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Early Action for Cholera Project OFFICIAL Early Action for Cholera Project Yemen Case Study Met Office, University of Florida & University of Maryland Authors: Met Office: Rosa Barciela, Tarkan Bilge, Kate Brown, Adrian Champion, Christophe Sarran, Maxine Shields, Helen Ticehurst; University of Florida: Antar Jutla, Moiz Usmani; University of Maryland; Rita Colwell Reviewers: Helen Bye, Kathrin Hall, Tim Donovan (Met Office) 02 July 2021 © Crown copyright 2020 Met Office Page 1 of 100 OFFICIAL Contents Glossary ......................................................................................................................................... 4 Executive Summary ....................................................................................................................... 6 1. Background: Predicting Cholera in Advance ......................................................................... 9 1.1 Prologue……………………………………………………………………………………………..9 1.2 Cholera, its treatment and prevention ................................................................................. 10 1.3 Predictive tools for cholera .................................................................................................. 10 2. Cholera Risk Model .................................................................................................................. 12 2.1 About the CRM…………………………………………………………………………………….12 2.2 Evolution of the CRM – what causes Cholera? ................................................................... 14 2.2 The environmental hypothesis of cholera ............................................................................ 15 2.3 Endemic and Epidemic Cholera .......................................................................................... 15 2.4 Predicting Cholera ............................................................................................................... 16 2.5 Operational use of the CRM ................................................................................................ 16 3. About the Rainfall Forecasts ................................................................................................. 17 3.1 Yemen’s Climatology Relevant to the Study ....................................................................... 17 3.2 Met Office Rainfall Forecasts for Yemen ............................................................................ 17 3.3 UNICEF Requirements ......................................................................................................... 19 3.4 Model performance………………………………………………………………………………..20 4. Use of the CRM and rainfall forecasts in Yemen (Contextual Analysis) ........................... 21 4.1 Cholera in Yemen ................................................................................................................ 21 4.2 Monitoring Cholera in Yemen .............................................................................................. 22 4.3 UNICEF’s role in Cholera Response in Yemen .................................................................. 22 4.4 Lessons learned from the 2017 wave of the cholera epidemic...........................................23 4.5 The need for predictive tools ............................................................................................... 23 4.6 How Forecasts were used ................................................................................................... 24 4.7 ‘No Regrets’ Interventions ................................................................................................... 26 4.8 Preventative action and fatigue………………………………………………………………….27 4.9 How UNICEF use the CRM and rainfall forecasts in 2020 ................................................. 27 4.10 Other stakeholders interested in early action for cholera ................................................. 29 5. CRM validation in Yemen ....................................................................................................... 30 5.1 Methodology ........................................................................................................................ 30 5.2 Validation process and results in full ................................................................................... 30 5.3 Summary of methodology and results ................................................................................. 39 5.4 Considerations....................................................................................................................39 Page 2 of 100 © Crown copyright 2021 Met Office OFFICIAL 5.5 Limitation(s)………..............................................................................................................40 5.6 Recommendations..............................................................................................................40 6. Validation of the Rainfall forecasts ....................................................................................... 41 6.1 Introduction .......................................................................................................................... 41 6.2 Methodology ........................................................................................................................ 41 6.3 Evaluation of the rainfall accumulations from the forecasts – Contingency Tables ........... 42 6.4 Evaluation of the spatial accuracy of forecasts – Fractions Skill Score (FSS) .................... 45 6.5 Epidemiological relationship between forecast rainfall and cholera ................................... 47 6.6 Summary of Rainfall Forecast validation methodology and results.....................................49 7. Summary and Recommendations ......................................................................................... 52 7.1 Summary of validation results .............................................................................................. 52 7.2 Introduction to Recommendations ....................................................................................... 52 7.3 Recommended use of the CRM in Yemen…………………………………......................53 7.4 Recommended use if rainfall forecasts in Yemen……………………………………………..53 7.5 Recommended use of the CRM elsewhere……………………………………………….54 7.6 Recommended use of the rainfall forecasts elsewhere………………………………….54 7.7 The need for further pilots using risk information to inform cholera response……………...56 7.8 Encouraging discourse and lesson sharing from pilots……………………………………….58 7.9 Opportunities to enhance the CRM and rainfall forecasts in the short-term (already in progress or straightforward to implement)………………………………………………………….59 7.10 Enhancements to the CRM and rainfall forecasts in the medium to longer-term………...61 7.11 Recommendations on data availability to support tools like the CRM……………………..63 7.12 Consultation on the Case Study Recommendations……………………...…………………63 7.13 Conclusions…………………………………………………………..…………….……………63 7.14 Summary of recommendations………………………………………………………...………63 References ................................................................................................................................ 68 Annex 1 ...................................................................................................................................... 77 Annex 2 ...................................................................................................................................... 77 Annex 3 ...................................................................................................................................... 77 Annex 4 ...................................................................................................................................... 78 Annex 5 ...................................................................................................................................... 82 Annex 6 ...................................................................................................................................... 83 Annex 7 ...................................................................................................................................... 88 Annex 8 ...................................................................................................................................... 90 Annex 9 ...................................................................................................................................... 93 Annex 10 .................................................................................................................................... 99 Annex 11 .................................................................................................................................... 99 Annex 12…………………………….. ……………………………………………………...……….100 Page 3 of 100 © Crown copyright 2021 Met Office OFFICIAL Glossary Acronym Meaning BHC Bradford Hill Criteria CERF Central Emergency Response Funds CAM Crisis Area Model; one of the Met Office’s limited area numerical weather prediction models, using boundary conditions from the Global Model. Case data Information on cholera cases CERF Central Emergency Response Fund (run by UN OCHA) COF Climate Outlook Forum COVID Coronavirus disease (COVID-19) CRM Cholera Risk Model DFID Department for International Development DRR Disaster Risk Reduction DREF Disaster Relief Emergency Fund EACH Early Action for Cholera ECMWF European Centre for Medium-Range Weather Forecasts EOC Emergency Operations Centre EOR Emergency Operations Room EMRO Eastern Mediterranean
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