Last Monday, World Health Organization (WHO) Director-General Margaret Chan declared the Zika virus outbreak a Public Health Emergency of International Concern (PHEIC). Perhaps more alarming is a recently released report by a United Nations panel on health-crisis response that stated, “the high risk of major health crises is widely underestimated, and the world’s preparedness and capacity to respond is woefully insufficient.”
In both the Ebola and Zika outbreaks, political and economic factors like state incapacity and uneven development created conditions conducive to the spread of infectious disease. While a public health approach eventually managed to contain Ebola, rapid responses to infectious disease threats often fail to address root causes — inadequate healthcare systems, poor sanitation and waste management and endemic poverty. Defeating these root causes could end the pernicious cycle that creates out-of-control pandemics.
Different pathogens, same vulnerabilities
In Guinea, Liberia and Sierra Leone, existing vulnerabilities such as low levels of human development, and weak and inadequate state health capacities, fostered Ebola’s quick spread and inhibited an adequate state response.
Countries currently responding to the Zika outbreak — Brazil, Colombia, and El Salvador — perform better on health and economic indicators. However, uneven and unequal development in the three countries as well as across Central and South America, are potential vulnerabilities that could complicate Zika control efforts.
For instance, Zika is primarily spread by mosquitoes, which are drawn to and breed in standing water. Access to improved water sources and sanitation facilities could greatly reduce its spread. But, urban and rural communities in Zika-affected countries have unequal access to clean water and sanitation facilities and the inequality is even more pronounced in the Central American countries now facing Zika.
Given this inequality, it’s notable that the Zika outbreak and a spike in cases of microcephaly were initially concentrated in the poorer and underdeveloped areas in northeast Brazil. In the long-term, birth defects linked to Zika will overburden health care systems, incur heavy social and economic costs associated with care giving, and keep already vulnerable populations in a position of continued insecurity for years to come.
What do I mean by insecurity? I study human security, which considers security from the vantage point of the individual, expanding the notion of security beyond safety from violent threats to include economic, health and food security.
Human security crises generate severe threats to vulnerable populations — those individuals who live in conditions of generalized poverty and thus are perpetually at the brink of socioeconomic disaster. A human security approach to health emergencies both stabilizes crisis situations and addresses the underlying sources of insecurity.
In a forthcoming article in the journal “Global Health Governance,” I examine the U.N.’s emergency mission for Ebola (UNMEER) using a human security lens. In this post, I draw from that article three lessons we can take from the UNMEER experience to inform the global response to Zika.
1. Approach the outbreak as a human security issue. Valuable time was lost during the Ebola response because the emergency was labeled both a “humanitarian” and a “health” crisis, which created confusion about which U.N. agency should lead and coordinate the intervention.
UNMEER took charge, but its public-health mandate meant that it primarily focused on implementing and funding health programs. UNMEER thus did not prioritize non-Ebola related assistance and protection activities for vulnerable populations. Recent revelations of an increase in gender-based violence, rape and teen pregnancies during the Ebola emergency are one example of the high cost of not viewing the outbreak as a human security issue.
2. Empower leaders. In large-scale humanitarian crises, a lack of global leadership often impedes swift, coordinated responses. In a notable move, the U.N. Secretary General empowered UNMEER with special authority — not typically afforded U.N. missions — to make decisions, hire staff, transfer assets, purchase materials, and take action. With this authority UNMEER established clear protocols and reporting lines, which fostered collaboration among various U.N. agencies and improved accountability. The U.N. panel on health crisis response suggests that UNMEER was most valuable in this role of “empowered humanitarian coordinator.”
3. Involve communities. During the Ebola response, areas where the community was educated and actively engaged had the most success in containing and monitoring new cases. In a survey of 1,500 residents in Monrovia, Liberia, Massachusetts Institute of Technology political scientist Lily Tsai and colleagues found that community outreach had a positive impact on citizen cooperation and trust in state authorities. Citizens who experienced outreach were more likely to support control policies, adopt preventative measures and cooperate with state authorities.
Maryam Z. Deloffre is an assistant professor of political science at Arcadia University. Her research and publications examine transnational NGO accountability, the professionalization and standardization of humanitarian NGOs, human security and global health crises and global humanitarian governance.