- Lead an outbreak response with an incident management structure.
- Analyse epidemiological data to guide the response.
- Preserve and strengthen the health system during and after the crisis.
1Organising the response: incident management
An epidemic is managed as an incident, with an incident management system (or emergency operations centre) under the authority of the Ministry of Health and supported by WHO and the cluster. It brings together clear functions: coordination, surveillance and laboratory, case management, infection prevention and control, WASH, risk communication and community engagement, logistics, vaccination.
The daily meeting follows a fixed order: epidemiological situation, stock status, geographical gaps, decisions and persons responsible. A costed response plan and a dashboard of indicators (cases, deaths, case fatality rate, time between symptom onset and treatment, vaccination coverage) guide decisions and advocacy.
2Reading the data: epidemic curve, attack rate and case fatality
The epidemic curve (cases per day or per week) shows whether the epidemic is in a growth, plateau or decline phase, and whether a common source is likely. The attack rate (cases ÷ population at risk) indicates the most affected areas. The case fatality rate (deaths ÷ cases) measures the quality and accessibility of case management: for cholera, it must remain below 1%; a high case fatality rate in facilities signals a quality problem, while a high proportion of community deaths signals an access problem.
Data are disaggregated by age, sex and location, and shown on a map. An apparent drop in cases may also come from weaker surveillance: always check the completeness of reports before drawing conclusions.
3Preserving essential services
During an epidemic, other causes of death do not disappear. Past outbreaks have shown that the collapse of essential services (assisted deliveries, routine immunisation, treatment of malaria, tuberculosis or HIV) can kill more people than the epidemic itself. Staff must therefore be protected (infection prevention and control, personal protective equipment, regular pay), triage at facility entrances maintained and essential service indicators monitored every month.
HeRAMS and the national health information system (often DHIS2) make it possible to identify facilities that are falling behind. Attacks on health care, which close entire services, are reported to the WHO SSA and included in the cluster's advocacy.
4From recovery to system strengthening
A good response leaves a stronger system behind. In practice: work within public facilities rather than alongside them, align incentives with the rules agreed within the cluster, train ministry staff, integrate EWARN into national surveillance, and gradually transfer procurement to national channels and the essential medicines list.
Preparedness is part of the job: contingency plans by risk season (cholera in the rainy season, measles in the dry season, meningitis in the African belt), prepositioned stocks, trained rapid response teams, simulation exercises and after-action reviews following each epidemic.
Exercise: the response dashboard
Using data from a measles outbreak (420 cases and 14 deaths in six weeks, 70% among children under 5, estimated vaccination coverage of 62%, three facilities out of vitamin A), build the incident management team's dashboard: indicators, targets, sources, frequency, persons responsible, then draft the three priority decisions for the week.
Key points
- Incident management under the authority of the ministry, with clear functions and a daily meeting.
- The epidemic curve, attack rate and case fatality rate guide the response.
- High case fatality in facilities = quality; community deaths = access.
- Preserve essential services and protect staff during the epidemic.
- Work within the national system, prepare for the next season and learn the lessons.
Further reading: course references
- Sphere Association (2018). The Sphere Handbook: Humanitarian Charter and Minimum Standards (Health chapter). spherestandards.org/fr/manuel-2018
- Inter-Agency Standing Committee (IASC) (2007). IASC Guidelines on Mental Health and Psychosocial Support in Emergency Settings. interagencystandingcommittee.org
- Inter-Agency Working Group on Reproductive Health in Crises (IAWG) (2018). Inter-Agency Field Manual on Reproductive Health in Humanitarian Settings. iawg.net
- World Health Organization (2012). Outbreak surveillance and response in humanitarian emergencies: WHO guidelines for EWARN implementation. www.who.int
- World Health Organization (2017). Interagency Emergency Health Kit (IEHK) 2017. www.who.int
- Global Task Force on Cholera Control (GTFCC) (2017). Ending Cholera: A Global Roadmap to 2030. www.gtfcc.org
- Global Health Cluster, World Health Organization (2020). Health Cluster Guide: a practical handbook. healthcluster.who.int
- World Health Organization (2018). Surveillance System for Attacks on Health Care (SSA). extranet.who.int/ssa
Daily quiz
3 questions to check what you have learned. Answer them all to complete the day.