Web Exclusives: Diseases
Research on a Mission: Five Years with MIDAS
This summer marks the fifth anniversary of the Models of Infectious Disease Agent Study, or MIDAS, a program that has helped researchers and policymakers around the world understand how contagious outbreaks can spread and be contained. We talked to Irene Eckstrand, scientific director of MIDAS, about the program's accomplishments so far and her hopes for the future.
MIDAS is a collaborative network of scientists who do research on models to understand the dynamics of infectious disease. One goal is to provide useful information to people who need to make health policy decisions. I like to call MIDAS "research on a mission."
Why is this kind of modeling work important?
There are many places where science and policy intersect. H1N1 [or "swine flu"] is a clear example. People need to know when to close schools, how to distribute vaccines, the best use of antivirals, and when to give vaccines to schoolchildren to really slow a pandemic. Modeling can give the people who make these decisions a great deal more information and help them examine the impact of various options.
How has MIDAS helped inform the government about flu?
We've participated in four policy discussions about flu, namely H5N1 or bird flu. Some of the questions discussed have included:
- Can you contain an influenza outbreak locally?
- If flu gets imported into the United States, what's the best way to slow it down while we develop a vaccine?
- If flu is in your community, what's the impact of non-pharmaceutical interventions like voluntary quarantine and school closures?
- How useful is distributing antivirals before an outbreak?
How do MIDAS researchers create reliable models?
We do thoughtful, careful studies that take into account as much information as we know about a particular infectious disease and how it spreads to help people make decisions. Doing this requires a lot of background research, subject matter expertise, and mathematical and computational expertise. It requires a really diverse group of people who communicate with each other on a day-by-day basis.
What can't models tell us?
Models don't necessarily give you accurate numbers to predict the future. The MIDAS models don't say exactly how many people will become ill or die in a pandemic. But they can suggest which particular interventions could slow an outbreak. For example, models might help us understand whether, and even when, to close schools, given that this intervention is very costly. Models might help us understand the impact of vaccinating children or high-risk groups.
Have there been challenges you didn't expect?
Questions emerge and develop almost in real time as we see issues, and even new outbreaks, emerging and developing. Modeling in that real-time context is much more complex than I thought it would be.
What diseases are MIDAS researchers studying?
Understanding flu is our biggest project, whether it's seasonal or pandemic flu. MRSA [methicillin-resistant Staphylococcus aureus, an increasingly common and hard-to-treat infection] is another high priority. MIDAS investigators are also studying cholera, dengue fever, malaria and tuberculosis, all major global health threats.
We're also going to put a lot more effort into understanding the ecology and evolution of disease, the impact of co-infections, and how antibiotic and antiviral resistance emerges and spreads. Another area is seasonality—why infectious diseases happen in waves in some places and not in others. If we could understand seasonality, we might be able to say if and when H1N1 will be back this fall.
Besides the models, what other useful research tools has MIDAS developed?
A really interesting one is synthetic populations. Using computational techniques, we can actually build local/state-wide/region-wide/nation-wide synthetic populations that have the same characteristics as real populations. We already have developed synthetic populations of humans, chickens, pigs and cows. I think those are going to be really useful research tools.
How is MIDAS trying to help the public understand its research results?
Something we're just starting to work on is visual tools that will make it easier for people—policymakers, decision-makers, public health, the public, school superintendents, anyone—to understand the dynamics of what's going on and the impacts of various decisions. I'm pretty excited about that.
What have you learned from directing MIDAS?
The most important thing is to keep in conversation with modelers, expert scientists and policymakers. All those people help each other make their decisions and do their jobs.
What are your goals for the next five years of the program?
I want other agencies, states and even countries to view the MIDAS network as a place they can come to for really reliable, thoughtful responses to the kinds of questions and concerns they have. Ultimately, I want the United States to be a world-class nation in the modeling of infectious diseases. We've come a long way in that, but we're not quite at that level yet.
You look happy about all of this.
I'm very happy about it. I'm very excited about what our researchers can do.