The investigation team is the first decision-maker; it can launch some activities immediately (improving surveillance and providing information, supporting case management) and should be capable of presenting the situation objectively and making the intervention recommendations most appropriate to the needs.
The level of involvement will then be determined by the response capabilities of the area in question and/or of the partners (Ministry of Health, WHO, NGOs, etc.) and by the available or obtainable resources.
The quality of that analysis will be crucial in decision-making and in deciding on a response strategy. The following elements should then be considered:
Intervention priorities
Analyse the investigation results within the broader context. If a number of areas are facing an outbreak, it is important to define the intervention priorities according to:
- The pertinence of the intervention: confirmation of the outbreak, the severity factors (incidence, attack rate and case fatality rate), the risk of spread, and the stage of the outbreak
- The added value of the intervention in the different areas: management of uncomplicated and complicated cases, vaccination, access to remote populations or those with little ability to respond.
The intervention space and means for implementing recommendations:
List the constraints of the proposed interventions and suggest a working plan for finding alternative solutions.
External constraints
- The intervention space: authorisation by the health authorities, declaration of the outbreak, etc.
- The response capacity of the MoH and/or regional or national partners (laboratory confirmation, treatment capacity, vaccine availability, etc.).
- The security context
Internal constraints
- Pharmacy/vaccine (and consumables) stocks, import authorisations and procedures, if necessary
- Logistics (cold chain, transport), human and financial resources
The completeness and pertinence of the emergency preparedness plan (organisation, stocks, contacts, etc.) will be essential to facilitate decision-making and implementation of a rapid response.
A rapid, effective response requires:
- Monitoring
- Preparation: an emergency and outbreak response plan
- Knowing how to investigate and analyse a situation in order to propose an action
- Putting that proposal in a broader context in order to make a joint operational decision