“For big data approaches to be effective in an emergency, however, they must be in place before the emergency.” — Amesh Adalja, MD
In February 2016, in the heat of the global health challenge posed by Zika, the World Health Organization (WHO) declared the virus a Public Health Emergency of International Concern. A few days later, the Centers for Disease Control and Prevention (CDC) elevated the virus to Level 1 in its Emergency Operations Center. Zika is particularly dangerous because there is no medicine for the virus. It has been linked to severe birth defects in pregnancies and nervous system disorders.
In this interview, Amesh speaks with Sickweather’s public health consultant, Ebele Mogo, DrPH on effectively responding to public health emergencies such as Zika. Amesh Adalja is an infectious disease MD whose work centers on pandemic policy, emerging infections and preventing bioterrorism. He is a Senior Associate at the Johns Hopkins Center for Health Security. He blogs at www.trackingzebra.com and can be found on Twitter @AmeshAA.
Mogo: You have mentioned the gap in translating public health messaging to frontline clinicians severally. This gap is costly, and in the case of Zika is responsible for the low numbers of high-risk babies being tested or receiving brain imaging. According to the CDC, only 1 in 4 of such babies at risk of congenital Zika received brain imaging after birth. What critical factors are responsible for this gap and how would you go about bridging it?
Adalja: The gap exists because new findings take time to diffuse to the frontline clinicians in any specialty. It is especially difficult in an emerging infectious disease situation. The best way to bridge this gap is via continual updates to medical professionals through varied channels and direct outreach to the public. It is daunting but during an infectious disease emergency, it is a crucial task.
Mogo: In a WHO review of big data’s role in global health, there is optimism around big data as a bridge between this gap in healthcare delivery and the broader field of population health. Are you equally hopeful?
Adalja: I am hopeful that big data will transform public health in a way that allows for rapid, precise, and highly effective interventions. In the infectious disease realm, there is already emerging evidence that big data can positively impact epidemiology.
Mogo: In this report Dye et al pointed out that while health officials predicted over 1,000 cases of microcephaly in North-eastern Brazil last year, there were fewer than 100. Why do you think there was a discrepancy between the forecast and the incidence of microcephaly? What lessons might this hold for forecasting and the epidemiology of outbreaks in general?
Adalja: Forecasting has to be wary of unmeasured variables that may have an impact and that may be what underlies the discrepancies in microcephaly. While causality has been established with Zika, it is unclear what other factors are at play such as pre-existing dengue antibodies.
Mogo: What role, if any do you see for big data and technology in the healthcare system especially during emergencies?
Adalja: Big data approaches can be used to manage large amounts of information coming from various sources to spot patterns, collate statistics, and detect aberrancies that may be then used to directly impact response activities. For big data approaches to be effective in an emergency, however, they must be in place before the emergency.
Mogo: Have you seen any instance where a public health emergency has been effectively curtailed? What would you consider the distinguishing ingredients of this response?
Adalja: There are many examples of this that range from Typhoid Mary to the Ebola response in the US. The distinguishing characteristics are a proactive, transparent, data-driven, evidence-based operation in which clinicians and public health authorities are empowered to take action. Strong leaders with active, intellectually engaged minds are also essential.
submitted by: Ebele Mogo, DrPH — Public Health Consultant