Ebola was a brutal wake-up call not only for people across West Africa, but also for the global health community whose job it is to prevent such disastrous outcomes. The United Nations, nonprofit organizations and foreign governments all promised to do better next time.
The first good sign came on February 1, when the World Health Organization declared Zika a public health emergency of international concern, rather than waiting many more months as it had during the Ebola epidemic.
But global health experts have forgotten an even more important lesson in the fight against Ebola: Don’t just act, listen.
During the Ebola outbreak, millions were spent to develop and deliver simple, generic messages about the disease and how to mitigate infection rates. Billions were spent on treatment facilities.
And yet despite what appeared to be clear messaging and growing access to treatment, some communities refused treatment, and many refused to change traditional practices such as burial rites even though messaging made clear that this was a major source of infection. Why did these people not accept common-sense instructions?
The missing link turned out to be something quite simple: Listening.
Almost no one took the time to have a conversation with the people in affected communities — to listen to their concerns and fears. Those who did, such as Tamba Sam or Emmanuel Boyah, who helped lead the International Rescue Committee’s Ebola response in the countries they called home, quickly found out that people — many of them poor and uneducated — were eager for information and ready to change their practices. But the messengers needed to be trusted.
In Liberia, politicians were in charge of Ebola communications in poor urban neighborhoods that voted for the opposition and distrusted the government. In Sierra Leone, Ebola messages were initially transmitted by parliamentarians. In all the affected countries, instructions were given through generic messages that were often impractical, and occasionally offensive, to local communities.
Practitioners with their ear to the ground gained the understanding and the trust needed to help get communities organized. Wherever this happened, the epidemic subsided, with local communities working themselves, on their terms, in locally relevant ways.
In Sierra Leone, for example, unsafe burials stopped when aid workers joined forces with communities to develop alternative burial approaches that were both safe and appropriate. This was the real, though too-seldom told, story of how Ebola was stopped. Treatment may be worth millions, but trust is priceless.
The global health community and the media are now in danger of making the same mistake in fighting the Zika outbreak. Having learned that the Zika virus poses threats to developing fetuses, governments and media outlets gave instructions to the population.
In El Salvador, for example, the government instructed all families to delay childbearing until 2018. Local and global media instructed people throughout Latin America to remove breeding grounds for mosquitoes. In Brazil, in an eerie reminder of some of the most tragic missteps of the Ebola epidemic, more than 220,000 troops have been deployed to hand out 4 million leaflets.
These actions are being taken with good intention, but they are missing something crucial. The messages are being delivered unilaterally, with little attention to the specific concerns of people affected: What about women, most of them poor, who do not have access to contraception? What about women who are already pregnant, and who have found out that their unborn child is already affected by Zika? How can communities organize joint action to reduce breeding grounds, which studies have shown to be an effective way to reduce disease transmission? Are soldiers credible when it comes to public health, or would local or religious leaders, for example, be more trusted messengers?
Epidemics are inconvenient to politicians, costly for businesses and alarming for general populations the world over. But in the clamor of this global panic, we ignore the voices of the communities directly affected at our peril. We need to hear from pregnant women in Brazil, from slum dwellers in El Salvador, and support them in taking individual and collective action. Listening to local communities, truly engaging them, isn’t just the right thing to do — it’s good public health.
Sadly, this isn’t the first time we’ve failed to learn. Communities hardest hit by HIV were often shunned, when they could have done so much to stop the epidemic. History has taught us that people directly affected by epidemics are a minority — often a feared, marginalized minority — but that they are the heart of the solution, just as they are the knot of the problem.
For Zika, coming so soon after Ebola, let’s not make this mistake again. Let’s remember that no matter how global they may seem, all epidemics are local.