We can curb potential pandemics by investing in prevention tactics
Along with the Ebola outbreak that’s already infected more than 1,600 people, the Democratic Republic of the Congo (DRC) is fighting another battle: An epidemic of fear and mistrust. Community members are afraid to seek treatment, including a promising experimental vaccine.
The murder of an epidemiologist on assignment from the World Health Organization on April 18, on top of attacks on several health centers, makes an already complex situation far more dire. Internal conflict is exacerbating the chaos, with aid organizations calling for a cease-fire until the disease is contained. Doctors Without Borders, which had been heavily involved in response, withdrew its workers in March, and the U.S. has refused to send its own experts, citing security risks.
{mosads}Violence against health workers has deep roots in government mistrust, which is common in fragile states. For a study published in The Lancet Infectious Diseases journal in March, researchers surveyed 961 people in Beni and Butembo in North Kivu at the epicenter of the DRC outbreak.
About 33 percent of those interviewed thought the outbreak was a crisis the government fabricated to make money, or to cause unrest in the region (36 percent). Some thought foreigners were bringing Ebola. About a quarter did not even believe the disease was real, and the suspicious were 15 times less likely to seek medical treatment at an Ebola center. A doctor in the DRC, Joyeouse Kivwira, said, “People say that we — the local health workers — are getting money to refer patients to the Ebola treatment centers where they are sent to die.” After getting menaced by a crowd of rock-throwing teens in April, Kivwira fled the government-run clinic where she had been working.
Political strife has worsened this escalating situation while highlighting vulnerabilities in handling outbreaks in fragile states. Given greater global travel, urbanization, and antimicrobial resistance, the likelihood of far-flung pandemics is only going to increase.
What lessons did we learn from the 2014 Ebola outbreak? The Lancet survey found residents trusted local authorities more than provincial or national leaders, and civil society organizations have seen this first hand. As with the DRC, Liberia was grappling with conspiracy theories that hampered the work of government and outside groups.
Community members stoned workers from the nonprofit Global Communities who tried to collect the dead for safe burials during that outbreak. The organization forged relationships with traditional leaders who would accompany county health teams on their community rounds. Addressing the 12 percent of the country who were Muslim, Global Communities developed and deployed burial teams staffed by Muslims to follow their burial traditions. Lesson learned: Involving tribal or religious leaders can show that health workers can be trusted.
Building the capacity of local health staff at the outset can also help establish trust among communities. Research on the role of maternal care community health workers (CHWs) during the 2014 Ebola outbreak found that residents continued to trust them over “outsiders” brought in to help handle the disease, and the CHWs were better able to handle Ebola-related activities as a result.
Ultimately, the most effective way to curb a potential pandemic is to invest in prevention tactics. We know what works: CDC investments in stronger surveillance systems, laboratory networks, and bio-containment capabilities helped West Africa stem Ebola in 2014. The World Bank says a severe pandemic could cost up to $3 trillion. Preparedness costs, on the other hand, are roughly $4.5 billion annually — globally, that is just 65 cents per person per year.
The U.S. last week published its Global Health Security Strategy, which goes in the right direction by recommending a broad systems strengthening approach. So does Congressman Gerry Connolly and Congressman Steve Chabot’s reintroduction of the bipartisan Global Health Security Act, which solidifies U.S. investment in our ability to prepare for and respond to public health threats and reduce or prevent their spread across borders.
The strategy does not, however, back its language with funding estimates, and annual updates are critical. We also need a health lead in the National Security Council to coordinate the work of the many U.S. agencies that contribute to global health security, a position the administration has not filled since it was vacated last May.
These high-level commitments to low-level action are the only way we can ensure the safety of those who are putting themselves in danger on the ground. Our future depends on their success.
Ashley Arabasadi is a health security policy adviser at Management Sciences for Health, a nonprofit global health organization, and past chair of The Global Health Security Agenda Consortium.
