Practical knowledge gained from firsthand observations of outbreak and epidemic responses can inform preparedness and response efforts for future public health crises. The public health response to infectious disease events such as the West Africa Ebola epidemic, the MERS outbreak in South Korea, and the emergence of Zika in South and Central America can inform our understanding of how an infectious agent is likely to cause a public health emergency and what can be done to prevent or respond to such events.
Though practical and operational knowledge gained during outbreak and epidemic responses are crucial for preparedness, the limited available public health and healthcare resources must be dedicated to performing response activities rather than conducting research on response activities. Observers external to the response are needed to capture and analyze the valuable, ephemeral data that are crucial for identifying challenges and improving operational response to future crises. During public health emergencies, direct knowledge of the challenges encountered and lessons learned during the response is typically limited to the minds of the government officials who are involved in day-to-day response activities. In the midst of a response, these individuals are, understandably, too busy to dedicate time to documenting and analyzing the operational knowledge and lessons they are observing. Often, is it not until after-action reports are compiled that responders have an opportunity to reflect on what they have experienced and learned. But after-action reports are often not produced until long after the response is over, which may be too late for other communities who wish to learn what they can do to prepare and improve their responses to similar crises. Additionally, after-action responses are typically critiques of a specific location’s or organization’s response and, therefore, tend to be focused on the response’s shortcomings rather than challenges inherent to infectious disease event response more broadly. These results may not be sufficiently generalizable to other communities’ preparedness needs.
Independent, expert observations by non-governmental experts are critical for capturing ephemeral information that maybe overlooked by responders and, additionally, for providing an unbiased assessment of the problems faced and the resources required to combat them in both directly affected areas and other, yet-to-be-affected communities. Practitioners and researchers with valuable skill sets may lack the connections and resources to enable them to establish timely collaborations with communities affected by public health emergencies that would benefit both the affected communities as well as others. Typically, those who are able to participate in these types of investigations are a limited number of senior, and already well-funded, laboratory-based researchers. This small subset of researchers has made important discoveries in previous epidemics; however, knowledge of how to best respond to future public health crises would be improved by the participation of experts with a broader set of skills and experiences.
Government officials who are directly involved in the response may be viewed as having a stake in the problem and may be accused of being alarmist and/or trying to expand their authorities and resources to combat the problem. The Johns Hopkins Center for Health Security, on the other hand, is a well-respected, trusted, and independent voice for the importance of preparing for outbreaks and epidemics, and we can provide an unbiased, external assessment of the challenges faced during the response. We have a proven track record of advocating for policies to promote effective response to public health emergencies, and our ability to continue influencing policy and practice will be greatly enhanced by gathering anecdotes and stories from responders who can comment explicitly about their needs and lessons learned.
The Outbreak Observatory was created to support observation and analysis of the strategic and operational dimensions of public health crises. The project has funding to support our sending team members and trusted colleagues with relevant expertise to observe outbreak and epidemic responses from on the ground in affected areas and to share with practitioners and policymakers the challenges and successes that are likely to be experienced by communities in future events. Staff who are deployed will meet and speak with public health and healthcare practitioners at the local, state, regional, and national levels (as appropriate) to better understand the challenges they face, the resources they need, and the solutions they identify.
As a matter of priority, we aim to share our findings via rapid communication channels—e.g., communications with policymakers, social media, blog posts. Additionally, we will consider writing longer pieces—e.g., commentaries, articles—if we deem them to be an appropriate and necessary contribution to the literature. Information sharing is our goal. Academic publication is not our primary objective. The Outbreak Observatory team intends to work with domestic and international networks of practitioners and local partners to identify high-yield, field-based operational and applied research projects in order to generate new knowledge and a better understanding of the impacts of infectious disease events as well as the strategies that work best to mitigate their effects on health and society. We will share our findings with pertinent policymakers, members of the broader biosecurity and public health communities, and the public to ensure that important lessons are understood by all who need to know, especially those responsible for planning and resource allocation decisions.
Ideally, our presence as observers will be seen as helpful to responders who want their hard work and stories shared with others. At the very least, we want to be an unobtrusive presence in any outbreak response. We recognize that, during emergencies, local practitioners are busy. We do not want our presence to, in any way, divert important resources from response activities.
We will only share information that we believe is useful to the broader community of practitioners and policymakers. We will not criticize or “audit” any localities specific response; rather, we aim to collect and share information that is applicable to infectious disease incident response more broadly and that others can use to improve their own responses. We aim to gather information on challenges inherent to outbreak response, not to identify shortcomings of any particular response or organization. We will not share personally identifiable or protected health information.
We respect the intellectual property and specific contributions of practitioners and others involved in the local response. We have no interest in taking credit for their accomplishments and discoveries. Rather, we want to share best practices with our broad network of practitioners, policymakers, and academicians. Though academic publications are not our priority, any that arise from our involvement will be coordinated with local practitioners, and authorship will be assigned as appropriate.
We believe it is important for local practitioners to share their stories. Ideally, local practitioners would serve as lead authors in developing academic articles about the operational challenges encountered and the lessons learned during their outbreak response. As Associate Editors of the academic journal Health Security, we have deep experience working with practitioners to develop or flesh out articles for publication in an academic journal, and we are happy to help local practitioners through this process. That being said, we also realize that practitioners are extremely busy and often do not have time to compose their own articles or work through the often-laborious process of submitting a manuscript for publication. In these cases, we are happy to lead the effort to document and publish pertinent findings in close collaboration with local co-authors.
While Outbreak Observatory broadly studies outbreak preparedness and response operations, we have identified six priority topic areas and capabilities that we believe are critical to implementing effective outbreak response operations. When identifying and discussing potential collaborations and research opportunities, we utilize this short list as a way of focusing our research efforts.
Establishing, maintaining, and utilizing robust disease surveillance systems to enable rapid event detection and characterization as well as conducting necessary epidemiological activities and maintaining situational awareness during response operations.
Implementing effective and feasible non-pharmaceutical interventions (eg, social distancing, masks, quarantine and isolation, improved hygiene) and other non-medical strategies to limit or interrupt disease transmission during outbreaks, both in the community and in healthcare settings.
Establishing and implementing rapid and effective distribution and dispensing protocols for applicable medical countermeasures (eg, vaccines, antibiotics, antivirals, immunoglobulin) in the midst of outbreak response.
Building the necessary relationships and shared experience to integrate public health activities, particularly those implemented in the community, with healthcare facility operations to support a comprehensive health response to outbreaks.
Identifying the resources (eg, financial, personnel) and other support (eg, guidance, policy) required to facilitate the development and operation of sustainable public health and healthcare capabilities and capacity for outbreak response operations.
Identifying effective strategies for communicating with and educating the public, with a particular focus in engaging with high-risk and vulnerable populations, before, during, and after the response to improve the adoption of evidence-based protective actions.
Jennifer Nuzzo, DrPH, SM
Director, Principal Investigator
Senior Scholar, Johns Hopkins Center for Health Security
Dr. Nuzzo is a Senior Scholar at the Johns Hopkins Center for Health Security and Visiting Faculty in the Department of Environmental Health and Engineering and Associate in the Department of Epidemiology at the Johns Hopkins Bloomberg School of Public Health.
An epidemiologist by training, Dr. Nuzzo's work focuses on international and domestic biosurveillance, infectious disease diagnostics, and disease mitigation strategies. She also has worked on issues related to the Affordable Care Act, tuberculosis control, foodborne outbreaks, and water security and advised national governments and nonprofit organizations. Prior to joining the Center, Dr. Nuzzo worked as a public health epidemiologist for the City of New York, where she was a part of the city’s Waterborne Disease Risk Assessment Program.
Matthew P. Shearer, MPH
Senior Analyst, Johns Hopkins Center for Health Security
Mr. Shearer is a Senior Analyst at the Johns Hopkins Center for Health Security and a Research Associate in the Environmental Health and Engineering Department of the Johns Hopkins Bloomberg School of Public Health.
Mr. Shearer has a background in epidemiology and emergency preparedness and response, and his research at the Center includes developing health sector resilience to high-consequence infectious disease events, assessing the impact of the ACA on infectious disease surveillance and response capacity, and building regional collaboration on biosecurity issues in Southeast Asia. Prior to joining the Center, Mr. Shearer worked in local public health, conducting outbreak investigations and developing, exercising, and implementing emergency response procedures, particularly for infectious disease events.
Diane Meyer, RN, MPH
Senior Analyst, Johns Hopkins Center for Health Security
Ms. Meyer is a Senior Analyst at the Johns Hopkins Center for Health Security and a Research Associate in the Environmental Health and Engineering Department of the Johns Hopkins Bloomberg School of Public Health.
Ms. Meyer's background is in infectious diseases, public health, and nursing. Her research focuses on resilience to disasters and infectious disease events, public health policy, and global health security. Her current work involves creating a Global Health Security Index, improving health sector resilience to high-consequence infectious disease events, and determining best practices for communicating information about infectious diseases to the public. Prior to joining the Center, Ms. Meyer worked as a burn/trauma intensive care unit nurse in a level one trauma center in Washington, DC.
Michael Snyder, MALD
Analyst, Johns Hopkins Center for Health Security
Mr. Snyder is an Analyst at the John Hopkins Center for Health Security and Visiting Faculty at the John Hopkins Bloomberg School of Public Health.
Mr. Snyder’s background is in international politics, and he has written on a wide range of topics in international affairs, including the use of geospatial technology by UN peacekeepers, democracy assistance by international organizations, and election violence prevention. He recently co-authored a report evaluating the UN Mission for Ebola Emergency Response in partnership with the Executive Office of the UN Secretary-General.
Prior to joining the Center, Mr. Snyder worked in health and humanitarian affairs and the Brian Urquhart Center for Peace Operations at the International Peace Institute, and he interned at the United Nations in the Department of Political Affairs. He served as Editor-in-Chief of the Tufts Observer as an undergraduate, and he is conversational in French and Arabic.
Divya Hosangadi, MSPH
Analyst, Johns Hopkins Center for Health Security
Ms. Hosangadi is an Analyst at the Johns Hopkins Center for Health Security and a Research Associate in the Environmental Health and Engineering Department at the Johns Hopkins Bloomberg School of Public Health.
Ms. Hosangadi has a background in epidemiology and vaccine policy. Prior to joining the Center, she worked at the World Health Organization and the Johns Hopkins International Vaccine Access Center, optimizing vaccine policy and assessing vaccine impact. Additionally, Ms. Hosangadi worked at the Johns Hopkins Center for American Indian Health managing active bacterial surveillance data collected on Native American reservations.
Ms. Hosangadi’s primary research interests include emerging infectious diseases, vaccine access and optimization, antimicrobial resistance, and public health policy and preparedness.
Lucia Mullen, MPH
Analyst, Johns Hopkins Center for Health Security
Ms. Mullen is an Analyst at the Johns Hopkins Center for Health Security and a Research Associate in the Environmental Health and Engineering Department at the Johns Hopkins Bloomberg School of Public Health.
Ms. Mullen has a background in epidemiology and global health policy. Prior to joining the Center, she worked in the World Health Organization Health Emergencies Programme as part of the Health Security Interface and supported the development of standard operating procedures and guidelines for deliberate biological outbreaks. Additionally, Ms. Mullen worked for the Irish Department of Health’s Health Protection Surveillance Centre, developing national screening guidelines for Hepatitis C Viral disease.
Ms. Mullen’s primary research interests include disease outbreak preparedness and response measures, global health policy, and bioterrorism.
Research Assistant, Johns Hopkins Center for Health Security
Mr. Trotochaud is a Research Assistant at the Johns Hopkins Center for Health Security and an MSPH student in the department of Health, Behavior, and Society at the Johns Hopkins Bloomberg School of Public Health.
Mr. Trotochaud’s background is in communication studies and public health. His past research, work, and academic experience has addressed effectively communicating major public health problems to promote protective actions among dynamic populations. Prior to his time at the Center, Mr. Trotochaud worked with an array of public health agencies, ranging from local health departments to academic centers, applying his communication skills to address health-related challenges.
Intern Analyst, Johns Hopkins Center for Health Security
Ms. Andrada is an Intern Analyst at the Johns Hopkins Center for Health Security.
She is a Jack Kent Cooke Scholar pursuing a BA in International Studies with a concentration in Global Health Security at Johns Hopkins University. Her interests include health security, health policy, infectious diseases, and emergency preparedness, with a regional focus on the Americas.
Athalia Christie, MIA
Center for Global Health, US Centers for Disease Control and Prevention
Ms. Christie joined the CDC in 1997 as a Public Health Prevention Service Fellow focusing on lymphatic filariasis. She served her state assignment as the Coordinator of the Expanded Contact Investigation Unit at the New York City Tuberculosis Control Program where she oversaw more than 30 outbreak investigations. From there, she embarked on a series of international assignments including establishing acute flaccid paralysis surveillance in the tribal areas of Pakistan for the Global Immunization Division.
Ms. Christie was seconded to the World Health Organization from 2001-05 to lead the polio eradication programs in Somalia and South Sudan. In 2006, she was detailed to the American Red Cross to lead the Measles Initiative, providing technical and financial support to more than 75 countries. Most recently, she served as the Deputy Director for the Center of Global Health, overseeing policy, strategy, and communications for CDC’s $2 billion portfolio of global health programs operating in more than 60 countries. During this time, Ms. Christie deployed repeatedly to lead CDC’s Ebola response teams in Liberia and Sierra Leone.
Ms. Christie has received dozens of awards for her service including the Watsonian Public Health Advisor of the Year, the Secretary’s Award for Distinguished Service, and the American Red Cross’ Spirit of Excellence. Ms. Christie received her master’s degree from Columbia University.
Lauren M. Sauer, MS
Assistant Professor, Johns Hopkins School of Medicine & Johns Hopkins Bloomberg School of Public Health
Ms. Sauer is an Assistant Professor of Emergency Medicine in the Johns Hopkins School of Medicine, with a joint appointment in the Center for Refugee and Disaster Response in The Johns Hopkins Bloomberg School of Public Health, and a doctoral candidate in health and public policy in the Johns Hopkins Department of Health Policy and Management, where she studies quality of aid in response to disasters and the effects of disasters on health care infrastructure. She is the current co-chair for the Society for Academic Emergency Medicine’s Disaster Interest Group, the Co-Director for the Johns Hopkins School of Medicine disaster course, and a Core Team Leader on the Johns Hopkins Go Team, a deployable Medical Asset.
Ms. Sauer has worked remotely and on the ground on several disaster responses including Hurricane Katrina, the 2009 California Wildfires, the Haiti earthquake and the Pakistan floods. She has spoken both nationally and internationally on a variety of disaster medicine topics and participated in the US Navy’s Continuing Promise missions in 2010 and 2011 and Pacific Partnership Mission in 2012.
Ms. Sauer is the Research Director of the Johns Hopkins Hospital's Biocontainment Unit, and she has worked in the field of disaster and public health emergency research and education for more than 10 years. Her current work focuses mainly on disaster and outbreak healthcare infrastructure, including rapid diagnostic systems and novel therapeutics in public health emergencies, clinical resource availability and access, and the impact of policy on preparedness and response capabilities.
Carlos Castillo-Salgado, MD, DrPH, JD
Professor, Johns Hopkins Bloomberg School of Public Health
Noreen Hynes, MD, MPH
Associate Professor, Johns Hopkins School of Medicine & Johns Hopkins Bloomberg School of Public Health
Christopher Hurtado, MHS
Analyst, Johns Hopkins Center for Health Security
Intern, Johns Hopkins Center for Health Security
The Johns Hopkins Center for Health Security works to protect people's health from the consequences of epidemics and disasters and to make communities more resilient to major challenges.
We examine how scientific and technological innovations can strengthen health security. We study the policies, organizations, systems, and tools to prevent and respond to outbreaks and public health crises. We advance policies and practice to address a range of challenges, including the global rise in emerging infectious diseases, a continued risk of pandemic flu, major natural disasters, our dependence on vulnerable infrastructure, outbreaks of foodborne illness, and the potential for biological, chemical, or nuclear accidents or intentional threats.
The Center conducts independent research and analysis, and our work is supported by government and foundations. We do this work through the combined talents of our scholars in science, medicine, public health, law, social sciences, economics, and national security. We help connect diverse and international communities of health and science experts, industry leaders, and government officials to strengthen health security.
This project is funded through support from the Open Philanthropy Project.