How to Predict the Path of Need
Nonprofit Direct Relief uses science to get supplies to disaster-struck areas
When pharmacist Alycia Clark first began working at medical aid nonprofit Direct Relief in September 2018, she realized quickly that allocating medical aid to thousands was going to require new tools.
“Coming here, none of this is traditional pharmacy… We have to meet the needs of 100 countries simultaneously, for every disease state,” she said. “This isn’t anything they train you for in pharmacy school, and so I needed a way to understand it.”
Distributing medical aid to Direct Relief’s complex network, Clark found, required unique tools, including estimators designed to calculate the medicines and supplies that a specific disaster might require, as well as specialized kits.
Mapping and Analysis to Inform Understanding
At Direct Relief, data and mapping were already key tools for deciding how best to allocate aid. The organization provides medical support to people affected by poverty or emergencies around the world, without regard to politics, religion, or ability to pay.
During a hurricane, for example, the organization’s Research and Analysis team combines population movement data with HRSA information about population size, disease states, and other information to decide how and where to best distribute resources.
“We don’t want to send the goods where everyone just left. We want to know where people are going towards,” is how Andrew Schroeder, vice president of Research and Analysis, puts it.
Data about the past 50 years of severe hurricanes (see above) has guided Direct Relief staff in pre-staging the medications and supplies most frequently requested in the wake of a storm in hurricane-prone locations. Similarly, the organization has developed a California wildfire map that combines social vulnerability data with wildfire risk information to determine which communities in the state are most endangered by blazes.
“In the most basic sense, we’re trying to fulfill our mission to help people, regardless of race, religion, etc., by meeting their medical needs, either normally or in crisis,” Schroeder said. “That means, from a data point of view, we need to understand what their needs are.”
Clark quickly jumped on board, developing a disaster estimator tool that allows her to plug in information about a given population experiencing a disaster and receive an analysis of what medications and supplies will be most needed in that community, and in what quantities.
But even for an organization accustomed to tracking population movement, analyzing public health data, and assessing risk factors to make decisions about allocation and distribution, COVID-19 has brought new challenges.
Working with data amid COVID-19
“The challenge COVID has presented to us is that it’s a problem everywhere. Everyone needs help all at once,” said Gordon Willcock, Direct Relief’s deputy director of emergency response. “We do need to have a framework to drill down on which partners we support…we don’t have enough for everyone.”
Direct Relief has historically worked in the United States by supporting a wide network of community health centers, clinics, public health departments, and other organizations aimed at providing safety-net care for the nation’s most vulnerable.
But when it came to COVID-19, “we needed to understand things about their capacity to respond right at the beginning of February,” Schroeder said. “So we had to generate new information.”
Direct Relief’s Research and Analysis team began polling safety net health care providers about everything from their available PPE supplies to their emergency plans. At the same time, the organization made use of available data from John Hopkins University’s COVID-19 tracking project (see below), the US Centers for Disease Control and Prevention, and other sources, building a dashboard that integrated their findings.
Schroeder also co-founded the COVID-19 Mobility Data Network, a team of researchers that uses aggregated, anonymized population movement data to help policy makers at the state and local levels understand how well social distancing measures are working.
The Research and Analysis team has also mapped the COVID-19 vulnerability of countries around the world, drawing together data about the prevalence of chronic diseases, HIV, food insecurity, and tuberculosis with hospital bed numbers and case counts (see image below).
The organization’s Emergency Response team relies on that data when deciding how to distribute medical aid internationally.
To help address the persistent challenge of allocating precious resources like PPE equitably, Clarke said, she originally worked to develop an estimator tool that would make decisions based on a particular provider’s population and needs.
“When we got one request a day, the calculator made sense,” Clarke said. “But a few weeks into the pandemic, every time I looked, I had six missed phone calls and 40 emails.”
Today, Direct Relief keeps tabs on where case counts are highest and need is greatest, providing a stream of continual, widespread support while issuing more targeted offers to areas experiencing particularly intense case spikes.
Recently, during a COVID-19 surge in the Midwest, the organization distributed PPE and other medical aid to more than 50 hospitals, health centers, and other frontline providers in the region through a targeted offer.
Helping a broader array of health care providers
Before Covid-19, Direct Relief worked primarily with the nation’s safety net clinics and nonprofit health centers, rather than with hospitals. But as the need for medications and supplies grew early in the pandemic the organization began to work with the nation’s hospitals, providing PPE, ventilators, oxygen concentrators, and ICU medications.
Early in the pandemic, Clark began preparing to respond to such requests. She realized, even as the world focused its energy on PPE shortages, that medication shortages weren’t far behind.
The situation required a new kind of kit, containing blood pressure medications, antibiotics, albuterol inhalers, sedatives, and other drugs. (More recently, Clark has been working to expand the kit’s offering to include anticoagulants and steroids based on current guidelines.) Each kit contains enough supplies to treat 100 patients.
Direct Relief started sending out hundreds of ICU kits in collaboration with the Society of Critical Care Medicine (SCCM), which helped the organization prioritize which hospitals most needed the support.
“We’re providing supportive medications that COVID-19 patients may need in their severe course of illness,” Clark said. “It became the next best thing we could offer, absent a vaccine.”
Talya Meyers is a Senior Editor and Writer at Direct Relief, where she writes about everything from rare diseases to the impacts of natural disasters. Previously, she worked as a freelance journalist with bylines in Smithsonian Magazine, BBC Future, Refinery29, and the Santa Barbara Independent.