Co-Directors of the centre

Régine Ducos

Director of International Relations at EHESP School of Public Health, Régine Ducos has a university background in pharmaceutical sciences and holds an MBA in “Health, population and nutrition in developing countries”. She has been working for various humanitarian organisations for more than 10 years. Through her humanitarian missions in Asia (Cambodia), Africa (Sierra Leone, Madagascar) and Europe (Turkey, Georgia, Bosnia, Serbia, and Albania), she acquired expertise in the following areas: HIV prevention, reproductive health and family planning, technical assistance to Ministries of Health (central and peripheral levels, sanitary planning, training, etc.), essential medicines and avian influenza.

Pr. Xavier De Lamballerie

University Lecturer and Hospital practitioner, Dr. Xavier De Lamballerie directs the Emerging Viruses Unit at Aix-Marseille II University School of Medicine. Expert in emerging viruses, viral genomics, and antiviral medicines, he is involved in research programmes in Gabon, Laos, Thailand and Bolivia.

Partners

The Mérieux Foundation, the University of the Mediterranean (Aix-Marseille II) as well as local authorities and public health institutions from Laos, Bolivia and Mali.

Strategic objectives

The centre aims to develop expertise in interdisciplinary research within the fields of international and humanitarian health in order to offer, in France as well as abroad, high-profile research and training programmes addressing public health issues critical to developing countries.
Relying on the expertise and experience of the International Relations Department and the various research and training departments of the EHESP School of Public Health, the centre sets out to collaborate with research institutes and foundations, national public health authorities and institutions within the partner countries, as well as international NGOs.

Staff

The international and humanitarian health centre is composed of two co-directors, one project assistant, a junior project coordinator, an EHESP doctoral student working in Bolivia (former EuropubHealth student) and a research engineer based in Laos. In line with its interdisciplinary approach, the centre also benefits from the contribution of researchers and professors from the EHESP, staff from the International Relations Department, as well as EHESP students and interns.

The international and humanitarian health centre has sites established in Bolivia, Laos, and Mali.

Scope

Major public health issues faced by countries undergoing the lowest level of development constitute the key priorities of the international and humanitarian centre of public health:

• Infectious diseases (malaria, tuberculosis, hepatitis, infectious diarrheas, HIV, respiratory diseases including flu, papillomaviruses, meningitis, leishmaniasis, trypanosomiasis, dengue and other arboviruses)
• Sanitary and epidemiological surveillance
• Environmental health
• Health systems analysis
• Management of healthcare and welfare establishments
• Human resources in public health
• Humanitarian health

Strategy

For more than 20 years, EHESP School of Public Heath has undertaken actions promoting the transfer and capitalization of expertise and skills in public health. A collaborative programme is successful when the partner is able to manage in an autonomous and sustainable fashion the specific public health issue at stake, whether it be related to research, capacity building, professional training, or operational aspects (diagnostics, management, care, etc.).

Accordingly, the working principles of the international and humanitarian health centre are:

• An approach synthesizing training and research. Training can target health professionals (in this case, priority will be given to the ‘training of local trainers’), but can also focus on the instruction of university students, integrating an LMD framework. The center proposes education and research-based curricula, allowing students to spend several months in French or European institutions, before returning to their home country to undertake a research project, the object being to reinforce students’ return to their country of origin where they will contribute to public health capacity building after their graduate studies. To this end, students’ graduate work is co-supervised by national partners.
• The integration within national systems (relying on existing skills in training and research).
• Working toward inter-institutional collaboration.
• The sustainability of the local set-ups (long-term presence), which is necessary in order to enhance visibility after a certain length of time and achieve significant results within education, research, and public health.
• An interdisciplinary scientific approach, adapted to the complexity of the issues, and integrating, in particular, the humanities and social sciences.
• The undertaking of pragmatic actions and endeavors having great potential in public health, including descriptive studies.

Current projects

3 strategic endeavors

• In Laos, a research programme on the impact of the A (H1H1) influenza will begin soon in partnership with the Ministry of Health and the Mérieux Foundation. At the request of the Ministry of Health, the feasibility of a hospital management training program is currently under consideration.

• In Mali, a collaborative programme in environmental health is beginning. Training and research projects concerning health surveillance, epidemiology, diseases of great magnitude (malaria, respiratory diseases and chronic disease), analysis and evaluation of the health systems, health economics and management of healthcare establishments are being contemplated.

• In Bolivia, interdisciplinary research, focused on dengue virus, is being conducted in partnership with the Ministry of Health and the French Embassy in Bolivia. A hospital management training programme is also being developed. Other themes of study under consideration encompass epidemiology, health surveillance, cervical cancer and influenza A (H1N1).

An international multi-center research project : WHO-CoPanFlu

In the context of the current emergence of the swine-like influenza virus A (H1N1) and its pandemic spread, it is crucial to acquire knowledge on collective and individual determinants of viral infection risk, the factors associated with the variable clinical expression, the nature of the immune response, the effectiveness of preventative and therapeutic methods employed, the behavioral changes induced by the emergence of the virus, as well as the social and economic consequences of the pandemic.
The CoPanflu International Influenza project aims to identify, on an individual level, the epidemiological, immunological (including a genetic analysis) and virological determinants of the risk for infection by the H1N1 virus. The viral transmission pathways, the infection parameters (reproduction number, generation interval), degree of pre-existing immunity, and temporal dynamics of the virus, will be assessed. Modeling will be used to study the virus’s role in the context of the emerging second pandemic wave.

For each participating international partner, the project is composed of a set of research modules, all structured around a cohort of 1000 households to be followed over a period of two years, during which time clinical events will be actively monitored and biological samples will be collected.

• (1) An epidemiological module designed to measure the incidence and study the determinants of risk for influenza infection, taking into account the immune status of the individual and the environmental factors modulating the risk exposure ;
• (2) A virological module to study viral diversity and the evolutionary mechanisms of influenza viruses and the virus/immunity relationship;
• (3) A mathematical modeling module to study the necessary conditions for the occurrence of the second pandemic wave, which will also evaluate in silico the impact of various preventive measures.
• (4) An immunological/genetic module designed to explore the repertoire of cellular responses against influenza virus, including the search for host genes conferring susceptibility/resistance.
• (5) A social sciences and health economics module for the evaluation of the perception of pandemic risk, the behavioral changes induced, the micro-economic impact of the pandemic and the control measures deployed.
• (6) An environmental module aiming to characterize, within a sub-set of households, the environmental conditions associated with the transmission risk.

The CoPanFlu study, for which a core protocol is built, will eventually allow between-country/international comparisons of the pandemic’s burden, its epidemiology, and its social and economic consequences.

Training in humanitarian health and action

In addition to the work being carried out at the 3 sites mentioned above, the international and humanitarian centre contributes to the management of a 5-week specialization course in humanitarian health and action within the context of the EHESP Master’s in Public Health, which is intended to enable humanitarian workers to develop skills in public health.