PLOS Update

In 2009, we launched PLOS Currents as an experimental platform for rapid communication of non-standard publications. A few communities embraced the experiment enthusiastically from the start, and the contributions of researchers who volunteered as editors

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How Can Africa Prevent the Next Haemorrhagic Fever Crisis? Invest in Research and Development

  By Dr. Jenniffer Mabuka In 2014, West Africa encountered its worst recorded outbreak of Ebola with over 11,000 reported deaths. The memory of this crisis hadn’t faded yet when Ebola reared its ugly head

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Responding to Emergencies One Behavior at a Time

A group of Ebola response volunteers in Nigeria.

To improve the health and safety of people in the United States and around the world, we have to influence and change behaviors. It can be difficult to try new things, or stop old things as behaviors range from simple to complex, but one way to consider behavior change is to think of any change as a passive or active choice.

Public health practitioners must think about interventions in terms of the behaviors they are asking people to adopt, stop or continue. What would encourage someone to change what they are currently doing? Before you can influence someone’s behavior or change their choices about a behavior (risky or protective) you need to know how their judgments and decisions are made about that behavior in the first place.

Behaviors are rooted in traditions

During the Ebola response behavior change was critical to prevent people from getting sick and ultimately stop a disease threat. In the wake of the outbreak, communities in West Africa were encouraged to give up or change their traditional burial practices. Some of these longstanding rituals, like washing the body, proved dangerous because the virus can live on the skin of a victim after death. Communicators developed public health messaging to help change social norms and customs for burials. It was important to understand behavioral science and anthropology in order to communicate about safe burial practices in a way that would make people choose to change a behavior that was ingrained in their culture.

Behaviors are rooted in social 7 Things to Consider When Communicating About Health. Trust: Will people trust the information? Who is the best source to put the information out? Information: What information is necessary, and how will people find it? How much is enough, or too much? Motivation: How relevant is the information to the people we’re trying to reach? Environment: What are the conditions that surround and affect the audience? Capacity: What is people’s ability to act on the information? Are there barriers? Perception: What will the audience think about the information? What will inspire them to act on it? Response: How will people respond? What can we do to stay engaged with them and give them support as they take action?norms

The 2016 Zika virus outbreak is the first time in more than 50 years that a virus has been linked to serious birth defects. Due to the impact of Zika virus infection during pregnancy, social norms and perceptions around provider visits had to be addressed to alleviate concerns about the cost of screening. Clinicians were educated about the risks associated with Zika virus, how to prevent infections, and reporting suspected cases to their state, local, or territorial health departments and women were offered free clinical services, education, and access to Zika prevention kits.

Behaviors are rooted in beliefs

The fight to eradicate polio teaches us the importance of beliefs in behavior change during a response to a public health threat. Creating an effective polio vaccine was only the first step in the effort to eradicate polio. Of course an effective vaccine was necessary to prevent polio virus infections, but getting communities to accept the vaccine was equally important. Public health practitioners created messages that build on cognitive, developmental, and social psychology to persuade parents to bring their children into clinics to get vaccinated.

Behaviors inform preparedness and response

Responding to emergencies effectively requires combined expertise in many fields, including behavioral science. Epidemiology, for example, allows us to understand how many people have a disease and characterize the disease, while behavioral science identifies the role of human behavior and psychosocial factors. Behavioral science expertise can identify methods to communicate and design campaigns to change behavior that are culturally and socially acceptable.

It is important that we maintain humility when we try to understand why people do or think what they do. We often assume that we understand human behavior, but we must remain open-minded when working with people from all different backgrounds and cultures. Who’s to say that what our culture considers right and true necessarily translates to the same belief systems elsewhere? Thus public health ethics is also an important consideration when suggesting behavioral change interventions. When we are in situations that are particularly dangerous or stressful, our assumptions about other people’s behavior can lead to recommendations or actions that seem counterintuitive or wrong to them. Careful application of behavioral science is critical to any mission that seeks to improve public health and safety, here and around the world.

The Communication Research and Evaluation blog series highlights innovative research and evaluation methods used at CDC to improve behavior change campaigns.

10 Ways CDC Gets Ready For Emergencies

Dr. Stephen Redd, Director, Office of Public Health Preparedness and Response
Dr. Stephen Redd, Director, Office of Public Health Preparedness and Response

One of the best parts of my job is the opportunity to learn from a wide range of experiences. We have an obligation to not only respond to emergencies today, but to prepare for tomorrow by learning from the past. Our work extends to households affected by disease, communities ravaged by disasters, and U.S. territories battling new and changing threats. In fact, all over the world – we try to get ahead of, and manage, complex responses that touch many lives through ever changing circumstances. In an ideal world the health in every community would be at a level that would make recovery and reliance easier. The reality is that emergencies happen in all kinds of environments and populations.

The Public Health Preparedness and Response National Snapshot is our annual report that gives us an opportunity to showcase the work that we and our state partners do. The report reminds us that no matter how big the emergency, we need to work together to respond to the best of our ability—with the cards we are dealt.

Here are 10 ways CDC’s Office of Public Health Preparedness and Emergency Response worked to keep people safer in 2016 that can inform our work going forward.

1) Four Responses at Once: An Unprecedented Challenge

CDC experts continue to provide 24/7 monitoring, staffing, resources, and coordination in response to natural disasters, terrorist attacks, and infectious disease threats. In early 2016, CDC managed four public health emergencies at the same time through our Emergency Operations Center :

  • Ebola
  • Flint, Michigan, Water Quality
  • Zika Virus
  • Polio Eradication

See us in action:

2) A Complex Threat: Zika Hits the U.S.

CDC scientists and responders were activated in CDC’s Emergency Operations Center, where they combed through research, developed and distributed diagnostic tests, and provided on-the-ground mosquito control and education to protect people at higher risk for the virus, including pregnant women and infants.

3) Right Resources, Right Place, Right Time

CDC’s Strategic National Stockpile is ready to send critical medical supplies quickly to where they are needed most to save lives. The stockpile is the nation’s largest supply of life-saving pharmaceuticals and medical supplies that can be used in a public health emergency if local supplies run out.

Last year, we helped conduct 18 full-scale exercises and provided training for 2,232 federal and state, local, tribal, and territorial emergency responders to ensure that systems for delivering medicines are functioning well before they are needed in an actual emergency. We continue to work with our federal, state, local, and commercial partners to make sure every step of the medical supply chain – from manufacture to delivery – is coordinated.

4) State and Local Readiness

CDC connects with state and local partners to provide support and guidance, helping every community get ready to handle emergencies like floods, hurricanes, wildfires, or disease outbreaks.

This year, we created a new process to evaluate how well state and local jurisdictions can plan and execute a large-scale response requiring the rapid distribution of critical medicines and supplies. Through this program, we conducted assessments of 487 state and local public health departments. The information from these assessments will be used to help improve the ability to get emergency supplies quickly to those who need them most.

5) Cutting-Edge Science to Find and Stop Disease

To protect lifesaving research, CDC experts in biosafety and biosecurity conducted approximately 200 laboratory inspections and thousands of assessments of those who handle dangerous select agents and toxins like anthrax, plague, and ricin to keep these materials safe, secure, and out of the hands of those who might misuse them.

CDC’s Laboratory Response Network (LRN)l also develops and deploys tests to combat our country’s most pressing infectious and non-infectious health issues, from Ebola to Zika virus to opioid overdose. The network connects over 150 labs to respond quickly to high priority public health emergencies.

6) Protecting Our Most Vulnerable

CDC supports efforts all across the country to help those who may not be able to help themselves when a crisis strikes. Some populations, like children, older adults, and others with functional and access needs may need extra help during and after an emergency.

From planning for the 69 million children who may be in school when disaster strikes to the millions of Americans who need to make sure prescriptions are filled, medical equipment is working, and help arrives even if power is out and roads are blocked, it’s up to us to protect our most vulnerable in emergencies.

7) Emergency Leaders: The Future of Incident Response

When every minute counts, we need people who have the knowledge to step in and take immediate action. Learning and using a common framework like the CDC Incident Management System helps responders “speak the same language” during an event and work more seamlessly together.

CDC experts train leaders from around the world—25 countries in 2016—through an innovative, four-month fellowship based at our Atlanta headquarters. Lessons learned from this course were put to work immediately to head off an outbreak of H5N1 influenza in Cameroon.

8) The Power of Preparedness: National Preparedness Month

Throughout September, CDC and more than 3,000 organizations—national, regional, and local governments, as well as private and public organizations— supported emergency preparedness efforts and encouraged Americans to take action.

The theme for National Preparedness Month 2016 was “The Power of Preparedness.” During our 2016 campaign , we recognized the successes of countries and cities who have seen the direct benefits of being prepared, looked at innovative programs to help children and people with disabilities get ready for emergencies, and provided tips for home and family on making emergency kits.

9) Health Security: How is the U.S. Doing?

As part of the Global Health Security Agenda, teams of international experts travel to countries to report on how well public health systems are working to prevent, detect, and respond to outbreaks. In May, a team made a five-day visit to the U.S. to look at how well we’re doing.

In the final report, the assessment team concluded that, “the U.S. has extensive and effective systems to reduce the risks and impacts of major public health emergencies, and actively participates in the global health security system.” They recognized the high level of scientific expertise within CDC and other federal agencies, and the excellent reporting mechanisms managed by the federal government.

10) Helping YOU Make a Difference

Get a flu shot. Wash your hands. Make a kit. Be careful in winter weather. Prepare for your holidays. Be aware of natural disasters or circulating illnesses that may affect you or those you care about. There are many ways to prepare, and in 2016 we provided the latest science and information to empower every one of us to take action.

Every person needs knowledge to prepare their home, family, and community against disease or disaster before an emergency strikes. Whether it’s how to clean mold from a flooded home, how to wash your hands the right way, or how to use your brain in emergencies, our timely tips and advice put the power of preparedness in your hands. From the hidden dangers of hurricanes to the heartbreaking dangers of flu, there are steps we can all take to stay safe every day as we work toward a healthy and protected future.

For more ways we are helping protect America’s health, check out the new National Preparedness Snapshot.

To find out more about the issues and why this work matters, visit our website.

 

Recognizing the Vital Work of Our Nation’s Public Servants

Greg Burel receiving SAMMIE award.
Photo credit: Aaron Clamage/clamagephoto.com

In April 2015, an Ohio doctor made an urgent call to CDC concerning a possible life-threatening botulism outbreak that posed a risk to as many as 50 people who had attended a church potluck dinner.

Within hours, CDC, the Ohio Department of Health, and a local hospital had determined that botulism antitoxin was needed to treat the food-borne illness. They made an immediate request to the only U.S. source: CDC’s Strategic National Stockpile (SNS).

Greg Burel received the request just after 2 p.m. that day. He quickly issued his approval and set in motion a process that rapidly deployed and delivered botulism antitoxin to Ohio just after midnight to help save the lives of 18 people who had become seriously ill.

For Burel, this was all in a day’s work.

Burel serves as Director of the Division of Strategic National Stockpile at CDC, where he manages the federal government’s $7 billion Strategic National Stockpile of emergency medicines and medical supplies, which are stored in warehouses across the country.

In a public health emergency, the U.S. pharmaceutical supply chain may be unable to immediately provide a medical countermeasure that may be required to prevent, mitigate, or treat adverse health effects resulting from an intentional, accidental, or naturally occurring public health emergency. SNS ensures the right medicines and supplies are available when and where they are needed to save lives.

And The Sammie Goes To…

In recognition of his exceptional leadership and unmatched excellence in the management of CDC’s SNS, Burel was the recipient of one of this year’s prestigious Samuel J. Heyman Service to America Medals―also known as the “Sammie” award―specifically in the Management Excellence category. In his decade-long tenure as Director of SNS, Burel has spearheaded 10 large-scale responses, including national responses to flooding, hurricanes, and influenza pandemics, and more than 30 small-scale deployments for the treatment of individuals with life-threatening infectious diseases including the botulism outbreak and the Ebola crisis.

Burel’s most recent challenge has been dealing with the Zika virus. In the wake of the Zika virus outbreak, SNS is working with diverse partners such as CDC Foundation, commercial pharmacies, and vector control companies to implement public health interventions that wouldn’t have been possible without the expertise and capability of SNS staff to bring it all together. “It’s more than just having the right product on the shelf and an established plan to use it,” Burel said. “We recognize the shifting realities of today’s public health threats and work with partners spanning the public and private spectrum to develop the capacity to respond to any public health emergency.”

Under Burel’s watch, the SNS has steadily expanded its focus so that it is capable of responding to all the global hazards of the 21st century. He says, “I am honored to receive the prestigious Sammie Award, and privileged to work alongside the many esteemed public servants who play an instrumental role in the stockpile’s daily operations.”

With more than 30 years of civil service, Burel has risen through the ranks of the federal government to become a proven leader in medical supply chain logistics, disaster and emergency management, financial management, quality improvement, and organizational design. He began his career at the Internal Revenue Service, and served in leadership roles in the General Services Administration (GSA) and the Federal Emergency Management Agency (FEMA).

The “Oscars” of Government Service

Burel is one of many dedicated and hardworking federal employees across the world. The Sammie Award is an award program that publically highlights excellence in the federal workforce. The awards are also known as the “Oscars” of government service and honor those employees who have made the commitment to make our government and our nation stronger. They are named for the Partnership for Public Service’s late founder, Samuel J. Heyman, who was inspired by President Kennedy’s call to serve in 1963. These awards align with his vision of a dynamic and innovative federal workforce that meets the needs of the American people. The prestigious medals are awarded to a handful of federal employees each year for outstanding service to their country and humanity.

For More Information

7 times public health preparedness proved critical

7 times public health preparedness proved critical | www.APHLblog.org

Our nation’s public health system responds to emergencies such as natural disasters, infectious disease outbreaks, bioterrorism attacks and more both domestically and globally. There’s no way to know what the next threat will be or when it will strike. To quickly and effectively respond to these threats, the public health system – including public health laboratories – must be prepared.

Here are seven stories that highlight the value of public health preparedness and response:

  1. Massive Molasses Mess and the Laboratory Response
  2. Testing for MERS-CoV: The Indiana Lab’s Story
  3. System Built for Responding to Bioterrorism Confirms Plague in Colorado Girl
  4. September 30, 2014: As Ebola Arrived, the Texas Public Health Lab was Ready
  5. Anthrax in Minnesota? The Laboratory Response Network Springs Into Action
  6. Responding to the Animas River disaster: Who’s testing what?
  7. Not Even Superstorm Sandy Could Stop Newborn Screening in New Jersey