Photo credit: Lee Henderson
Professor Raina MacIntyre
University of New South Wales | 2015 | $2,491,912.80
'Travel and globalisation mean that infections spread rapidly around the world, so that global solutions are required for epidemic control'
NHMRC Centre for Research Excellence, Integrated Systems for Epidemic Response
With more new found types of influenza being transmitted from animals to humans, the likelihood of a major pandemic has escalated. 1 The need to quickly and effectively manage disease outbreaks such as this is at the epicentre of the NHMRC Centre of Research Excellence (CRE) – Health Services Research: Integrated Systems for Epidemic Response (ISER).
Driven by the Ebola outbreak in 2014, Professor Raina MacIntyre set up this research centre to take a holistic approach to responding to epidemics.
‘It addresses critical systems gaps in epidemic control—conducting applied systems research, enhanced collaboration across sectors and building capacity in systems research for epidemic control,’ Professor MacIntyre said.
NHMRC developed the Centres of Research Excellence (CRE) scheme to have clear objectives for building research excellence. It aims to improve health outcomes and promote or improve translation of research outcomes into policy and/or practice. It provides support for teams of researchers to pursue collaborative research and develop capacity.
The CRE for Integrated Systems for Epidemic Response (ISER) brings together researchers from different fields to investigate everything from innovative early detection methods to cross-sector stakeholder engagement for more effective collaboration in the event of an epidemic. It also looks to build the next generation of fully-equipped researchers and first responders.
‘The Ebola epidemic made me reflect on the fact that there are so many aspects to epidemic control—not just drugs and vaccines. Part of it is the system. A health agency alone can never control a big epidemic like that, you need multiple other agencies working together to bring it under control,’ Professor MacIntyre said.
‘An informed, efficient and integrated response to a disease outbreak is key in preventing unnecessary deaths. Although an invisible outcome, prevention is better than cure.’
The first step to having a more integrated approach was getting all the stakeholders together to understand the problems they each faced in responding to an epidemic. A hypothetical pandemic scenario was held, where stakeholders from health respondents, NGOs, military, emergency services to police participated.
Broken into groups, they were made to act out roles outside of their own. For example if you were from police you were made to act out the health role and if you were from health you were made to act out defence.
‘This was so that people got to step into someone else’s shoes and think about the problem from a different perspective,’ Professor MacIntyre said.
‘It was an extremely successful event where you could see those connections happening and see people starting to view things from another perspective.’
It also brought focus on non-pharmaceutical interventions, the kinds of systems intervention that are important in epidemic control—quarantine, personal protective equipment, hand washing.
‘Often during an outbreak there are no drugs or vaccines—all you have is personal protective equipment and quarantine. That sort of systems approach is really critical,’ Professor MacIntyre said.
Similarly understanding the needs of stakeholders who use tools, such as those to predict epidemics, are important for better planning practices.
‘Tools like FluCast were developed as a response to stakeholder engagement. It uses data to develop a risk score for the coming flu season. It can be used by health departments and doctors, and will be a public tool. It is able to provide vital information for planning purposes—how many beds are going to be needed? Is it going to be a bad flu year?’ Professor MacIntyre explained.
‘We have really reached out to the end users and taken on board their feedback. I think that’s the best kind of translation.’
Alongside that, the CRE has been working on rapid epidemic intelligence or better ways of identifying epidemics early.
‘The goal is to develop a system that prompts urgent action when it is needed,’ Professor MacIntyre said.
One of these projects focussed on bringing together researchers from different fields and levels, and from across the globe. A competition was held to develop a digital disease detection tool. This led to the winners being able to pick up a signal of the Zika virus months earlier than it was officially detected.
The winners—a PhD student in public health and an undergraduate student from Brazil—where the Zika epidemic originated—came up with the excellent idea of using social media data to detect signals of the disease. They developed algorithms to search for words or groups of words on social media such as ‘fever’ or ‘rash’.
‘These students will be able to develop their idea further in the CRE with us,’ Professor MacIntyre said.
‘To me the capacity building is one of the most important parts of the CRE. We want to make sure younger people are developing in a way where they will have a sustainable career to really contribute to the field, beyond the life of this grant.’
1 Bui, C.M et al (2017) An overview of the epidemiology and emergence of influenza A infection in humans over time, Archives of Public Health, 75:15