public health significance of outbreak research preparedness

Public Health Significance of Outbreak Research Preparedness

Emmanuel Benyeogor BSc, MCSA, MScPH candidate26th November, 2014

Global Health Trials One Workshop

ObjectiveBy 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

Definition of key terms• Public Health• Outbreak Research Preparedness

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.


• 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


• 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.


• 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


• Research?

• Research is the bedrock

of societal growth

and development

But ?


• “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


• Why is this?

• Those projects have better chance of

getting funded.


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


What is Preparedness?

Importance of topic• Why bother

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

WE OUGHT TO

PREPARE FOR OUTBREAK RESEARCH

Public Health SignificanceIndividual Stifled Health SystemEconomy

Individual

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)

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 OfficersPatric

k Sawy

er

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

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

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

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.


“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.


• Inpatient health services where severely affected by the

Ebola outbreak.


• 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.


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


Health care provision disproportionately

impacted by Ebola results in difficulty to

establish isolation wards.

Lack of information and training about

How To Care for

Ebola Patients

Economy

Economy Human suffering Vs Economic toll

Economy

Human suffering Vs Economic toll

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”

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.

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.

Economy

Fiscal challenges

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.

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.

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

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

ConclusionOutbreak 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

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/#

http://america.aljazeera.com/articles/2014/9/16/ebola-impact-publichealth.html



http://www.brookings.edu/blogs/africa-in-focus/posts/2014/10/01-ebola-outbreak-west-africa-sy-copley



Thank you and Questions

public health significance of outbreak research preparedness

Health & Medicine