What can the Ebola crisis teach us about responding to Zika?
Nigel Timmins Oxfam International Humanitarian Director
18th Feb 2016
As concern grows about the link between the mosquito-borne Zika virus and an increase in babies born with abnormally small heads Nigel Timmins, Oxfam's Humanitarian Director, reflects on what Ebola has taught us about working with communities on health-related emergencies. Oxfam works in 11 countries where the Zika virus has been transmitted locally and is currently monitoring the situation closely.
Reliable information can serve as a form of immunisation when people are able to act on it. This is one lesson from the Ebola crisis that is worth remembering as the world responds to the 'explosive' spread of the Zika virus.
Unlike Ebola, Zika is primarily transmitted by mosquitoes. It is also a much less violent disease causing mild symptoms in most patients. But its suspected link to increasing numbers of babies being born with abnormally small heads, and to neurological disorders, is far more concerning.
Controlling both diseases is likely to depend on local people's participation in planning and implementing changes in their communities. In West Africa, Oxfam workers supported communities to change centuries-old burial practices. Natural actions like shaking hands and comforting the bereaved carried risks, while the washing of hands took on life-changing significance.
Working with communities requires building trust - especially where there is mistrust of government advice. In one extreme case in southern Guinea, villagers attacked and killed a group of health workers. Helping a community to prevent or overcome an outbreak must involve working with locally-trusted people such as religious leaders, traditional healers or other local organisations.
With so little information about the possible paths of Zika transmission - especially from human to human - the atmosphere is ripe for rumours. In some areas, communities are suspicious about the chemicals being sprayed to help control mosquitoes.
Local modes of mass communication like radio stations or mobile phone technology can be very effective ways to dispel rumours and provide reliable answers. They can also be vehicles for spreading rumours, so trust in the advice and effective communication are paramount. In responding to the Zika virus, it is vital that governments and donors recognise the importance of community engagement from an early stage.
But it is equally important that the advice to counteract such rumours is practical. It is not realistic to advise women against getting pregnant without making contraceptives and family planning services widely available. Zika-carrying mosquitoes can breed in standing water yet covered water containers may be beyond the means of poorer families. Community-wide measures are needed so that rain water puddles are filled in and household waste water is carefully disposed of.
Data on the geographical spread of the Zika virus is still patchy, but some experts are already predicting it will follow the pattern of dengue and Chikungunya. These viruses, which are carried by the same type of mosquitoes, are not confined to poorer areas but do tend to cluster here. Poorer people are less likely to have access to running water, effective drainage, good healthcare or mosquito control measures. If there is a causal link with microcephaly, the condition affecting newborns, this
will place an enormous burden on the poorer women who must care for them - sometimes for life.
The Ebola crisis highlighted the critical importance of resilient health systems, including surveillance. While the World Health Organisation (WHO) has been swift to declare a 'Public Health Emergency of International Concern', it is vital that governments cooperate to share information and scale up investment in research for vaccines and medicines.
The Ebola crisis highlighted the failure of the current research & development system to diagnose, prevent and treat emerging diseases. The Zika virus is yet another reminder that we need a system for medical research that puts patients before profit.
Header image: Naomi Kollie, an Oxfam Community Health Volunteer, demonstrates hand-washing to a community in Clara Town, north of Monrovia, Liberia, as part of Oxfam's Ebola response. Credit: Pablo Tosco.