Mass Gatherings Series: From the Experts

During our Infectious Disease and Mass Gatherings Series, The Disease Daily had the opportunity to speak with Dr. David Heymann and Dr. Bonnie Henry via telephone and email regarding their work with mass gatherings.

Dr. Heymann is currently the Head and Senior Fellow at the Centre on Global Health Security at Chatham House (London) and professor in infectious disease epidemiology at the London School of Hygiene and Tropical Medicine. Dr. Henry currently directs the Public Health Emergency Management program at the British Columbia Centre for Disease Control. Dr. Henry has worked on outbreak management with SARS and Ebola as well as polio eradication.

Both experts have been tasked with preparing their cities for Olympic games; a gathering that presents a significant challenge to public health professionals. At a 2010 Lancet Conference on Mass Gatherings Medicine, Dr. Brian McCloskey, of the UK Health Protection Agency, outlines the enormity of the upcoming 2012 Olympic Games in London: approximately 15,000 athletes, 20,000 members of the press, an average of 180,000 spectators per day and approximately 17,000 people living in the Olympic Village. The underlying challenge, he says, is to “plan to respond to anything that can happen at the Olympics” while continuing “with all the routine health protection work of a major capital city.”

To learn more about preparations for the Olympics, we asked both David Heymann and Bonnie Henry about their experiences.

When comparing the preparation for the Hajj and the Olympics, Dr. Heymann explains, “the concern is that you can never tell what diseases might be brought in by persons associated with the Hajj or the Olympics, or what diseases might be present locally that are able to amplify in transmission because of conditions unique to mass gatherings – strains on water, sanitation and food supplies; or the density and immune status of populations that have come to the event. But basic preparedness is the same for both. It involves good sanitation; safe water and food supplies, and a system to rapidly detect and respond to an unexpected disease outbreak no matter what the cause.”

Dr. Henry reinforces the importance of good sanitation and safe food supplies as she discusses preparations for the Vancouver Olympics in more detail:

“There were a number of initiatives that started in the years leading up to the Games. For example, food safety training for food vendors [was implemented] at the Games sites but also for all restaurants in the province to ensure that standards were up to speed. We also had a program of encouraging hepatitis vaccination for all food handlers. We also had influenza on our radar as a potential issue during the Games…[I]n the year before the Games we had the H1N1 pandemic so we spent a lot of time…ensuring that things like alcohol-based hand rub and tissues were available and that all participants…had access to immunization and antivirals if needed.”

Dr. Henry served as the lead for provincial level surveillance, response and planning for the 2010 Winter Olympics. This position required close coordination with organizations such as local public health organizations and the International Olympic Committee. “There was a great deal of work to set up all the connections [and] data sources in the years leading up to the Games”, she says. She further emphasizes the importance of “really getting to know each other,” so that if a public health threat emerged, “everyone knew where to go for information and who was going to respond to each aspect.”

Communication remained an extremely important component to protecting public health throughout the Olympic Games:

“During the games themselves, it was really just [about] keeping the communication going and analyzing the data everyday. We set up what we called our “EpiCentre” and had a team of analysts and epidemiologists who worked with each data stream…we met together to review…and developed a daily report which went, by email, to our partners. Our day would start with an early morning teleconference with the Games operations team to review the events of the day, then a health specific call midday and finally a public health surveillance call later in the afternoon.”

Dr. Henry also speaks to the legacy of the Vancouver Olympics, meaning the improvements the Vancouver health systems experienced as a result of hosting the Olympics:

“The biggest gain we got from the Games, I think, was in making strong connections that we still have today with…partners who we did not typically link with…These connections have helped us deal with the arrival of a migrant vessel with 490 Tamil refugee claimants….and even an increase in overdoses seen in one community. Working together during the Games helped make those connections that we may not have had otherwise.”

Dr. Henry closes with a note on how outbreak management and mass gatherings are different. With SARS and Ebola, teams had to focus on “outbreak management, caring for the community and controlling the disease, then helping the community recover.” For mass gatherings, these events may or may not happen. Further, she states, “they may happen to a large group of people in a very short period of time, so the focus is on being able to detect things rapidly.” She also warns about knowing when things are not happening: “never underestimate the importance of rumor control, especially for a high profile event.”


The Disease Daily thanks both Dr. Heymann and Dr. Henry for taking the time to speak with its writers.


This brings our series on Mass Gatherings to a close. As public health events related to Hajj may be detected long after Hajj has come to end, HealthMap’s Hajj map is still active and bringing you the latest on disease outbreaks from countries with pilgrims who visited Saudi Arabia.


Dr. David Heymann is currently Head and Senior Fellow at the Chatham House Centre on Global Health Security, professor of infectious disease epidemiology at the London School of Hygiene and Tropical Medicine, and chair of the board of the UK Health Protection Agency, and has held these positions since 2009. Previously, as assistant director general of the World Health Organization, he has worked with the Saudi Arabian Government on Hajj preparations, led the WHO global effort on containment of SARS, and headed the polio eradication initiative and other infectious disease control activities. Prior to work at WHO Dr. Heymann spent 13 years in sub-Saharan Africa on assignment from CDC where he participated in the investigation of the first and second outbreaks of Ebola and worked with African governments to strengthen malaria and other communicable disease prevention and control activities. Prior to that, Dr. Heymann worked for two years in the India smallpox eradication program.

Dr. Bonnie Henry is the Director of Public Health Emergency Management with the British Columbia Centre for Disease Control and Medical Director for the provincial Emerging and Vectorborne Diseases program.  Dr. Henry also has significant experience in disease eradication programs, as she worked with the WHO/UNICEF Polio eradication program in Pakistan in 2000 and with the WHO to control the Ebola outbreak in Uganda in 2001.  Shortly after, she worked on the response to SARS in Toronto and as the lead for provincial level surveillance, response and planning for the Vancouver Olympics.

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