Ebola in Conflict-Affected Areas

Ebola in Conflict-Affected Areas

As the Ebola outbreak in the Democratic Republic of the Congo continues, security issues are impacting response efforts. This post explores prior Ebola outbreaks that occurred in similar situations.

Reflections on the Need for Operational Research

Reflections on the Need for Operational Research

During the West Africa Ebola epidemic, numerous organizations were on the ground working to contain the spread of disease. This unprecedented response likely created many opportunities for responders to capture operational data that could have not only informed immediate response activities, but also benefited future preparedness and response efforts. But to what extent did this actually happen?

That is the question that we tried to answer in an analysis recently published in the International Journal of Infectious Diseases: “Evaluating the frequency of operational research conducted during the 2014-16 West Africa Ebola epidemic.” We conducted a quantitative analysis of the peer-reviewed literature to determine the volume of research published during and after the West Africa Ebola epidemic that addressed operational aspects of the response. We defined operational articles as those that discussed activities pertaining to disease detection and control, disease surveillance, and risk communication that were written by individuals or organizations that played an active role in the outbreak. We excluded basic science studies that addressed disease epidemiology, clinical patient care, and medical countermeasure development as well as think pieces written by individuals who were not directly involved in the outbreak.

We found that, while there was a large surge in the number of Ebola-related papers published during and after the West Africa epidemic, very few studies were operational in nature. Of the 3,681 Ebola publications published during the designated research period (March 2014 to December 2017), 97% addressed topics other than response operations. We found that many of these articles “pertained to high-level assessments of the overall response efforts, disease pathogenesis and epidemiology, or laboratory-based studies or clinical trials aimed at countermeasure and diagnostics development.”

We also wanted to know when operational research was published with respect to the timing of the epidemic. We found that more than half of the operational studies we identified “were published after the WHO first officially declared the epidemic to be contained on January 14, 2016.” This is probably not surprising, given the enormity of the challenges that existed on the ground. Responders were likely too busy trying to contain the outbreak to collect, analyze, and write-up data for peer-reviewed publication. Additionally, the peer-review process itself can take many months to complete.

While these findings are not necessarily surprising, we believe they are indicative of a larger problem in outbreak preparedness: the absence of a dedicated effort and available resources to learn operational lessons from outbreak responses as they occur. There is a need to rapidly vet and share findings from these events so that we (ie, the broader outbreak preparedness and response community) can better prepare for future outbreaks. While we do not prescribe a certain percentage of research conducted during outbreaks that should be devoted to operational research, we know from experience that many responses continue to face similar challenges and repeatedly “learn” similar lessons. As Outbreak Thursday readers may recall from our previous posts on the ongoing Ebola outbreak in the Democratic Republic of Congo, important operational questions remain about the best methods of containing deadly outbreaks of Ebola and other diseases.

Our research provides quantitative evidence that very few findings, lessons learned, or other operational aspects of the West Africa Ebola response have been vetted and shared in the peer-reviewed literature. Since this type of research could be directly applicable to future preparedness and response efforts, it is imperative to intensify efforts to conduct operational research so that this information can be captured and disseminated. As noted in our article, other organizations, including Médecins Sans Frontières (MSF), have made similar calls to action.

We believe that a failure to conduct operational research during outbreaks is not due to lack of interest, but rather a result of barriers that hinder the conduct of such studies. Responders have limited time and resources to support any work beyond activities that apply directly to the outbreak response. People who are actively involved in the life-saving work of containing outbreaks simply do not have time to conduct this kind of research. Few funding mechanisms exist to support individuals or organizations external to the response in conducting operational research, and these external groups may find it difficult to embed themselves in the response and conduct operational research without impeding response efforts.

We created Outbreak Observatory with this premise in mind: to provide a dedicated mechanism for the conduct of operational research during outbreaks through partnerships with responding organizations and to facilitate the collection, analysis, and dissemination of broadly applicable lessons. This research could not only help future preparedness and response efforts, but it could also arm public health advocates and policymakers with data that illustrate the continued need for public health resources such as funding, staff, equipment, and other supplies.

We believe our analysis supports the need for collaborative efforts to conduct and publish peer-reviewed operational research to ensure that lessons learned during outbreaks can be improved upon during future crises. We invite other organizations to partner with us on this mission.

Outbreak Observatory aims to collect information on challenges and solutions associated with outbreak response and share it broadly to allow others to learn from these experiences in order to improve global outbreak response capabilities.

Acute Flaccid Myelitis in the US

Acute Flaccid Myelitis in the US

After outbreaks in 2014 and 2016, cases of acute flaccid myelitis (AFM) are on the rise again. Health officials have been unable to definitively identify a causative pathogen, which complicates response and public communication efforts.

Typhus Bites Back in Los Angeles

Typhus Bites Back in Los Angeles

Murine typhus, a centuries-old disease typically associated with overcrowding and poor hygiene, is on the rise in Los Angeles, with potential to spread to other US cities.


Ebola- Contact Tracing and Monitoring in DRC

Ebola- Contact Tracing and Monitoring in DRC

A recent surge in cases, particularly in high-conflict areas like Beni, raise concerns that the DRC Ebola outbreak could be worsening. Outbreak Thursday looks for evidence to assess the current surveillance and monitoring efforts.

Winter is coming…. So is flu

Winter is coming…. So is flu

This week’s blog post reviews the severity of last year’s influenza season, the lack of seasonal flu vaccine uptake, and the potential role technologies could have in improving flu awareness and vaccination rates.

Progress towards TB elimination in the United States

Progress towards TB elimination in the United States

This week’s blog post reviews progress towards TB elimination in the United States with the goal of understanding some of the barriers that may still exist in low incidence settings.


Monkeypox in the UK

Monkeypox in the UK

The first two cases of monkeypox in the UK were identified earlier this month. Both cases were in travelers who recently arrived from Nigeria, but health officials have not identified any epidemiological link between the two patients.

Zimbabwe Cholera Outbreak Test of New Government

Zimbabwe Cholera Outbreak Test of New Government

Zimbabwe declared a State of Emergency after an outbreak of cholera sickened thousands of people, prompting the newly-elected government to ban public gatherings in the capital city, Harare. We explore Zimbabwe’s recent struggle with cholera and the role these social distancing measures might play in responding to cholera.