Podcast – A Conversation with CORI Analysts: Outbreak Resources and Strategies for Health Departments

In this podcast episode, Domestic Preparedness Publications and Outreach Specialist Teresa Farfan speaks with Haley Farrie and Sarah Gillani, analysts at the Johns Hopkins Center for Outbreak Response and Innovation (CORI). They discuss the critical need to strengthen outbreak response efforts in communities nationwide and how CORI supports state and local health departments through guidance and resources. This conversation was recorded on April 30, 2025, during the Preparedness Summit in San Antonio, Texas.

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Teresa Farfan

Hello and welcome to Domestic Preparedness: The Podcast, where we bring you the voices of preparedness. I am your host, Teresa Farfan, and in this episode recorded at the 2025 conference of the National Association of County and City Health Officials, or NACCHO, we are diving into the critical work being done at the intersection of public health and emergency preparedness.

With me today are Haley Farrie as well as Sarah Gillani, and they are analysts at the Johns Hopkins Center for Outbreak Response and Innovation. So let’s start with that. What’s the primary mission of the Center for Outbreak Response and Innovation—CORI?

Haley Farrie

Yeah, absolutely. So thank you again for having us. We really appreciate the opportunity to speak with you and get out to your audience. So we are the Center for Outbreak Response Innovation, or CORI for short, and we are funded by the CDC Center for Forecasting and Analytics, and our purpose is to essentially scale what’s working well, find out what’s working well from the perspective of state and local health departments, and then bring that to scale at a national level. So, for example, what we’re doing right now is looking for modeling and analytics tools. That could be as simple as a Power BI dashboard or as complicated as a forecasting tool for supply chain. And then what we do is, we bring those tools to our community of practice and then help to scale up that tool and utilization across the country.

Farfan

That’s a big responsibility, right?

Farrie

Certainly.

Farfan

So what do you think are the greatest challenges state and local health departments across the nation are facing today?

Gillani

I think we saw during COVID, and even now with measles, is that health departments are often understaffed and overburdened, and there is a clear need for a standardized framework and tools to help make outbreak responses easier and more efficient so that they can maximize public health impact given the limitations that they may be facing.

Farfan

This is something that it’s concerning a lot of people. It’s … spreading beyond those states that is being detected as of today. And what would you say to them? What are you finding?

Farrie

Yeah, I think that’s a great question. This is something that we’ve actually been looking into for almost exactly a year now. We started looking into measles outbreaks last year around this time, when we saw a spike for the first time since 2020, and what we’re seeing now is that this is growing, and we can expect it to continue to do so. And so what I would say to health departments and to emergency managers is that now is a great time to prepare for measles. And when we did interviews with health departments last year, what we found is that this would be the first time that a lot of different health departments would see measles in a long time. And that’s because the vaccine has been so effective up until this point, and it still continues to do so, but we’re seeing declines in vaccine utilization and coverage and increasing vaccine hesitancy. So now’s a great time to get out in the community and talk about measles vaccination and the importance of doing so, and then, from a preparedness perspective, it’s a great time to test your plans, rewrite them, modify them, and think about what’s working well and what’s not.

Gillani

In order to support health departments, CORI has developed a resource repository for measles, of off-the-shelf tools that can help them spend more time on what matters most, responding, focusing on community outreach efforts, rather than starting from scratch and writing case investigation scripts [for example]. Oftentimes in outbreak responses, public health practitioners who are working in different areas are being asked to respond to measles, even though they don’t necessarily have the training. So spending more time training instead of developing the tools is really important. Something else that CORI offers, which is intended to help health organizations as well, is, risk assessments to enhance situational awareness as well, which is very important. Even if there’s not a measles case in your county or in your state, it’s important to know if there is spread occurring nearby to be able to respond. We have a tool called the U.S. measles 2025 dashboard, which provides county-level case information and outbreak information, so that public health decision-makers are able to know where cases and outbreaks are occurring, so that they can make informed decisions. For example, we heard from a health department that they utilized our dashboard for exactly that, and that helped inform their protocols. Previously, their healthcare facilities were only screening for international travel, but now they’re also considering looking at folks who might have had domestic travel to areas that are experiencing active measles outbreaks. The earlier that we can detect a measles case, the earlier we can respond and make sure folks have what they need to stay healthy.

Farfan

That’s been a little challenging. This is a disease that was pretty much eradicated. How do we identify it if we haven’t been exposed to that information recently? Can you talk to us about how challenging that situation is?

Farrie

Yeah, I think that’s a great point. When we did interviews with our health department partners, one of the main challenges that we heard time and time again is the difficulty of symptom recognition, and that is relatable for both the individuals, the patients, people in the households that are affected, but also the providers, because providers are not used to seeing measles. One of the other challenges we heard specifically is recognizing measles on different skin tones. And this is difficult because it looks different on different skin tones. Oftentimes, physicians are trained to look for a raised pink rash when that is only really relative on lighter skin tones. So to support health departments and clinicians based on that feedback, what we did is we went out, and we searched for the best photos available, and we compiled all that information into a skin assessment guidance document for different skin tones. And providers can access that on our website, and health departments can download it as well so they can promote it on their website.

Farfan

How do they access your information?

Gillani

Yeah, it’s on the website. We don’t keep anything behind paywalls or community membership rules. Everything is available. It’s public-facing. You can go specifically to the measles subpage on our website, and there’s an accordion file that includes everything. We may be updating this to make this more easily findable through search bars. But in the meantime, go to the website and just look at the accordion file.

Farfan

Can you give us that website please?

Farrie

Yeah, absolutely. So we can—you can find us by reaching out to the Center for Outbreak Response Innovation, or CORI at, JH.edu.

Gillani

The website in particular, it’s called Cori.CenterforHealthSecurity.org and we have all of our tools and information about other projects, aside from measles, available there as well.

Farfan

I was going to ask that, okay, this is measles, but how do we prepare ourselves, you know, health departments across the nation, for emerging illnesses that were eliminated at one point. How do we foresee that? How do we prepare for that?

Farrie

I think one approach is that we need to start to think about infectious diseases, and how do we prepare for them, regardless of what the disease is. We’ve heard a lot about that at the conference this time around. And I think what we’re calling it is essentially disease-agnostic, scalable approaches. So what that means is what works well almost all of the time, and one of the things that we’re hearing is that having a modern data management system is critical. And it’s important for every disease, regardless of the cause of transmission. And one example of that is REDCap [Research Electronic Data Capture]. And what we have heard from our partners, for those in emergency management that may not be familiar with the tool, and some health departments that may also not have heard of it, it’s originally a data management system used for clinical trial research, and so it is encrypted. It is secure. You can have health information in it, and you can adapt it very easily, without any coding or advanced credentials to make it what you need it to be. And we’ve been working with health department partners to build a REDCap template project for measles. But this is just the foundation. This is a tool that can be adapted, should there be a need for H5N1 [bird flu] monitoring, or forbid any other new, emerging infectious disease threat. And we found that it’s really helpful for health departments to reduce their staff time, and also easier for the individuals that are being monitored, because it allows them to have, ideally, less time on the phone with someone from the health department. They can receive simply a text message checking in on how they’re doing, and then they have a direct line to the health department simply over SMS.

Farfan

And so is this part of AI, an artificial intelligence component, or is it just data collection?

Farrie

That’s a great question. REDCap does not require AI. This is a fairly simple tool. And the great thing is, is that it’s also free for health departments. They do not charge the individuals that are nonprofits or the organizations that are nonprofits. And so this is a low-tech solution.

Farfan

Great information to share with our communities, for sure. Looking back at the COVID-19 pandemic, what key takeaways should public health professionals and policymakers hold onto as we move forward?

Farrie

Yeah, I think one of our key findings from COVID and for measles is that there often isn’t the evidence available that we need when we need it. This is something that we found really resonates with members of the community, with governors, with health officers, and probably also with emergency managers. And what we found is that we really are taking, we can take easily things for granted, like antibiotics when you have an infection or going to get a surgery. You know that those things work because the evidence is available for it. And so what we want to take away from COVID, and now from measles, is that it’s really important to spend time gathering and generating the evidence that we need to make good decisions. And one of the ways we want to be doing this going forward is through creating a new outbreak response innovation network where we can work with health departments to bring the randomized control trials, the things that brought medicine into the 21st century, into public health, so that we can set a new standard for evidence that we can trust and that we can make better decisions going forward.

Farfan

These are challenging times, and do you think that CORI will be successful in the near future in helping local health departments in aspects like that?

Farrie

I think it’s our brave ambition to be successful during these times, and I think it’s especially important to do so now, because now more than ever, we need trusted sources of information. We need good, solid evidence that we can make decisions, both individuals and communities. I think in the case of measles, we need to be able to trust the evidence that’s available about vaccination. But there are also areas for improvement where we do need to be exploring whether or not the evidence is what it needs to be to guide our decision-making. We could talk a little bit about one of our systematic reviews where we’re doing that, but I think the truth is, is that we need to be open and honest, especially now, and truly invest in what we need to be doing to generate evidence and have good communication about that evidence.

Farfan

Do you care to elaborate?

Gillani

We also have partners with a large healthcare employer, and partnership[s] with local broadcast meteorologists. So in this time when there is so much uncertainty, we are creating pathways for communication, to build trust and to generate evidence, and also disseminat[ing] that knowledge too.

Farfan

The next question is about the online database that you were talking about, and as you explained, it’s easy to access it, open to anyone with interest. But what do you think will be the consequences? What do you expect coming out of this resource?

Farrie

Yeah, I think that’s a great question, and I can add some additional details to that. So the REDCap system is something that is available as kind of like a shell for the health departments to use. But to be clear, it is only something that health departments, once they talk with their IT systems and get it set up and the encryption that’s there, that needs to be there, is there, can it be utilized. And the surveys that go out to the individuals that only provide simply a data collection tool, kind of like a SurveyMonkey, so the individuals receiving the link don’t have a way to get into the system. It’s a very well-protected data management system.

Farfan

The local health department has to reach out to you and say, Do you want to come on board and help us with this template?” Or are the templates already created, so they just kind of input the information themselves?

Gillani

Yeah, so we are putting our REDCap templates on our website so that it is freely accessible. We’re also planning to work with REDCap to have it embedded into their library so that folks can more easily access it as well.

Farfan

What else happening in CORI that you think our audiences will benefit from knowing?

Farrie

I think one other great project would be our risk assessment work. We do a lot of work each week to make sure that we have updated data and risk assessments for H5N1bird flu and measles, dengue—cover a diverse range of infectious diseases and really monitor what the population-level risk is overall, but also the sub-population risk. And the idea is that these risk assessments can help individuals make informed decisions for themselves, but can also help decision-makers inform decisions on stockpiling…

Gillani

…Especially now in the face of incomplete, or data that might not be available, we try to provide a high-level situational update so that public health decision-makers and community members can act accordingly. And as part of that, we also include recommendations as well, whether that be checking on your vaccination status, making sure that you’re up to date, or receiving a second dose of vaccine if you’re, or a dose of vaccine, if you’re traveling, for example, internationally.

Farfan

So it’s like a repository of information of what you’re seeing. And so you’re saying, Oh, this might, you know, be coming up, or, this case happened. Can you explain a little more about the process? How did you come about this identification?

Gillani

The risk assessments are scenario-based, and they don’t evaluate the likelihood of a situation occurring. It provides situations that could occur based off of research that our team does and works with experts in the field to anticipate what could happen so that individuals can prepare accordingly.

Farfan

Can you give us an example of something like that?

Gillani

Sure, so for measles, we have five different scenarios outlined. The first scenario would be introduction of only sporadic cases. And when I say sporadic cases, that means one or two cases. Usually, these cases are from individuals that traveled internationally to an area where a measles outbreak is occurring. And usually that’s what we most frequently see, because measles is not currently endemic to the United States. However, when vaccinations drop below the herd immunity threshold of 95%, sometimes we see small outbreaks, which is three or more related cases. This would be our second scenario, a development of a small outbreak, and the increase is from there. Our third scenario would be the development of a medium-sized outbreak, which is 10 to 49 cases. And usually this happens again in under-vaccinated communities, typically that have high density or close contact with one another, which allows the virus to spread more rapidly, especially in unvaccinated communities, and then it increases from there. Then we have the development of a large outbreak, which would be 50 or more cases. And then one of our other scenarios is also the loss of measles elimination status. So that would be if there is spread of measles in a single chain for a year. And when I say a single chain, that just means continuous spread, related spread. So it would be, for example, the Texas outbreak, which started in late January, if spread from that outbreak continues into next year, is January.

Farfan

Thank you for that explanation. What is it that we need to know? What kind of information health departments and local health departments particularly need to have about measles so they can start preventing or preparing better at this point?

Farrie

I think also part of that is building strong partnerships with communities that you believe will likely be impacted, whether that’s migrant communities or certain religious communities, and I think strengthening the communication between those communities as well, and what we’ve heard a lot about at this conference, and is also central to our work, is just making sure that that communication is bi-directional. So, what we mean by that is holding listening sessions, really listening when people are saying what their concerns are, and validating them as needed, and then coming with new information that they are interested in. I think that that kind of partnership-building and communication is really important right now, and I think it’s also really important to be communicating, as we mentioned, about what the risks and the symptoms are, and also how contagious measles is. When we talk about the R naught, as we might remember from COVID, it’s really important to realize that measles was the other end of the spectrum of the most contagious side. So it’s really important to be communicating that with communities so that they can start to make informed decisions as well.

Gillani

I think it’s also important for public health to be unified in our communication, and that the MMR vaccine is highly safe and very, very effective, and to work towards working with communities understanding that there is not a one-size-fits-all approach, and that you need to meet people where they are and understand their concerns and connect with them in a way that is the most useful for them. One recommendation is to work with community leaders to have them champion and work with their community members to share trusted information.

Farfan

That’s very important. So you work every day with, you know, the possibility of outbreaks at this point, and CORI, what are your major concerns? What keeps you up at night?

Farrie

I think that’s a great question. There is more than one thing. I think as the Center for Outbreak Response, we do take a national lens, and so we really do focus on perhaps what keeps us up at night in the U.S. But there are also global concerns. And I think right now, for me personally, one of the things that is concerning me and our work is H5N1. I think that right now, you can see on our risk assessment on our website that we do consider the current risk to the general public to be low, and we hope that it continues to be that way. But there are certain activities that could make sure that it stays that way, and we aren’t taking as much action as we could be. One of the components of our risk assessments across all of them is, we give the risk, but we also talk about what it is we should be doing right now to make sure that we don’t go to that next level in the scenario, which is always the goal. And I think one of the things that we should be seeing more of, to make sure that bird flu stops where it is now rather than getting worse, is making sure that farmers have everything that they need to protect their workers and to make sure that the bird flu does not continue to become transferred between farms and between animals on farms. And so we have seen great examples of work being done out in Pennsylvania, where they are funding farmers to improve their biocontainment efforts, and that can mean anything from conducting on-site risk assessment to making sure that they have PPE and know how to use it if they’ve never used it before. So, I think one thing that would help me sleep better at night for containing outbreak response in the U.S. would be to see a wider investment in utilization of biocontainment efforts on farms.

Farfan

What’s keeping you up at night?

Gillani

I think I certainly echo that concern. I think there are a lot of areas where there could be improvement. And I think also, just looking at this from—again, I’m going back to measles. I’m just very concerned about measles. Measles is a preventable disease. There is a highly effective vaccine out there, and I think what’s concerning me is the mis- and disinformation that’s out there. But I am very proud of health departments’ responses. We, of course, reference, not only state health department resources, but we also look to county-level health department resources. And health departments left and right are stepping up, and they’re providing a lot of transparency in terms of cases that are occurring, public exposure information [and guidance]. So I’m really happy that there is a very strong response, and I just hope that it continues in this way, and they continue to respond.

Farfan

Let’s hope for that, right? And so any final thoughts that you might want to share with us?

Farrie

I think the one of the closing thoughts I’ll share is just, we’ve talked about the lessons learned from COVID, and also the lessons we are continuing to learn with measles and H5N1, but I’d really like to bring home the importance of generating good evidence for these outbreak responses. This is something that we still need to do, and we need to make investments in, and it’s something that we’re really interested in doing here at CORI, and we’re looking for additional partners. That could be health department partners that are interested in piloting new ideas or promising practices, or it could be industry partners that are interested in solving new problems or taking new modeling or analytic approaches to their distribution. So we would just make a call out to partners that are interested in connecting, and we reiterated our email as well at CORI, C, O, R, I@jh.edu.

Farfan

We hope, certainly, that health departments, in particular the local level, they reach out and use the resources that CORI, you know, offers to them. Well, thank you very much for being with us. This is Teresa Farfan again for Domestic Preparedness The Podcast.