BY ANDREA BLINKHORN AND CAROLINE GIMMILLARO
As the world’s attention fades from the devastating impact of the Ebola virus epidemic to the new uncertainties of the Zika virus outbreak, it is more important than ever for the international community to consider the communication lessons learned from West Africa.
In the aftermath of Ebola, the international community faced harsh criticism for its inadequate response to the epidemic. While many lessons can be drawn from the epidemic in preparation for future public health emergencies, one of the top recommendations in the World Health Organization’s (WHO) “Report of the Ebola Interim Assessment Panel” published in July 2015, was the need for more cooperation between the international humanitarian community and health community. Shockingly few experts, NGOs, governments, or donors understood the dynamics of both systems, which prevented the coordination necessary to address the multiple facets of combatting Ebola transmission. Early on in West Africa, the need for communication quickly became apparent. Lack of engagement with local communities led to high levels of mistrust, low compliance with the behavior changes needed to reduce transmission, and the spread of rumors.
In any public health emergency, there is going to be a lack of knowledge about the pathogen, its transmission patterns, effects, and long-term implications. That does not mean that communication is futile. In fact, it is the uncertainty that requires more careful information sharing to enhance the safety of the population. Short, frequent messages that acknowledge the knowns and the unknowns are important for public information providers to establish credibility and reduce distrust that erodes the public confidence in the health response.
And while Zika is not Ebola, communication is as important as ever. One major difference in how the international community is responding to Zika compared to Ebola has already occurred. Wasting no time, the WHO declared Zika a “public health emergency of international concern” on February 1, 2016. In contrast, Ebola did not receive this elevation until August 8, 2014 – 6 months after initial reports of several cases in both Guinea and Liberia.
Utilizing lessons from Ebola, there are several key factors that public information providers such as national Ministries of Health, the WHO, media outlets, and other actors should use when crafting effective messaging strategies:
1. Communicate Continuously and Admit Known Unknowns
There is still a high degree of uncertainty surrounding Zika and its effects. Despite that, what is known (i.e. characteristics of the disease, the nature of the vector, the transmission patterns, etc.)
can be communicated while more information is being gathered. As stated by Dr. Michael VanRooyen of Brigham and Women’s Hospital at a recent panel held at the Kennedy School, what is known about Zika should be communicated continuously, thoroughly, and accurately, despite the uncertainty that exists. Information providers should be honest with the public about the limitations of their knowledge and pledge to provide new information as soon as it is discovered. Acknowledging that public health officials do not have perfect information will help the public trust authorities if new information arises or guidelines change. The Centers for Disease Control infographic displayed here is a good example of how information providers can admit uncertainties while remaining credible.
2. Enlist Trusted Leaders
A message can fulfill all the requirements of good communication but, if the messenger is not recognized as reliable and trustworthy, the communication effort will likely fail. That is why trusted local leaders are an integral component of the dissemination of information. Who is trusted will, of course, vary between different communities based on political, religious, and other demographics factors. For example, in Sierra Leone, those responding to the Ebola outbreak asked religious leaders to help them communicate prevention strategies to their communities. They often used religious texts to encourage people to follow public health officials’ advice, including justifying temporary changes to traditional burial practices to help reduce transmission. Identifying and mobilizing trusted messengers to help spread messages about prevention and treatment should a key component of the communication strategy.
3. Craft Messages that are Nuanced and Distinguish Zika from Similar Diseases
One of the problems early on in the Ebola epidemic was trying to communicate why the public should be particularly concerned about the disease. Symptoms of Ebola are similar to many other illnesses endemic to West Africa such as Lassa Fever and Malaria. It was therefore difficult for some people to understand why this particular illness warranted their attention. The symptoms of Zika (fever, rash, joint pain, and conjunctivitis) also mirror the symptoms of other illnesses endemic to many of the affected areas, including Dengue and Chikungunya. Furthermore, Zika is rarely fatal. It is therefore important to communicate (1) how to tell the difference between Zika and other illnesses (in this case through a blood test conducted by a healthcare professional), and (2) why the public should be particularly concerned about Zika.
4. Reach and Appeal to All Major Demographic Groups, Especially Those Most at Risk
Demographic factors often affect people’s ability to access information and treatment. Factors like gender, age, income and wealth, proximity to urban centers, religious affiliation, and minority status must be considered while crafting communication strategies that reach all major demographic groups. For example, during the Ebola outbreak, wealth and income affected what kinds of media people could access. When responding to Zika, gender will be particularly important to creating strategies that protect the public from Zika. The main concern about Zika is its potential to cause Microcephaly in fetuses, meaning that the fetus’s brain does not properly develop during pregnancy or stops growing after birth. It is therefore important that information reaches women who are pregnant or who may become pregnant. To do this, information providers should analyze how the social construct of gender (which will differ from region to region) affects women’s ability to access information and treatment.
5. Adapt the Communication Strategy to the Context
While those responding to public health emergencies often face similar communication challenges, strategies need to be adapted to country and community-specific contexts. So while paying attention to the lessons learned during Ebola will help improve communication strategies for Zika, they must be adapted to the historical, political, economic, cultural, and demographic contexts of the affected areas. Ways to adapt communication strategies to local contexts include: using the target audience’s preferred language, ensuring that messages are culturally appropriate, and maximizing the impact of each dollar by choosing the types of media that will reach the most people in all major demographic groups. Anthropologists and other social scientists proved to be an important bridge between foreigners responding to the Ebola outbreak and local populations. They might also prove to be an important resource for connecting with communities dealing with Zika.
Caroline Gimmillaro is a second-year Master in Public Policy student at the Kennedy School. She is a Foreign Language and Area Studies Fellow for Africa and a Belfer International and Global Affairs Student Fellow researching emergency preparedness and response. Before Harvard, Caroline spent two years in Kenya writing strategic plans and designing programs for NGOs focused on public health, microfinance, and street-dwelling children. She also founded clubs to teach young people about sexual and reproductive health and rights.
Andrea Blinkhorn is a Master of Public Policy candidate at the Harvard Kennedy School. Before coming to the Kennedy school she worked at the U.S. Committee for Refugees field office in Albany, N.Y., where she worked on job placement services and community partnership building.
Photo by user coniferconifer via Flickr