Why global health emergencies first need a dose of trust

A new world body set up to track preparedness for pandemics finds a key missing piece is trust in basic institutions. One cure: more community engagement.

Hundred march in Goma, Congo, to support Ebola response teams that have seen increasing attacks and resistance among communities.

In only the fifth time in its history, the World Health Organization declared an international public health emergency in July to head off a pandemic. The trigger was an unexpected spread of the Ebola virus in Africa. While that crisis appears contained, the warning was a reminder that medical interventions alone cannot deal with such outbreaks. The missing piece, according to a new report, is trust between communities in crisis and the institutions that serve them.

The report, issued Wednesday, comes from a new body set up by WHO and the World Bank to provide independent judgments on the world’s readiness to respond to health emergencies. The 15-member Global Preparedness Monitoring Board concluded that the current state of readiness is “grossly insufficient.”

“For too long, we have allowed a cycle of panic and neglect when it comes to pandemics,” stated the report. “We ramp up efforts when there is a serious threat, then quickly forget about them when the threat subsides.”

One of the recommendations is that countries improve their capacity for community involvement well before a crisis hits in order to alleviate fear and trauma. “Long-term, sustained community engagement is crucial for detecting outbreaks early, controlling amplification and spread, ensuring trust and social cohesion, and fostering effective responses,” the report stated.

This was a key lesson from the devastating 2014-16 Ebola outbreak in West Africa. At the time, high levels of distrust in health services not only hindered efforts to deal with the outbreak but contributed to its spread. In addition, WHO’s declaration of an emergency, while necessary for the rest of the world to heed, may have created undue fear in local communities and also a narrative of victimization.

The world must “heed the lessons these outbreaks are teaching us” and learn how to “fix the roof before the rain comes,” says Tedros Adhanom Ghebreyesus, director-general of WHO.

The report warns of a general crisis in trust of institutions. “Governments, scientists, the media, public health, health systems and health workers in many countries are facing a breakdown in public trust that is threatening their ability to function effectively,” it found.

In many health crises, the first task is often to dampen fear in order to build up social trust. In one study of Congo’s Ebola crisis, scholars found fewer people sought care as fear of the disease increased. “How very little can be done under the spirit of fear,” advised Florence Nightingale, the famed 19th-century nurse. It is a lesson worth recalling as the world learns to better prepare for health emergencies.

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