Opinion: Putting communities at the center of disease prevention

Community members attend a briefing by a social mobilization team in Lester Road, Freetown, Sierra Leone. Photo by: Martine Perret / U.N.

In late August, a man travelling on a small, packed bus headed for the Malagasy capital, Antananarivo, passed away suddenly of respiratory failure. His body was taken to the nearest hospital where it was prepared for burial by health care workers. Within days, more than 30 people who had been in contact with the man became ill; four of whom died.

The cause was pneumonic plague, the most virulent form of a disease that has tormented humanity for centuries. This is the disease that, over the past millennia, has killed tens of millions. And here again today, it has killed more than 140, infected as many as 1,900, and sown fear across an entire country.

It is, by any measure, a public health crisis, a fact made all the crueler given that plague can be cured and contained with standard and easily accessible antibiotics.

The situation in Madagascar is also a powerful reminder of our world’s high vulnerability to epidemic and pandemic threats. It repeats a pattern that has become far too frequent. Last year, the Zika virus affected millions across the world, mainly in South and Central America. And of course, in 2014, the Ebola virus found its way from a forest to the capital cities of Liberia, Guinea, and Sierra Leone, claiming more than 11,000 lives.

Ebola taught us many things, including the disregard viruses show to international borders.

In the aftermath of the Ebola outbreak, the world’s capacity to prepare and respond to major health threats was described as “woefully insufficient” by a high-level panel convened by then United Nations Secretary General Ban Ki-Moon. Yet, despite major post-Ebola reforms, our vulnerability to these threats remains unacceptably high. Why?

Points of disease vulnerability

There are, of course, many answers. Massive economic inequality and woeful under-investment in public health systems and capacities mean that too many countries are ill-equipped to effectively respond to health crises quickly and effectively. In countries where health systems are chronically weak and unable to cope, we need more clinics, more hospitals, more nurses and doctors, backed by better resourcing and better training.

But even if investment in public health grew to the levels needed in all countries — and that is a big “if” — the threat posed by plague, Zika, Ebola, and countless other diseases, would remain. Treatment is only part of the equation. The key lies in early detection and very rapid response.

In Madagascar, as was the case in West Africa during Ebola Virus outbreak, by the time authorities realized there was a problem, the disease had already taken hold and started to spread. Again, preventing outbreaks is about stronger health systems, including health surveillance mechanisms, but the most effective preparedness and early warning systems are built at the community level.

Preparedness at the community level

Epidemics and pandemics begin in communities. The U.N. panel called on governments and international organizations to streamline their engagement with communities and promote local ownership, invest in local action, and build trust.

“Ebola taught us many things, including the disregard viruses show to international borders.”

— Elhadj As Sy, secretary general, The International Federation of Red Cross and Red Crescent Societies

All actors in global health security need to consider whether they have acted on this. They need to ask themselves if they have done enough to incorporate communities, including local volunteers, into national and international epidemic preparedness and response plans.

This is the role that Red Cross and Red Crescent volunteers often play in health emergencies. When supported, our volunteers can be a link between isolated and remote communities and formal health structures. They can play this role because they themselves come from the communities. They are there to see the first signs of unfamiliar illnesses, and sound the alarm.

They can also quickly relay public health messages that are crucial to halting the spread of highly infectious diseases. And of course, they can support treatment efforts, including offering care and support for the families of the sick and dead.

Last week, at our global Red Cross and Red Crescent meetings in Antalya, Turkey, we began a process that we hope will lead to better recognition of, and support for, this critical community role. We adopted an ambitious resolution that, among other things, commits our global network to work with governments to intensify their efforts to build early alert and rapid response capacity in high-risk communities.

Very specifically, we will advocate to governments to include our Red Cross and Red Crescent National Societies, in line with their auxiliary role, in national disease control, preparedness, and response frameworks. Looking internally, we will also commit to put the safety of our volunteers and staff responding to these dangerous situations at the center of our coordinated plans.

Plague, Zika, Ebola: these were wake-up calls. What follows could be worse. We need to be ready — the communities that are on the frontline of these threats need us to be ready.

Examining how global health affects security and vice versa, Devex, PATH, and Johnson & Johnson look at how country governments, donors, foundations, the private sector, and civil society can better respond to and anticipate threats, asking whether increased investment in global health security is critical to the security of all countries. Join our conversation on preparing for the unexpected by visiting the From Healthy to Secure site and tagging #Health4Security and @Devex on social media.

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About the author

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    Elhadj As Sy

    Elhadj As Sy is the secretary general of the International Federation of Red Cross and Red Crescent Societies. He has extensive experience in leadership roles in the humanitarian sector, having previously served at a senior level with UNICEF, UNAIDS, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and other agencies for more than 25 years.