Zika: Don’t Forget Community Engagement

As local and national authorities mobilize to counter the outbreak of Zika virus in 23 countries of The Americas, policy makers must ensure that engagement with the affected communities is central to their efforts.

This blog post makes the case for cutting edge communication methodologies and practices to be included in all policies, strategies and plans, and to be resourced as adequately as the technical or medical responses.

The international health emergency declared on February 1, 2016 by the World Health Organization[1] in the face of the “explosive” spread of the mosquito-borne Zika virus in Latin America has spurred governments, public health authorities, scientists, international agencies and development experts to intensify mosquito control efforts.

Authorities are relying, at least initially, on standard, technically-oriented practices — using insecticides and removing the standing water where mosquitoes breed. As important as these control methods are, they have not proved sufficient over decades of efforts to control the spread of dengue, yellow fever and chikungunya, all propagated by the mosquito that carries Zika.

For weeks, official messaging has called upon people in high-risk areas to avoid being bitten by mosquitos – a near impossible task in impoverished communities and environmentally degraded environments. Because of the apparent link of Zika infection to thousands of cases of babies born with microcephaly, women – not their partners, interestingly -- are being told not to get pregnant or, if they are pregnant, to get tested for the virus. Medical facilities and labs lack equipment and protocols to respond.

Soldiers are being mobilized in Brazil to mount a military-style operation in the places where mosquitos breed, armed with newly-issued legal authority to inspect homes for sources of standing water.

Zika is new to the region, which means that populations lack immunity to the virus. No vaccine or cure exists. Research is being fast-tracked into different lines of attack, ranging from development of a human vaccine to genetic modification of mosquitos themselves. But the research and trials are expected to take several years to determine what may be effective.

Fear among the public is running high, fueled by the multiple unknowns and uncertainties surrounding the Zika epidemic. On top of the mosquito vector, sexual transmission among humans has now been confirmed in several cases. Women’s and human rights groups are questioning calls on women to avoid pregnancy where access to contraception is limited, abortion illegal and sexual violence common. Religious tenets and cultural norms regarding sex, birth control and abortion are being challenged in the face of the crisis.

The environmental and health impact of widespread use of pesticides and larvicides, including the possible resurrection of DDT to kill mosquitos, have elicited concern on the part of public health and environmental experts. The implications and costs of caring for children born with microcephaly are staggering. The potential for stigma and discrimination against affected children and families is huge.

In such a fraught and uncertain scenario, the need for appropriate communication strategies is great. Risk communication is essential to convey accurate information and prevent panic. Behavior and social change communication is needed that is realistic, practical and takes into account the barriers that people may face in order to implement official advice. It must be aligned with local realities and be sensitive to the rights of different populations.

Communication strategies using traditional channels and new technologies are needed to amplify the voices of communities putting forward solutions of their own design. And communication must take into account underlying drivers of disease such as climate change, poverty and urbanization.

Lessons learned from decades of efforts to prevent and reduce the spread of dengue are particularly pertinent. As one study of dengue control initiatives in the Americas states:

Prevention and control of epidemic dengue has become increasingly problematic. The disease exists in large tropical cities where the mosquito vectors live in intimate contact with the crowded human host. Many of these cities have populations of 15 to 20 million people. To effectively control the mosquito vector using current tools, every house and office in the city must be visited on a weekly basis, a near impossibility without the help of the community.[2]

The same conclusion was reached in the recent Camino Verde project, a randomized control trial of community-driven dengue prevention in Mexico and Nicaragua:

“Traditional policies and programs, based on the use of larvicides and pesticides, have not managed to control the spread of the dengue virus and its vector, the Aedes mosquito. The trend in recent years has been towards strategies that incorporate some form of community participation, but before Camino Verde there was no hard evidence that community engagement actually had an impact on the disease.”[3]

Among other things, the study[4] concluded that community mobilization led by local volunteers resulted in reductions of about 30% of dengue cases among young children — the first study to actually measure the direct physiological impact of community-led vector control and education in cases of dengue.

Communication for Development (C4D)[5] that is focused on community engagement often gets short shrift – or is completely ignored -- when it comes to planning, funding and implementing strategies to curb the spread and limit the toll of infectious diseases. This, despite the fact that the involvement and participation of communities have been shown to play a crucial role in mitigating past epidemics (Ebola being the most recent case), in tandem with other life-saving interventions.

This must not be allowed to happen in the case of current efforts to prevent the Zika virus from spreading further. Failure to engage with and rely on communities could lead to unprecedented suffering. As starkly stated by one public health expert:

"Zika’s challenges come from the mosquito vector. This mosquito is ubiquitous, found in every region of the world. If we are not proactive and attack the problem with overwhelming resolve, the hazard of Zika will spread worldwide. If we see a wave of fetal abnormalities nine months after Zika outbreaks, it will be an enormous ethical and public health failure."[6]

Community engagement must be at the heart of this “overwhelming resolve”. Rain Barrel Communications is one small actor amongst hundreds of NGOs, bilateral agencies and companies that possess experiences in strategizing for locally-based and community empowerment actions. We would be pleased to provide technical communication and/or on-the-ground support to all stakeholders in the fast-evolving Zika outbreak.

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[1] See WHO statement: http://www.who.int/mediacentre/news/statements/2016/1st-emergency-committee-zika/en/

[2] Gubler DJ. The emergence of epidemic dengue fever and dengue hemorrhagic fever in the Americas: a case of failed public health policy. Pan Am J Public Health 2005; 17(4): 221–224 [PubMed]

[3] See the Camino Verde website: http://caminoverde.ciet.org/en/about-us/

[4] The results of the Camino Verde trial were published in the BMJ (British Medical Journal) in July 2015. See: http://bmj.com/cgi/content/full/bmj.h3267.

[5] Also called Behaviour and Social Change Communication (SBCC) and other names.

[6] Dr. Lawrence Gostin, cited in What The Ebola Crisis Can Teach Us About Responding To The Zika Outbreak (The World Post, 1/30/2016)