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Simulated measles outbreak trains next generation of public health leaders
By Cynthia Fazio
Days after Canada lost its measles elimination status, students in the Master of Public Health program engaged in a realistic outbreak scenario
By Cynthia Fazio
Days after the Pan American Health Organization confirmed Canada lost its measles elimination status, the Master of Public Health (MPH) program hosted an all-day outbreak simulation workshop led by Ava John-Baptiste, PhD, professor in epidemiology and biostatistics.
“We were in class when our professors broke the news that Canada’s measles elimination status had ended,” said MPH student Laura Martinez. “We were all feeling disappointed because we’ve had the elimination status for almost three decades. Losing it also means we need to take further action as public health professionals.”
Fifty-eight MPH students were immersed in a realistic outbreak scenario requiring them to make critical decisions about measles case investigations and outbreak responses.
“This workshop mimics the outbreaks in Ontario. I created a synthetic data set of measles cases that resembled the data from the outbreak in Ontario which ended in October," said John-Baptiste. "The students were tasked with analyzing case data from that outbreak and drawing conclusions from their analysis."
Students were split into 10 teams, with each representing one of the public health units in Southwestern Ontario. They were given two hours to prepare mock presentations for Public Health Ontario at a multijurisdictional outbreak investigation meeting.
Students were not given the topic for this workshop in advance.
The element of surprise and fast-paced environment closely mirrored what an actual day working in this field would look like.
“I had previously worked in a government setting in Saskatchewan, and this is very indicative and aligns with how the government operates from my experience,” said Martinez. “Sometimes the unexpected will come up and you need to reprioritize and pivot.”
‘Trains us well’: Preparing for high-pressure outbreaks
The students kicked off the morning analyzing measles surveillance data to create an epidemic curve – looking at the number of cases by date to track an outbreak – and then analyzing the shape of the curves, which indicates change over time, to determine if an outbreak is abating or continuing.
“This workshop was really comprehensive. We’re integrating everything we learned from courses such as biostatistics, epidemiology, research and social determinants of health,” said MPH student Sam Lam, BMSc’24. “I think this trains us well for the workforce because we’ll adapt well to high-pressure, fast-paced situations – especially in public health where an outbreak happens and you need to work with a team to provide an accurate report within a tight deadline.”
Cheryl Currie, PhD, director of the Interfaculty Program in Public Health at Schulich Medicine & Dentistry and professor in epidemiology and biostastics, explained the purpose of integrative workshops in the MPH program is to have students take everything they’ve learned through the program and use it to take action on a real issue in the community.
"The idea is that people learn best by doing," she said. "Not just by reading a textbook, but by applying their knowledge to real-world problems. We are making sure our students are job-ready to serve their communities.”
The idea is that people learn best by doing. Not just by reading a textbook, but by applying their knowledge to real-world problems. We are making sure our students are job-ready to serve their communities.
Director, Interfaculty Program in Public Health
John-Baptiste said it’s becoming even more important to create simulations and equip students with the skills to tackle measles outbreaks or other infectious agents.
“We seem to be at an inflection point where the harms associated with infectious disease are increasing. We had a public health success story, at least in Canada and other high-income countries, because we had been able to vanquish a lot of these illnesses,” she said.
“Through a combination of global warming, misinformation and being a victim of our success – with people having no firsthand understanding of how harmful infectious diseases have been – we now find ourselves back in a position where we are going to increasingly face harms. The decision to revoke our measles elimination status almost seems like a harbinger of that. Now, we are making sure that this next generation is ready to work on these issues.”
Students were given several tasks to help build their skills.
Later in the simulation, teams were asked to prepare either a qualitative investigation or a quantitative survey proposal to better understand the causes of vaccine hesitancy. Others created a rapid review proposal with evidence-based approaches to address parental vaccine hesitancy, tailoring their recommendations to various demographics and communities. Those teams worked through research best practices to gather the most accurate and relevant review papers with ideas for effective, evidence-based intervention.
For the qualitative investigation, teams came up with ideas to encourage more survey respondents and focus group participants, to get a more fulsome picture of causes, considerations and rationale behind vaccine hesitancy.
One team suggested inviting a public health practitioner who spoke the language commonly used in the specific community to lead the focus groups as a way to help break down cultural barriers and build trust. Gaining a better understanding of the various causes behind vaccine hesitancy could help public health stakeholders to better plan targeted and effective interventions John-Baptiste explained.
“Having to gather all that data in two hours and distilling the information so that it can be presented in a way that the public can understand really helps prepare us to do it with real cases,” said MPH student Charli Abitbol, who was part of a team that worked on a quantitative survey proposal.
“We had the opportunity to practice combatting an outbreak, today.”
On Nov. 13, national health reporter Alanna Smith attended this workshop virtually to capture an inside look for The Globe and Mail. Read their coverage.