The COVID-19 pandemic is unprecedented in many ways, but some issues raised in the global health crisis are all too familiar. We dug through The New Humanitarian’s 25-year archive of reporting on pandemics and epidemics for eight takeaways to inform today’s response.
Preparedness pays off, even if it's unpopular. Funding for and attention to preparedness doesn’t come easily. But it works.
It's the (social) economy, stupid. Every pandemic takes a social and economic toll – the trick is to prepare for that, too.
Look out for the most vulnerable. The poorest and most marginalised sectors of society are at highest risk of disease outbreaks and often have the least support.
Don't expect a vaccine to solve everything. A vaccine is only as good as the ability to vaccinate.
To fight disinformation, engage local communities. Past Ebola outbreaks offer powerful lessons about disinformation.
Don't forget to laugh. Comic relief is a common tactic to ease anxiety and fear during pandemics and other illnesses.
Mind your language. The words used to describe epidemics can have powerful consequences.
Keep things in perspective. While the COVID-19 pandemic continues, it’s worth remembering that we are much more likely to die from any number of other threats.
Preparedness pays off, even if it’s unpopular
Funding for – and attention to – preparedness doesn’t come easily. Especially in countries where so many more urgent and visible needs go unmet, setting aside funds for what may happen tomorrow usually doesn’t win favour with politicians and their constituents. Pandemic preparedness can quickly become deprioritised or a hot potato issue, as we reported in 2008.
But it works.
The 1995 outbreak of Ebola haemorrhagic fever in the Democratic Republic of Congo prompted the World Health Organisation to create global intelligence and response networks that became instrumental when rumours of a “fatal flu” arose in China in late 2002. The WHO argued this was key to “How a Global Epidemic was Stopped”, referring to what came to be known as SARS. Unprecedented cooperation among scientists from 11 laboratories in nine countries led to the early identification of the virus that causes SARS and the development of diagnostic tools. This cooperation by governments (with noted resistance from China) combined with 24-hour SARS reporting hotlines; networks of hundreds of thousands of trained volunteers; and – yes – contact tracing, quarantine, and infection control kept the outbreak under control.
Those investments in pandemic preparation continued to pay off: in 2012, countries in Asia were ready to roll out early detection mechanisms and rapid response programmes when swine flu hit.
Similarly, in Africa, establishing community detection sites and rolling out public information campaigns helped curb the 2012 cholera outbreak in Guinea and Sierra Leone. According to global health researchers, this prevented a repeat of the situation in Zimbabwe in 2008-2009, when some 100,000 people were infected and more than 4,000 killed.
It’s the (social) economy, stupid
Hotel rooms in popular tourist destinations left empty. Airlines losing millions of dollars. Employers forcing workers to take unpaid leave. Shoppers staying at home and consumer spending dropping.
No, it’s not COVID-19. These were the economic impacts of SARS, as we reported in 2008.
Every pandemic takes a social and economic toll – the trick is to prepare for that, too.
In Africa, where the crippling effect of HIV/AIDS on African economies began sounding alarm bells in 2002, UN officials advocated for incorporating the social impacts of the epidemic into national and global development targets; adapting poverty reduction efforts accordingly; and preventing the collapse of key public services.
In 2005, when the “destructive relationship” between HIV/AIDS and hunger became clear, the International Food Policy Research Institute sought to measure the impact of the disease on household-level income, especially for those who depended on farming.
Every pandemic takes a social and economic toll – the trick is to prepare for that, too.
But lessons are hard learned. In 2008, as bird flu hit Asia, the UN’s influenza coordinator at the time, David Nabarro, warned that preparedness plans had failed to take into account the broader consequences of a pandemic: joblessness, children out of school, and disruption to essential services.
By the time the Ebola outbreak of 2014 came around, West African governments were forced to boost expenditures by millions despite shrinking budgets, as Ebola left a wake of economic destruction: halted construction, shuttered restaurants, and a devastated agricultural sector.
Oxford University’s Hugo Slim summed it up recently in an opinion piece for TNH, calling for money to move faster than the virus in today’s crisis.
Look out for the most vulnerable
Time and again, TNH reporting has found the poorest and most marginalised sectors of society at highest risk of disease outbreaks, and often with the least support.
In 2004, many Liberian refugees in Guinea received little to no federally funded treatment for HIV/AIDS due to the government’s inability to cover the cost in an overburdened healthcare system. The “loose morals” of refugees were blamed for bringing the virus to the town of Nzérékoré, where 20,000 of them lived.
Similarly, in 2008, migrant and refugee communities in Egypt were systematically excluded from avian flu pandemic preparedness measures under the national programme, leaving them highly vulnerable.
During the Zika outbreak of 2016, Brazilian women from poor communities were at the forefront of the disease and were less informed than women of higher socioeconomic status about how to protect themselves and their unborn children from becoming infected. Even if they were informed, they were unlikely to be able to afford mosquito repellent or other precautionary measures. At the same time, low-income communities often suffered from poorer infrastructure in their water supply, making their neighbourhoods the perfect breeding grounds for mosquitoes carrying the virus.
Countries most vulnerable to disease outbreak are those in the midst of or recovering from conflict, where health systems have deteriorated and a lack of security can hinder vaccine distribution and other prevention measures. The rise of tuberculosis in Iraq in 2005, due to a shortage of medicine and harsh living conditions, is just one example. Crippled by years of conflict, Yemen’s inability to cope with and prevent cholera in 2017 due to weak health systems, poor sanitation and hygiene, and near-famine conditions suggests what may emerge as COVID-19 spreads there.
All this makes a recent call from Michiel Hofman, of Médecins Sans Frontières, not to abandon the most vulnerable affected by COVID-19 all the more prescient.
Don’t expect a vaccine to solve everything
Even when a vaccine for COVID-19 becomes available, it may not be readily obtainable by all countries and, even more worrying, it may not eradicate the virus completely.
Consider polio, for which public health messaging has offered cautious optimism that the disease is on the brink of defeat. Health experts still worry behind the scenes, especially where access to affected people caught in conflict is a problem. For example, in Syria, besieged by conflict, a vaccine alone was not enough. When civil war disrupted routine vaccination services in 2014, polio re-emerged. Eradicating polio in Afghanistan has also been especially difficult, as mistrust, a lack of access for health workers, and a dearth of female healthcare workers are just a few of many persistent challenges.
In October 2019, 64 years after the first polio vaccine was introduced, the WHO’s expert advisory group on vaccines and immunisation complained of “serious concerns about the overall state of eradication efforts”, citing an inability to control outbreaks in Africa and Asia.
And, as we reported last year amid an outbreak of Ebola in Congo, “a vaccine is only as good as the ability to vaccinate.” Despite the success of an experimental vaccine, local conflicts prevented response teams from reaching and vaccinating contacts effectively.
As Jeremy Konyndyk, the former head of the Office for US Foreign Disaster Assistance, said in a TNH webinar, if and when there is a vaccine for COVID-19, “there aren't going to be seven billion doses ready immediately…. When the first 100 million doses of vaccines come out, it's going to be a big fight over who gets those… and it's going to be very important that they not just go to those who can afford them.”
To fight disinformation, engage local communities
UN Secretary-General António Guterres has referred to COVID-19 as a “global misinfo-demic”, warning of the “falsehoods filling the airwaves”.
These include US President Donald Trump’s suggestions to inject Lysol or douse the body with ultraviolet light – reminiscent of previous ill-informed guidance. Consider the widespread industry of untested remedies and quackery that ran rampant during the fight against HIV/AIDS in 2007.
And misinformation can stand in the way of sensible, scientifically proven remedies and precautions, as well. As absurd as the 2015 advice “don’t kiss your camel” sounds as a practice to prevent MERS, it was actually sensible, given that camels were known to play a role in its spread. Camels In Saudi Arabia and other parts of the Middle East are ubiquitous and beloved, so a wet slobbery kiss from one of them is not uncommon.
But arguably the most powerful lessons about disinformation come from outbreaks of Ebola in West Africa in 2014 and again in the ongoing outbreak in Congo that began in 2018.
As aid workers failed to share health information in local dialects and in culturally sensitive ways, we reported on some of the failed information campaigns that left communities desperate for practical information and training to combat the disease.
And in Congo, where suspicion and rumours circulated on a hotbed of mistrust created by decades of conflict, people were bombarded by misinformation in 2018-2019 through social media – many believing Ebola didn’t exist or was being used as an excuse to destabilise the area.
What’s the takeaway for this time of COVID-19? Support greater involvement from local communities to build trust and equip residents with accurate information, but ensure aid agencies’ messaging is well-suited to community contexts, languages, and social norms. In Congo, agencies mapped what languages were spoken where, and in West Africa they identified influential, trusted people who could help share information and silence rumours. In Congo, strengthening community-based surveillance and locally led response actions – such as awarding a “best prevention prize” to community groups, neighbourhoods, or villages that effectively support (and contribute to) the Ebola response – has had success.
Don’t forget to laugh
Comic relief is a common tactic to ease anxiety and fear during pandemics and other illnesses.
In the fight against HIV/AIDS, a “Caravan of Hope” travelled through Mauritania in 2004 to bring entertainment and humour to communities while spreading important messages about transmission and prevention.
Laughter can also be a way to educate and to help people talk about taboo subjects, reduce fear, or raise awareness.
In 2006, we reported on laughter easing the pain of child cancer patients in Iraq, where “the trauma of staying in the dull rooms of the hospital contributes to the bleak outlook of patients, but the entertainers bring a bit of light”. And in 2009, Clowns Without Borders brought laughter and entertainment to children displaced in Congo.
Laughter can also be a way to educate and to help people talk about taboo subjects, reduce fear, or raise awareness. In 2012, gold-plated turds were placed in the halls of the London School of Hygiene and Tropical Medicine to spur conversations about poo and the health dangers inherent in poor sanitation.
In the midst of COVID-19, we’ve already seen amusing memes, quick-witted quarantine gifs, and lyrics dubbed with coronavirus themes. The online silliness has come to define this moment just as much as facemasks and nightly clapping sessions to show appreciation to health workers.
Mind your language
The words used to describe epidemics can have powerful consequences.
“Gay cancer” or “gay-related immunodeficiency” (GRID) were terms used to describe HIV/AIDS in the early 1980s in the United States, reinforcing negative biases.
Terminology in Africa was no better. In 2008, our urban dictionary of HIV/AIDs slang identified some pretty vulgar language. In Uganda’s Luganda language, “Okugwa mubatemu”, which roughly translates to: “You have been waylaid by thugs”, was used to describe someone who contracted HIV/AIDS. The football reference of “getting a red card” was used in Zimbabwe to signify “life for you is over”. This slang reinforced the stigma and fatalism around the virus, which advocates worked hard to curb.
It didn’t stop there. “If the 2003 SARS outbreak and the 2014 West African Ebola outbreak offer us any lessons, it is that in an information vacuum, it is easy for an outbreak narrative to form, one that scapegoats and marginalises,” anthropology professor Adia Benton recently wrote.
In the COVID-19 pandemic, descriptors such as “Wuhan virus”, “China virus”, and “Asian virus” – sometimes used intentionally to fuel racism – have led to discrimination and xenophobic attacks against Chinese in other countries.
Keep things in perspective
This 2012 story, “How We Live and Die”, is a reminder of rapidly changing mortality and morbidity patterns. At the time, researchers were surprised by a global shift away from infectious diseases, such as malaria, as a cause of death towards non-communicable diseases such as cancer, stroke, and heart disease – referred to as “lifestyle diseases”.
To put things into perspective, consider this: in 2010, HIV/AIDS and malaria continued to pose threats and infectious diseases were the cause of one quarter of global deaths, but non-communicable conditions accounted for 65 percent of deaths globally. Car accidents and other injuries accounted for 10 percent of global deaths.
Now, only 25 percent of deaths globally are due to infectious diseases and maternal, neonatal, and nutritional causes. More than 65 percent are due to non-communicable conditions, and just under 10 percent are related to injuries – the bulk of them happening on increasingly deadly roads in the world’s poorest places.
These trends have continued, according to the WHO’s Global Health Observatory database.
So, while the COVID-19 pandemic continues, it’s worth remembering that we are much more likely to die from any number of other threats. As we recently reported, HIV, tuberculosis, viral hepatitis, malaria, neglected tropical diseases, and sexually transmitted infections are expected to kill an estimated four million people in 2020 – well above COVID-19’s death toll to date of over 380,000.
More lessons from TNH reporting, 2002-2020
- Interview with Stephen Lewis, UN envoy for HIV/AIDS in Africa (2002)
- Quackery hinders AIDS treatment efforts (2007)
- Business booming for untested AIDS remedies (2007)
- Whatever happened to SARS? (2008)
- Ebola – is culture the real killer? (2015)
- Has Syria really beaten polio? (2015)
- MERS's best friend is ignorance, so it's time to wise up (2015)
- A short history of an Ebola vaccine (2019)
- Inside Congo’s Ebola emergency (2019)
- Reporter’s Diary: Hazardous handshakes and other indignities in the time of Ebola (2020)
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