in this report, RI draws in part from the framework of the international initiative to safeguard women and girls in emergencies — the Call to Action on Protection from Gender-Based Violence in Emergencies — and urges the donors and humanitarian organizations that are Call to Action partners to implement it more effectively and with urgency during this emergency. more
In the analyses and recommendations provided in this report, RI draws in part from the framework of the international initiative to safeguard women and girls in emergencies — the Call to Action on Protection from Gender-Based Violence in Emergencies — and urges the donors and humanitarian organizations that are Call to Action partners to implement it more effectively and with urgency during this emergency. more
The PDF "Vamos proteger-nos da Cólera" provides comprehensive guidance on cholera prevention and response strategies, particularly for use in community health settings. It emphasizes the importance of safe water use by treating water with bleach, b
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oiling it for at least 5 minutes, or using purification tablets like Aquatabs. Handwashing is highlighted as a key measure, especially after using the latrine, before preparing food, and before eating. Sanitation practices include using and maintaining clean latrines or, if unavailable, burying feces far from homes and water sources.
The document also addresses diarrhea treatment, recommending the preparation and use of Oral Rehydration Solution (ORS) with added zinc for effective recovery. It encourages breastfeeding for infants with diarrhea and stresses the importance of cooking food thoroughly, keeping it covered, and ensuring all utensils and surfaces are clean. Proper waste management, including the disposal of household waste, is highlighted to maintain a clean and safe environment.
In emergency situations, the guide advises seeking immediate medical attention for severe diarrhea and emphasizes the prompt burial of bodies during outbreaks to prevent contamination. Additionally, it provides visuals and strategies for community engagement, empowering health workers and communities to promote awareness and adopt effective cholera prevention measures.
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According to official figures from Migración Colombia by the end of June 2019, there were more than 1.4 million Venezuelan refugees and migrants living in Colombia. The majority of people have settled in the border departments of La Guajira and Norte de Santander, continuing to cities along the Car
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ibbean coast, or larger cities inland such as Medellin and Bogotá. Significant numbers of Venezuelans continue to cross Colombia by foot, heading for larger cities with more opportunities and better services or towards the southern border with Ecuador to continue their onward journey to a third country. Refugees and migrants arrive in Colombia with immediate humanitarian needs including access to safe accommodation, food, basic health care, but the prolonged nature of their displacement also requires longer term solutions including access to formal employment, education and social integration. The Interagency Group for Mixed Migration Flows (GIFMM) works closely with the Government at both the national level, and across 11 of the most affected departments, to deliver direct emergency assistance, protection, socio-economic integration activities and seeks to build the capacity of the host government.
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This is an online orientation to strengthen the competencies of health sector actors working in emergencies to establish, support and scale up Mental Health and Psychosocial Support (MHPSS) in count
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ries. The focus of this channel is on how to apply existing practical, evidence-based, scalable tools and practice-led approaches for successful implementation of projects to strengthen MHPSS in emergencies operations, protection from mental health and psychosocial consequences of crises and towards the realization of universal mental health coverage.
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This introductory level channel provides a general overview of the National Action Planning for Health Security (NAPHS) process and methodology. This includes the critical steps necessary to support the development, implementation and monitoring of
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5-year strategic NAPHS as well as 12/24 month operational NAPHS.
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The Coronavirus Disease 2019 (COVID-19) has had a continuous and robust impact on world health. The resulting COVID-19 pandemic has had a devastating physical, mental and fiscal impact on the millions of people living with noncommunicable diseases (
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NCDs), as they have a higher risk of severe illness and death from COVID-19. COVID-19 has been associated with an
excess in all-cause and cardiovascular disease (CVD) mortality beyond that related to the infection itself and its immediate consequences. Studies in the
United Kingdom (UK) and United States of America (USA) have clearly shown increasing deaths from ischemic heart disease, stroke and hypertensive disease due to COVID-19. Overall, the impact has been greater in individuals with lower socioeconomic status, even in high income nations.
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This SOP guides AFRO management, incident responders, and the Support for Health Operations Centre (SHOC) on managing public health events, detailing processes from event detection and risk assessme
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nt to resource mobilization and communication between country offices, the Regional Office, and WHO Headquarters
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This channel offers learning resources for strategic health operations, including Ebola and Marburg diseases screening and treatment center design, ultra-low temperature vaccine management and WHO Mobile Very Small Aperture Terminal installation.
The aim of the Technical Brief is to offer guidance to education professionals on how to integrate Mental Health and Psychosocial Support into Education in Emergencies programming. An overview of Mental He
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alth and Psychosocial Support activities that can be implemented in Education in Emergencies contexts is detailed, in line with the MHPSS Minimum Service Package. Country examples and case studies are featured.
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The webpage introduces the “Health Cluster Coordination” channel on World Health Organization’s OpenWHO platform, focusing on training and resources for coordinating
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health-cluster operations in humanitarian emergencies. It outlines how participants can learn about setting up and managing health clusters, establishing collaboration among partners, and ensuring effective service delivery in crisis settings.
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