MRC Centre for Outbreak Analysis and Modelling
Centre profile from the MRC Network publication issued July/August 2008
The world-leading MRC Centre for Outbreak Analysis and Modelling was set up following a recent push to support translational research – which gave the already established group a funding structure that would allow it to operate optimally.
The team, led by Professor Neil Ferguson at Imperial College, is now able more readily to combine cutting edge basic research with practical applications, particularly in the areas of pandemic preparedness and the global fight against preventable diseases. Its core activities are flu pandemic planning and preparedness, developing generic real-time analysis tools, and tracking the spread of polio, malaria, HIV and TB – some of the planet’s biggest killers.
“The centre develops the basic cutting-edge science and then uses it to supply scientific advice to inform public health policy. Being a centre is allowing us to do both without falling behind, while also developing our capacity.” said Professor Neil Ferguson.
Before becoming a centre the team already had a breadth of experience spanning animal and human infections with radically different patterns of spreading – such as BSE (mad cow disease), foot and mouth disease, HIV, polio and SARS. They had also developed sophisticated real-time disease modelling and outbreak analysis technologies. However, collaborations with national and international bodies were ad hoc and took more time than the scientists could reasonably devote to them.
“We were becoming victims of our own success, with more queries from governmental and international bodies than we could handle,” recalled Neil. “The centre grant has allowed us to develop the infrastructure we need to respond to the requests we get. There has definitely been a shift in expectations from governments and international organisations such as the WHO. They increasingly expect modelling to be used not only live during a crisis, but also ahead of any problems, as part of preparedness exercises and routine policy-making.”
Pandemic preparedness
The centre now has a dedicated Outbreak Analysis Unit with several staff. This has two modes of operation: ‘peacetime’, when the unit responds to more general requests for assistance and advice and establishes relationships with relevant bodies across the globe, and ‘wartime’, when it would be on call to deal with a potential epidemic or pandemic. Their expertise applies to both human and animal diseases.
Dr Simon Cauchemez has been working with Neil Ferguson on modelling the impact of school closures on an outbreak of influenza. “What we found was that closing schools would not dramatically change the total number of people who would contract the disease – it would prevent only one in seven cases. Crucially however, such a measure would significantly reduce the burden of an epidemic at its peak. This would alleviate the strain on the health service and hopefully result in better outcomes.”
Simon’s speciality is transmission analysis, both at the national/international level, and at the community, and even household, level. The unit would be first in line to help optimise control policies if an outbreak occurred. Dr James Truscott also works in the Outbreak Analysis Unit, looking more specifically at people’s movements, especially in their commutes. He recalled a recent foot and mouth epidemic training exercise: “It was quite an eye opener. We were working around the clock and spent a good chunk of the night ensuring the software we were running to model the epidemic could cope with the amount of data. It gives you a feel for how tough it would be to sustain that level of work in a real situation. We often have quite precise data for animal disease epidemics, but human epidemics are more complicated. Data collection and access to data about movement is more difficult… and trying to control spread is trickier. You can’t cull people!”
Tackling global killers
Another part of the centre’s remit is providing expert advice, analysis and research capacity for international agencies and governments around the world. A lot of this work occurs at the intersection betweens patterns of human behaviours responsible for disease transmission and the biology of the infectious agents involved.
Professor Geoff Garnett did a lot of the original work modelling the spread of HIV/AIDS. His work continues today, with a focus on identifying effective intervention strategies for different communities in developing countries. “HIV is an outbreak that’s lasted 25 years so far,” he said. “My work aims to identify the outbreaks within the outbreak and develop interventions that can help bring an end to HIV. The collaborations I have here with other members of the centre allow me to stay at the cutting edge of the mathematical and computational research while looking closely at what works on the ground.”
Geoff travels the world looking at outbreaks in specific communities – drug users in St Petersburg, gay men in Peru – how they affect the populations the groups live in and how they can be controlled. His work helps inform the UNAIDS Reference Group, which he chairs and which feeds into work by the Global Fund, a charity set up to fight AIDS, TB and malaria, to assess intervention strategies in 20 countries.
On the other side of Imperial College’s St Mary’s Campus, where the MRC Centre is based, is Dr Nick Grassly whose work focuses on polio. Nick works in collaboration with the Global Fund and with Rotary International. “My mission is to use the surveillance data on the spread of infection to not only answer public health questions, but also feed on-the-ground observations and outcomes back into the basic science end of the equation. Observation is crucial to informing research into how these diseases can be tackled. At the moment, my main focus is on comparing different polio vaccines, some tackling one strain while others tackle all three strains of the crippling disease, to compare their effectiveness. Places where polio is still endemic include India, Pakistan, Afghanistan and Nigeria, where we’re seeing another outbreak at the moment.”
Professor Azra Ghani has recently re-joined the centre. Her focus is chiefly on malaria, for which the Gates Foundation has set the tall order of eradication. “Our goal is to create generic models of the disease which can be tailored to specific localities and aggregated to obtain a better picture of the regional or even global patterns of the disease. If we are to eradicate malaria even locally, we need to move towards these pandemic models to understand better the disease cycles and how the disease reappears. We also need a better understanding of how treatments like Artemisinin reduce the length of time a person is infectious and what impact that has on the spread of the disease. And my team is working to find out more about the potential long-term impact of measures such as insecticide treated nets on innate immunity in different populations,” said Professor Ghani. Another focus of Azra’s – and other staff in the centre – is TB.
Increasing demand
The new Rector of Imperial College, Professor Sir Roy Anderson, is also a lead researcher at the centre. His work covers a broad range of infectious pathogens. “The centre’s researchers are world leaders in this highly demanding area, constantly devising new tools and techniques for understanding the spread of disease. Sadly we expect to see more epidemics in the coming decades because of world population growth and increased travel. The centre will play a crucial role in helping the UK Government and international agencies cope with and reduce this predicted increased burden,” he said.