At the Epicentre of Humanitarian Aid

| April 6, 2013 | 0 Comments

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Epicentre is home to the behind-the-scenes number crunchers that for 25 years have informed the priorities of its well-known parent organization Doctors Without Borders (Médecins Sans Frontières, or MSF). Epicentre’s raison d’etre is to collect epidemiologic data that MSF teams use to more effectively deploy medical missions. For instance, an epidemiology team will investigate the scope of a measles outbreak and evaluate vaccine coverage in order to develop a strategic plan ahead of the MSF team’s arrival. As the organization has grown and come into its own, it has expanded its research priorities to include broader studies of population health and clinical research on new treatments and diagnostic tests for infectious disease.

This expansion of Epicentre’s research agenda has offered some bold research in a sector that can often be bound by conventional thinking. For instance, the primary strategy for increasing vaccine coverage under constraints of the cold chain necessary for keeping the vaccine viable has been to strengthen infrastructure that will improve the timely delivery of the vaccines in remote areas. Epicentre has instead approached the issue by asking what the limits are of the cold chain; in other words, whether a vaccine outside the cold chain can be equally safe and effective against infection. A randomized clinical trial currently under way in Chad is evaluating the tetanus vaccine under controlled temperature chain, which for tetanus means transportation and storage in the cold chain up to the district level, then exposure to ambient temperatures before the vaccine reaches the individual.

A second area of focus at Epicentre has been on data quality. In a literature review of mortality and nutrition surveys conducted in North Kivu, DRC, Epicentre puts its own evaluation head-to-head with those of two prominent French and Italian NGOs.[1] The paper draws attention to biased sampling and ethical concerns in the implementation of the other surveys. The underlying message is that in situations of humanitarian crisis, other NGOs skip writing protocols and consulting epidemiologists, both which lead to serious issues in data validity.

Such a challenge to organizations in their same line of work highlights one of the main questions regarding the nature of Epicentre’s mission. On the one hand, it is MSF’s right-hand-man, an in-house team that assesses feasibility and improves operations. Yet Epicentre is also a semi-academic and ostensibly neutral organization in the pursuit of new solutions and better information in humanitarian settings. Director of Epidemiology and Population Health Rebecca Grais, who spoke to a group of students at the Harvard School of Public Health in late January, describes the organization as picking up precisely where academic researchers leave off.[2] Critics may see only self-promotion in Epicentre’s sometimes pugnacious activities, but it’s hard to deny the value of their research. Hopefully Epicentre’s example will raise the bar and inspire others to find the resources, institutional support, and courage to demand better data.

 


[1] Grais RF “Learning lessons from field surveys in humanitarian contexts: a case study of field surveys conducted in North Kivu, DRC 2006-2008.” Confl Health. 2009 Sep 10;3:8

[2] Infectious Disease Seminar Series, February 11th 2013, Harvard School of Public Health, FXB G12

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