This is Episode 24 of Contain This, brought to you by the Indo-Pacific Centre for Health Security. This episode is hosted by Damian Facciolo, an Adviser and workforce development specialist from the Indo-Pacific Centre for Health Security at Australia’s Department of Foreign Affairs and Trade.
In this episode, Damian speaks with epidemiologists Ha-Linh Quach and Ngoc-Anh Hoang from the ASEAN-Australia Health Security Fellowship program, which provides scholarships for health professionals from Southeast Asia to complete the Master of Philosophy in Applied Epidemiology at the Australian National University. Both in their second year of the fellowship, Ha-Linh and Ngoc-Anh share highlights from their research and experiences working in public health, and provide insights into Vietnam's success in controlling outbreaks of COVID-19.
We hope you enjoy the episode.
For more information about the Indo-Pacific Centre for Health Security, visit our website https://indopacifichealthsecurity.dfat.gov.au.
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The views presented in this podcast are the views of the host and guests. They do not necessarily represent the views or the official position of the Australian Government.
Damian Facciolo 00:01
Welcome to the Contain This podcast. My name is Damian Facciolo and I'm an advisor at Australia's Indo-Pacific Centre for Health Security. On this podcast, I am very excited to be able to showcase one of the Centre for Health Security's flagship investments in field epidemiology training. The ASEAN Health Security Fellowship program provides scholarships for students from Vietnam, Cambodia, Laos, and Myanmar to complete the Master of Philosophy in applied epidemiology, also known as the MAE at the Australian National University. The program aims to increase the capacity of health professionals in the region to prepare for and respond to infectious disease outbreaks. And through these fellowships, the Centre for Health Security has created opportunities to build links between institutions and between health professionals. In 2020, we saw the very critical role epidemiologists play in advising decision makers on public health measures and helping to understand disease transmission. And today we have two epis from Vietnam who've done just that. I'm pleased to be able to introduce two of our ASEAN Australia Health Security Fellows Ngoc Anh Huang and Ha Linh Quach, both based in Hanoi and in the second year of the fellowship program. Various fellows are in placements at Vietnam's National Institute of Hygiene and Epidemiology, which is also called NIHE, one of the agencies that has helped to build and to guide Vietnamese response to COVID-19. And as many listeners will know, Vietnam has had great success in controlling outbreaks of COVID-19. So welcome to the podcast and thanks for making time to talk about your research. Ngoc Anh, maybe I could start with you and then ask you to introduce yourself and speak a little bit about your journey in public health. Why did you decide to apply for a fellowship?
Ngoc Anh 01:50
Thank you, Damian. Good afternoon. My name is Ngoc Anh and I am a Master of Applied Epi student at Australian National University. Three years ago I'm a student at Hanoi Medical University and my major is nutrition. My interest in applied epidemiology began around two years ago when I worked as a research assistant at Hanoi University of public health. I have chances to work with a senior epidemiologist who inspired me with how professional they are and how crucial applied epidemiology is. She is one of the professionals who introduced me to the MAE program. At my first impression I'm very happy to find a very good and practical program that fit with my goals.
Damian Facciolo 02:35
Thanks very much and Ha Linh, I know you are completing study in Hong Kong when you applied what motivated your interest in the MA program.
Ha Linh 02:45
Thank you Damian and Centre for Health Security for this opportunity. So my name is Ha Linh Quach. And I am also a second year postgraduate student in a Master of Applied Epidemiology in Australian National University under the ASEAN Australia Health Security Fellowship funded by the Department of Foreign Affairs and Trade. So after one year of studying Master of Public Health in the University of Hong Kong, I found that the need... because the previous program is more about coursework and I need more firsthand experience and work experience. So the motivation that I apply for the fellowship and the MAE program is pretty obvious. This great program is well-known and the number one ranking for Applied Epidemiology in Australia. The program offers great competencies and experience for students and workers in public health, preventive medicine and medical expertise alike, with a hybrid learning experience of both field placement and coursework, which I appreciate. It can be demanding in field experience, and it is exactly what I am looking for in the fellowship to actually get more first-hand opportunity working with public health sectors, in working with government agencies that I lack a lot from my previous study. So that's the reason why I applied.
Damian Facciolo 04:12
I should say for those listening to the podcast that the MAE program is a special two year advanced research degree that trains the public health leaders of the future. Through the MAE fellows undertake a field placement, a short period of intensive coursework normally delivered in Canberra and a research thesis on top of that, and as you said, the MAE is Australia's only field epidemiology training program. It's accredited by a global network known as TEPHINET. The ANU has run the MAE program since 1991, primarily for Australian students, but with DFAT support, the MAE has been open to international scholars since 2019. And our partnership has also enabled Australian epidemiologists to lead field work and capacity building in Southeast Asia. One of the elements that makes the MAE so special is the partnership with laboratories with health departments and research organisations across Australia and around the region. Health Security fellows, like yourselves, are assigned additional supervisors to oversee field work in country. And this mentoring and support is critical for the success of the program. And critical for similar field epi programs around the world. There's a very strong emphasis on peer to peer learning among scholars in the cohort as well. So what have you learned from other people in the program, from your supervisors or professors and other students during your time in the MAE?
Ngoc Anh 05:41
I think personally, two main thing I impressed me from others during MAE time, first and foremost, never underestimate the power of networking. It was to invest in a good working environment and supportive colleagues because we will stick through many times with them. So the second thing, we should learn to say no, don't expect appreciation from others at the beginning. Everyone is replaceable, and I think to do less with high quality is better than many low-grade activities.
Damian Facciolo 06:14
Okay, thanks very much. Maybe I'll go now to you, Ha Linh, what have you learned from the program? What lessons and experiences have you learned from others that have taken part in the MAE?
Yes, thank you, Damian. So there's a great deal of things that I learned and also continue learning from my time in the MAE. My academic supervisors previously Dr. Philippa Binns who is the ANU convener of the program. And now Dr. Florian Vogt from Western Australian Department of Health, always support for both of our projects. They are even the tiniest and widest ideas that we have during our field placement, they are very supportive in the thinking the way how to elaborate it, even with the geographical differences. Dr Florian is always on call for our questions, and his goal-oriented vision to what MAE competencies so keep both of our projects in focus while balancing the few placement activities. And I also learned a great deal of importance of planning and organising research by him from him. Of course, we cannot forget to mention our field supervisors in the field placement of NIHE where we have our projects taken place. We learn how to work with important stakeholders how to integrate our projects with multi-agency research, other medical research with Ministry of Health, with WHO [World Health Organization] in Vietnam, with CDC [Centre of Disease Control] in Vietnam. Right now we are deployed by the National Steering Committee of COVID-19 Prevention and Control, which is already a great opportunity for every epidemiologist out there. Thankfully, we also have our MAE training cohort as Ngoc Anh mentioned and the importance of networking. And the MAE alumni, they are very open minded. They have helped us a lot from the first time we got to Canberra to now with a lot of get-togethers, to work together, even to share our problems and even to write our cases together. And they also encourage us to speak up if we have any problems or questions with a class or with a faculty if we have anything, especially in communication with an academic supervisor, which I really appreciate. Okay, thanks. And you mentioned earlier when you were speaking Ngoc Anh about networking, what skills and attributes do you think make a good epidemiologist?
Ngoc Anh 08:48
Oh, I think many skills contribute to the good epidemiologist, such as critical thinking, presentation, teaching and other technical skills. And personally, I think communication and time management are the most important ones. Firstly, epidemiologists are in charge of many on-the-ground activities. Therefore they directly contact with people in the community to support them for health services. Therefore, there is a large return. However, they are in between the launching and distributing good health services. Therefore good communication is a key component to attract and convince people to use them. Secondly, epidemiologists are usually doing many tasks. A good schedule with clear priorities is a good strategy in the long run for epidemiologists.
Damian Facciolo 09:38
I agree. And Ha Linh, have you found that that balance between technical skills and soft skills is really important in making a good epidemiologist?
In my opinion, epidemiologist is the one that have to have a lot of skills that you think is very necessary but quite opposite to each other. So even though you have to be very detailed and focus on the data and the trend. But you have also be very quick on your feet to adapt and to respond to every type of emergency or event that happened in the area. For example, right now we have a new outbreak in Hanoi. And it's been in Vietnam, and this has been more than two months without any community transmission. And you can be deployed, you can be caught up, like right now, right there in the middle of the night, and you have to go right away. So that is the way that an epidemiologist have to be right, they have to be in the field, they have to be very ready on the field, to be there right away to set up the data, to analyse everything and to have answers in a short time in the field right away, within 10 seconds if someone asks you a question, you have to have the answer right away. So I think that the skills are more than only the technical skills, but the soft skills is the one that you need in the field epidemiologists.
That's great. I'd like to give you a chance now to speak about your own research, which was commended at last year's TEPHINET conference. Congratulations, it's a really great achievement for your work to be recognised at a regional level. And could you talk about some of the findings from your research into COVID transmission in hospital settings, Ngoc Anh?
Ngoc Anh 11:23
I fortunately had a chance to work with a project of investigating COVID-19 transmission in a tertiary hospital in Vietnam. We conducted also network analysis to study transmission patterns during this outbreak. This study showed the potential importance of non-clinical hospital staff in driving transmission dynamics during COVID-19 outbreaks. These people are often overlooked during the initial response. So Secondly, we demonstrate the value of social network analysis as a method for field epidemiologists to discover the COVID-19 transmission, particularly in hospital and other close settings.
Damian Facciolo 12:02
So you mentioned the non-clinical staff involved in a non-clinical element of transmission, is that the people working at the hospital, cleaners and administrative staff but also people that might come and visit patients? And do you have any strategies maybe that you can work to reduce the risk from transmission with those people? Is it training or more information? What kind of findings did you explore?
Ngoc Anh 12:30
Okay, so the non-clinical hospital staff are the key component, are the key super spreader in this outbreak.
Damian Facciolo 13:05
So I guess the key thing is that you need to work with everyone in that hospital context, not just clinical staff, but the people who bring the food and the cleaning staff and some cases also the people that come to visit patients and make sure that they're aware of the risks and that they're also part of the response. Ha Linh, I wanted to move now to your research on the modes of transmission on long haul flights. You also won an award at last year's TEPHINET conference. So maybe you could just explain for the listeners, what some of the interesting findings you found looking at long haul flights in Vietnam?
Thank you, Damian. So my research concerning transmission on a long haul flight is one of the memorable, most memorable experience of COVID-19 in Vietnam, which draw a lot of attention to the magnitude of imported risks and border control in the early time of the pandemic. So actually, we found one, from one in-flight symptomatic case that returned from London to Hanoi, the capital city of Vietnam, we found we discovered 15 additional cases on the flight and five secondary cases in the community, making this most infectious flight outbreak in Vietnam in the time of non-quarantine or testing policies available. So from this one symptomatic flight that dispersed to 15 other cases, that 12 actually clustered within the business class settings. Then we felt that two rows and the transmission on board and actually can well travel beyond the two row, two seat recommendation the WHO and previous ASEAN infectious control guidelines that have laid out. And we are from this, even with the seemingly low number of cases, we conducted contract tracing for nearly 200 passengers and crew members on the flight, and more than 1300 secondary contacts in the community across 15 provinces and cities in Vietnam. It is also the first time that we conducted an extensive contact tracing for all passengers and crew members. And that is how we actually have the conclusion that the transmission can actually be beyond the scope that we normally do contact tracing. So the containment measures took nearly two weeks to conduct but to trace, to test, to quarantine every possible person with COVID-19 exposure takes a lot of efforts, a lot of collaboration across the disciplines. And the flight actually raised a lot of attention to the importance of pre-flight and post flight screening, testing and quarantine, because the symptomatic case wasn't picked up by the pre-flight or the post-flight screening in place in London and boarding in Vietnam at that time. And which later Vietnam actually adopted a blanket policy to test and quarantine all travelling passengers from high risk areas to Vietnam in late March 2020, to compensate the need, or even obsoleted the need of contact tracing and also the burden of financial and human resources for the activities. So that is the finding of my research.
There has been a lot of attention on contact tracing and making sure that there's quick follow up of contacts. Do you were you involved in some of the some of the work? Or do you have any observations from Vietnam's experience with contact tracing?
Yes, so actually, the day that we got back from Canberra is the day that we found the symptomatic case was found. Even though we come back a little bit late, like five days later, we were right away deployed by the National Steering Committee and we had done contact tracing right away. So we have to do a lot of phone call to all the possible contacts on the flight and also their contacts in Vietnam and know how the contact tracing can be very, like complex and hard working for our people, like our public, our workers across the country, because people tend to move around mostly tourists, they move to multiple locations. And we actually find them in a third or fourth location even, when they are in Vietnam. So that took us a lot of hard work. And we were actually on the front line of that and even right now we are also doing the contact tracing in Vietnam for the new outbreak.
Vietnam's response with contact tracing and community mobilisation, there's been lots of lessons that that I think other parts of the world have learned from Vietnam's success. Did you have any other reflections, maybe Ngoc Anh I'll ask you, for any other sort of things you wanted to share from your own experience in the last six months or so, contributing to the response?
Ngoc Anh 18:29
I think the most important thing we would like to share from the Vietnam side for the contract tracing is that it required the collaboration of many major sectors involved in from the beginning. So we work quite quick to containment, to find a case and contact tracing for many other ground contacts with the case. And now we are zoning, it's not about the zoning, but it's our quarantine the real way where there are confirmed cases and other cases. [Plus] other places where the case is going in contact with other people. The process is quite quick and require many, many sectors and jurisdictions involved.
Thank you. Now I wanted to sort of look to the future you're halfway through the program now, halfway through the MAE course. What will be the focus of your research this year? And and what are you looking forward to in the future? Ngoc Anh, I will start with you.
Ngoc Anh 19:45
I think the most important thing we would like to share from the Vietnam side for the contract tracing is that it required the collaboration of many major sectors involved in from the beginning. So we work quite quick to containment, to find a case and contact tracing for many other ground contacts with the case. And now we are zoning, it's not about the zoning, but it's our quarantine the real way where there are confirmed cases and other cases. [Plus] other places where the case is going in contact with other people. The process is quite quick and require many, many sectors and jurisdictions involved. In this year, in the future, I would like to invest more time with the network analysis. I think it's gonna be the trending technique for investigating outbreaks in Vietnam in upcoming times. Otherwise multi-level analysis are interesting ideas for me as well.
Damian Facciolo 20:05
And you'll continue your work with the Steering Committee on COVID-19. Are you going to start to look at other diseases in the future as well?
Ngoc Anh 20:13
Yes, that's true. So I will be continuing with the National Steering Committee of COVID-19. And maybe to cope with other infectious diseases in the future.
Damian Facciolo 20:23
And Ha Linh I'll ask you, what you're looking forward to, in terms of research and what challenges for 2021? And ahead?
Thank you. So we both finished, I think hopefully, half of the requirement of the course last year. So for 2021, we shall continue to work on the last two projects, which again, involve the situation of COVID-19 in Vietnam after a year of his debut in the world. So the world is settling for the new normal post COVID. We know now that is clearly to stay, and we, as public health workers need to find a way to accommodate it to the common global health situation. So I want to focus more on the COVID-19 vaccination and how its impact on the resumption of health activities, health worker risk, other priorities of the health service in Vietnam, and also in regional context. I also want to focus more on extra projects involving teaching and working with other public health officers in Vietnam, to share our experience of applied epidemiology and also the MAE program, this fellowship if it's possible. And yes, we continue to work with the National Steering Committee of COVID-19. Because, as you know, it is here to stay. So we are also here to stay to continue to combat it. That's right.
I think it's very clear that good epidemiology and good public health knowledge are going to be very important for the future. Hopefully, the program has helped build your skills and given you new insights for a long career in public health.
Thank you, Damian, and the Centre for Health Security for having us. We really appreciate the chance to actually share our experience of working and being an MAE alumni, being an MAE scholar for the first time in our ASEAN country and to share our perspective of working between and being the bridge between the collaboration of ANU and the Australian Government and DFAT and also government agencies like NIHE in Vietnam. So thank you very much.
Ngoc Anh 22:46
We hope to have we have a chance to meet you in Australia before we take the graduation.
Damian Facciolo 22:54
Thanks very much. And congratulations again on your research last year. It was great that you were able to win those awards at TEPHINET. And I know Pip and Florian have been very happy with the work you've done. So it's a really, really great achievement and I'm glad we were able to include Vietnam in the program. You've been listening to Ngoc Anh Huang and Ha Linh Quach ASEAN-Australia Health Security Fellows on their experience studying the Masters of Applied Epidemiology at the Australian National University, and completing placements at Vietnam's National Institute of Hygiene and Epidemiology. I'm Damian Facciolo from Australia's Indo-Pacific Centre for Health Security. Join us next fortnight for the next episode of Contain This.