Center for Research in International health Sciences and Interdisciplinary Solutions for Humanitarian issues (CRISIS-H)

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

xavier-delamballerie University Professor – Hospital Doctor, Xavier De Lamballerie directs the joint research unit “emergence of viral diseases” (UMR 190) at the Faculty of Medicine, Université de la Méditerranée (Aix-Marseille II). The Université de la Méditerranée Aix-Marseille II, the Research Institute for Development (IRD) and EHESP have been jointly involved in this unit since January 2012. As an expert in emerging viruses, viral genomics and antiviral drugs, Professor Xavier de Lamballerie is involved in research programs in Gabon, Laos, Thailand and Bolivia.

Team

Integrated within the Office of International Relations headed by Regine Ducos, and in close proximity to the joint research unit UMR 190 led by Professor Xavier de Lamballerie, the center’s team is composed of a project assistant, two researchers and two doctoral students. In addition, in each of the target countries (Laos, Mali and Bolivia), a coordinator and team ensure local implementation of the projects.

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

Drawing on the expertise and experience of the Office of International Relations and other EHESP academic and research departments, the center aims to collaborate with institutes and research foundations, national authorities, universities and public health institutions in partner countries, as well as international agencies and major NGOs. To best address public health problems in emerging or developing countries, the center has set various targets in terms of research, expertise, education and collaboration:

Research

Initiate high-level research on public health issues in emerging or developing countries
Propose operational research themes deeply rooted in field experience

This includes an interdisciplinary scientific approach tailored to the complexity of the problems involving not just virology and epidemiology, but also social sciences and management sciences.

Expertise

Offer Southern countries multidisciplinary expertise in international and humanitarian health.

Education

Enhance the offering of public health education specifically focused on priority themes for emerging and developing countries
Create a humanitarian health education program.

Collaboration

Create a multidisciplinary network of partners (North-North and North-South), sharing scientific and educational interests in public health, thus mutually promoting understanding, knowledge and skills. This requires integration into national systems based on existing expertise in education and research and a prolonged presence in the country, needed to provide medium-term visibility and achieve significant results in the field of education, research and public health actions.

Research Topics

The center proposes operational research themes deeply rooted in field experience. The priorities revolve around the following themes:

Infectious diseases (respiratory infections, papillomavirus, dengue and other arboviruses, etc.).
Epidemiology and Health Monitoring
Management of health and social facilities
Analysis and strengthening of health systems
Health and environment
Humanitarian Health

Locations and projects

International sites were chosen to establish EHESP’s scientific policy and international policy.

The CRISIS-H center is intended to be a cross-functional platform for the various departments and disciplines of the school, to drive North-South research in public health. The CRISIS-H center currently has operations in three locations: Laos, Mali and Bolivia. These countries were chosen based on the following criteria

priority was given to countries whose public health infrastructure is inadequate to meet their needs;
the presence of universities and local authorities who expressed needs in terms of education, expertise and research;
prior presence of at least one of the institutional partners of the EHESP (Fondation Mérieux, the French Red Cross, IRD, etc.).

In Vientiane, Laos

The EHESP is hosted by the Christophe Mérieux Center in Laos, part of the Ministry of Health. A first research project on the impact of the H1N1 pandemic called CoPanFlu Laos is underway. This is a general population cohort composed of 807 households and 4,000 subjects followed for 2-1/2 years. A collaboration with the French Red Cross on a community health project in rural areas is being conducted and a partnership has been established with the University of Health Sciences, Vientiane, both for education and research. Research projects on respiratory infections in hospitals, dengue fever and the quality of drugs are also being considered.

In Bamako, Mali

The EHESP is working with the Research Consortium composed of the Millennium Development Goals Center for West and Central Africa (MDG-WCA) attached to the Earth Institute, Columbia University, and the Laboratory of Applied Molecular Biology at the University of Bamako (LBMA – UB) on the project CoPanFlu Mali. This project includes two studies:

Influenza seroprevalence studies conducted on 202 subjects, in collaboration with the Millennium Village, in a rural Malian area within the 8 villages of the Tiby cluster (Millennium Villages in Dioro in the Ségou region).
CoPanFlu Bamako: creation of a cohort of 30 households (350 subjects) recruited through the community health center in Banconi, Bamako.

In Santa Cruz, Bolivia

The EHESP is working with the Cenetrop (Centro Nacional de Enfermedades Tropicales), the Embassy of France, the IRD and the US Navy Medical Research Unit 6 on the research project CoPanFlu Bolivia. This involves a cohort consisting of 401 households (1644 subjects) distributed between the cities of La Paz, El Alto, Cochabamba and Santa Cruz, followed for 1-1/2 years. A multidisciplinary (epidemiology, social sciences, virology) and multicenter research project focused on dengue fever is being conducted by a PhD candidate from the EHESP doctoral network.

An international multi-center research project : CoPanFlu International

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.