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How does the UK Public Health Rapid Support Team investigate and respond to disease outbreaks?

Expert Q&A with team director Daniel Bausch
Caption: Sierra Leone mudslide. Credit: UNICEF

The UK Public Health Rapid Support Team (UK-PHRST) is a group of public health experts, scientists, academics and clinicians ready to support countries around the world responding to disease outbreaks. The UK-PHRST is partnership between the London School of Hygiene & Tropical Medicine and Public Health England, with University of Oxford and King’s College London as academic partners.

In April 2017, Professor Daniel Bausch was appointed Director of the UK-PHRST. Prof Bausch is a specialist in emerging infectious diseases trained in internal medicine, infectious diseases, tropical medicine, and public health. He has extensive experience in sub-Saharan Africa, Latin America, and Asia combatting deadly global health threats such as Ebola virus, hantavirus, and SARS coronavirus.

A year on from the team's first deployment, Prof Bausch tells us more about the team and how they work to assist in managing disease outbreaks. 

How did the UK Public Health Rapid Support Team come about?

The 2013-16 Ebola crisis in West Africa shocked the world and highlighted the need to be able to investigate and respond to disease outbreaks as quickly as possible before they pose a global threat.

It also showed us that we weren’t ready to quickly implement the important research needed to find treatments during an outbreak.

Responding to the short-comings identified in the global response to Ebola, David Cameron the then Prime Minister announced plans to create the UK-PHRST - a team of British epidemic experts that would be on call to reach any part of the world within 48 hours.

The UK-PHRST, funded by the UK government, launched in November 2016 as a partnership between Public Health England and the London School of Hygiene & Tropical Medicine, with academic partnerships with the University of Oxford and King’s College London.

What’s the purpose?

We focus on three important things:

  • saving lives and outbreak response
  • innovative research to generate evidence on best practices for outbreak control
  • capacity building for outbreak response in low and middle-income countries eligible for UK Government Support

We’re working to address the emergencies that may happen today, but also to understand how to make our future responses more effective. Then, we want to build capacity so responses can come more from within the affected countries or region. Ultimately, of course, our goal is to strengthen the health systems so that outbreaks never occur at all.

What do the individual team members do?

The UK-PHRST is made up of a multidisciplinary group of public health experts and researchers who are ready to deploy to tackle outbreaks of disease anywhere in the world within 48 hours’ notice. The team includes epidemiologists, microbiologists, clinical researchers, a social scientist, clinical and infection prevention nurses, a data scientist and a logistician.

We work in partnership with host countries and other international responders to control an outbreak as quickly as possible, but also to help countries to develop their own capacity for improved and rapid national response to future disease outbreaks.

Why do we need one in the UK?

Diseases can spread rapidly and do not respect borders. Our team investigates and responds to outbreaks at the earliest stages of a possible epidemic to tackle the problem locally before it grows into a global issue. Stopping the spread of disease at its source is also the most effective way to protect the UK. Helping put out a fire in your neighbourhood not only helps the people where the fire started, but also prevents it from coming down on your house.

How do you decide when to deploy?

We respond when the deployment of our specialist expertise can reduce the threat and save lives. But we can only go where we’re invited. This might be a direct invitation from the government of the concerned country or indirectly through international agencies, such as the World Health Organisation’s Global Outbreak Alert and Response Network (GOARN), with whom we work closely.

There’s no shortage of work. While the outbreak responses are important, and perhaps the most visible part of what we do, the behind-the-scenes research and capacity building parts of our remit are what hold the potential to change things in the long term, preventing big outbreaks from happening in the first place. When they’re not actively deployed for an outbreak, our team is busy with these essential research and capacity building activities aimed at developing innovative new approaches and tools to aid epidemic preparedness and future responses to outbreaks. We currently have a number of ongoing research projects underway both in the lab and the field.

In the first year of its existence, the UK-PHRST has already demonstrated its capacity to respond to international health threats. We’ve deployed teams to outbreaks in Ethiopia, Nigeria, Sierra Leone, Madagascar, and Bangladesh, tackling serious diseases that we luckily don’t see in the UK such as plague, cholera and diphtheria, some of which have the potential to wipe out entire communities.

During an outbreak in Madagascar, we worked with various local and international partners to establish a study of the pulmonary form of plague so that we can better distinguish that disease from other respiratory diseases that initially look like plague but turn out to be other more common and usually less serious diseases. The results of this study will help us more rapidly identify the people who have plague and get them the medical care that they need, thereby reducing onward transmission.

The UK-PHRST is new, so we’re still learning and growing. This year we’ll be creating a system of reservists—people not permanently on our team, but with skills and expertise that we need and whom we can call in when needed.

We want to build bridges and collaborations across the vast biomedical and public health expertise within the UK in government, academia, or the private sector. We’re also engaged in numerous training and capacity building endeavours in Sierra Leone, Uganda, Ethiopia, and elsewhere. For example, we’re working with the Sierra Leone College of Medicine and Allied Health Sciences to help sponsor a new Masters of Public Health course, which encompasses, amongst many other things, training in epidemiology and biostatistics—key knowledge areas for effective outbreak control. The goal is to create a generation of local experts that will be able to prevent and control outbreaks with minimal need for outside support.

Many of the outbreaks we’ve responded to so far have been for diseases for which vaccines exist, so they were all preventable. It’s just that a complex mix of economic, social, political, and cultural factors often form barriers to health care delivery. A prime example is the Rohingya refugees in Bangladesh, who have been recently battling an outbreak of diphtheria, a disease for which a very good and safe vaccine exists. Nearly every child in the UK has been vaccinated against it. But this hasn’t been an option for the Rohingya.

The take-home message to me is that we have to continually advocate for health as a human right to make sure that our biomedical and public health advances reach those most in need.

Read about the team's latest deployment here.

This interview was first published on Public Health England’s Exposure.