Lessons learnt from the applying the Centers for Disease Control and Prevention (CDC) evaluation framework to the measles incident management system response, USA, 2020-2021

Abstract

The functionality and performance of public health programmes at all levels of government play a critical role in preventing, detecting, mitigating and responding to public health threats, including infectious disease outbreaks. Multiple and concurrent outbreaks in recent years, such as COVID-19, Ebola and Zika, have highlighted the importance of documenting lessons learnt from public health responses of national and global agencies. In February 2020, the US Centers for Disease Control and Prevention (CDC) Center for Global Health (CGH) activated the Measles Incident Management System (MIMS) to accelerate the ability to detect, mitigate and respond to measles outbreaks globally and advance progress towards regional measles elimination goals. The activation was triggered by a global resurgence in reported measles cases during 2018-2019 and supported emergency response activities conducted by partner organisations and countries. MIMS leadership decided early in the response to form an evaluation team to design and implement an evaluation approach for producing real-time data to document progress of response activities and inform timely decision-making. In this manuscript, we describe how establishing an evaluation unit within MIMS, and engaging MIMS leadership and subject matter experts in the evaluation activities, was critical to monitor progress and document lessons learnt to inform decision making. We also explain the CDC's Framework for Evaluation in Public Health Practice applied to evaluate the dynamic events throughout the MIMS response. Evaluators supporting emergency response should use a flexible framework that can be adaptable in dynamic contexts and document response activities in real-time.

Keywords: Health systems evaluation; Immunisation; Measles.

Figure 1

The Measles Incident Management System (MIMS) organisational structure included leadership positions (Incident Manager, Chief Science Officer and Chief of Staff), technical teams (Evaluation, Communication, Detect, Mitigate and Respond) and liaison positions (Partnerships, Sustain and Laboratory).

Figure 2

The evaluation team followed the six steps and the four standards of the Centers for Disease Control and Prevention (CDC) evaluation framework over the course of the evaluation.

Figure 3

The Measles Incident Management System (MIMS) high-level logic model depicted was developed from a Theory of Change model which defined the problem and associated strategies. The final logic model included inputs, activities, outputs and outcomes and linked the response goals to a health impact. CDC, Centers for Disease Control and Prevention.