4.1 Outbreak management committee | MSF Medical Guidelines

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An outbreak management committee must be formed at the national, regional and district levels. This committee is charged with “managing” the outbreak, that is, ensuring that resources are appropriate to needs.

The committee meets on a regular basis: daily at the start of the outbreak, and then weekly until the operation is over. The meetings are short and have clear agendas.

The minutes are distributed to managers at the various levels and to the partners. Feedback can also be given via a weekly report relaying the essential information.

4.1.1 Composition of the committee

At each level, the committee is composed of representatives from:

The Ministry of Health (including representatives from the national immunisation programme):
The laboratories
The hospitals
The administrative authorities
The support agencies (WHO, UNICEF, bilateral cooperation) and non-governmental agencies involved
The community

Outbreak response requires close coordination with other sectors, which collaborate according to the needs. These sectors are:

Information (radio, newspapers, television, social media, etc.): the media disseminates information on the existence of an outbreak, the symptoms of the disease, treatment locations, free care, and vaccination dates/locations using language appropriate to the target populations
Education: schools can host vaccination sites; teachers can help make up vaccination cards and keep a tally of those vaccinated
Customs: it can facilitate the importation of drugs, medical supplies and vaccines
Public safety: known and accepted local stakeholders can help maintain order during mass vaccination campaigns.

4.1.2 The committee’s role

The Terms of Reference (responsibilities and decision-making level) are drawn up on a case-by-case basis and in accordance with national guidelines.

The major strategic directions are generally decided at the national level. The other levels (regional and district) are involved in the warning system and in implementing the response. Subcommittees can be charged with specific technical aspects such as laboratory, vaccination, information and communication, logistics, etc.

Defining strategies

The committee defines the surveillance, patient management, vaccination and public information strategies (Table 4.1). It implements activities by mobilising the necessary resources and coordinating and informing the partners.

Table 4.1 - Objectives and key steps in defining strategies

	Objectives	Key steps
Epidemiological surveillance	To provide weekly data for decision-making. To define operational priorities (care and vaccination: age group and geographic area).	Reach a consensus on a standard case definition. Strengthen or set up a simple, regular, systematic and reliable data collection system, including community-based surveillance. Get feedback from staff and partners.
Patient management	To shorten the time between the first signs of the disease and treatment by improving access to care. To reduce the CFR and sequelae. To make appropriate treatment available at all times and at all levels.	Create and distribute treatment protocols (hospital and peripheral centres). Assess needs in terms of: Specific treatments Inpatient and isolation capacity (beds and staff) Nutrition care Define drug supply strategy: Determine the final composition of the kits Centralise kit preparation Organise the distribution (timetable and priorities). Set up a monitoring system for quantities distributed and drug availability. Set up education and information sessions with the patient.
Vaccination	To quickly protect the at-risk population. To limit the spread of the outbreak.	Decide whether or not to conduct a mass vaccination campaign. If yes, define: WHO: define the target population WHERE: identify the places to be vaccinated and prioritise them HOW: approach and planning WHEN: revise the vaccination schedule as a function of the weekly epidemiological data
Public information and community engagement	To assess the public’s perceptions/attitudes about the disease and vaccination. To provide the public clear, practical information on the outbreak, patient care and vaccination.	Determine: WHICH messages TO WHOM they are addressed How and WHEN to transmit them.

Arranging for free care

The committee decides what will be free of charge to the public and identifies who will pay the costs for the different components of patient care:

Outpatient visits
Hospitalisation
Medications provided specifically for measles and its complications
Other treatments (e.g. for malaria)
Laboratory tests done as part of measles surveillance
Transfer of complicated cases

Estimating the budget

The committee draws up budget forecasts, taking into account the following costs:

Personnel: salary, per diem and training
Drugs and medical supplies (including cleaning and waste management supplies)
Food for hospitalised patients and caregivers
Vaccination: vaccines, cold chain, injection supplies, kits and modules;
International and domestic shipping
Staff transportation: vehicle rentals, fuel, travel, etc.
Logistics equipment: ropes, stakes, tents, megaphones, etc.
Administrative materials: vaccination cards, date stamps, tally sheets, training
documents, etc.
Information and social mobilisation
Communications equipment (telephone and card, radio, etc.)

The cost of vaccinating one person in a mass vaccination campaign will vary depending
on the context and the means deployed. In 2023, it was an estimated US$1.5 to US$4 per person vaccinated.

Evaluating the response

Evaluation is an essential component of any operation. It should be planned and prepared before the response begins. The aim is to improve operations by formulating recommendations with regard to what was done in practice.

As soon as the operation begins:

Define the objectives
Define the evaluation indicators
List the information that will be needed
Set up data collection (e.g. stock cards, donation forms, patient registers, epidemiological forms, etc.)
Define the methodology
Identify and train the people who will be in charge
Train and supervise the evaluators