Where there is a disaster or a conflict situation and health is not part of the response – and not addressed properly – then the situation can develop into an epidemic or a pandemic.
We have recently seen one of the worst cholera epidemics in Yemen, in a conflict situation. Like you all, I’m afraid at what might happen in Cox’s Bazar, Bangladesh, where we all know that we are sitting on a ‘WASH’ (water and sanitation) time bomb. We have experienced similar things in many other parts of the world where we are responding to natural shocks and hazards as well as conflict situations. So that’s one side of the story.
The second side of the story is that health is becoming a humanitarian challenge of its own, because – outside of disasters and conflicts – we have been experiencing outbreaks that start as a localized threat, and which can very quickly develop into a larger, and even an international threat.
Why is this? Because we are living in the world that is more global than ever before; a world that is more interconnected than ever before. A world in which we can travel within 24 hours from any corner of the globe to the next extreme one. And as we travel, bugs, viruses and bacteria can travel too.
If we add to that the other issues that may serve as multipliers, such as climate change, it all provides fertile ground and breeding space for many of those bugs that we care about. If we add another multiplier – like rapid urbanization plus demographic pressure – that is pushing us, humans, further and further towards sharing the same habitat as the fauna, then we find ourselves in a situation where animals can live with many of the threats, but we cannot. And the closer we get to them, the more our cohabitation becomes deadly.
While I’m speaking here with you now, we are deploying Red Cross Red Crescent teams in the Democratic Republic of the Congo, trying to contain the country’s tenth Ebola outbreak. It is taking time to contain because it’s happening in a conflict situation with many safety and security challenges. Not only are we facing a situation in which we have registered 200 deaths for the first time, but if we are not well prepared in the neighbouring countries of Uganda and Rwanda, it can spread very easily. Once it spreads, we never know where the limit will be.
Three years ago, we had, for the first time, an Ebola outbreak in West Africa. It was the first urban outbreak, and the first time such an outbreak affected three countries at the same time. We even had a reported case in New York City – it happened very quickly.
It reminds us of the simple fact that, nowadays, no matter how far away such outbreaks can be, none of us are safe unless and until the outbreak is contained at source.
In situations like this, we take a lot of actions, such as temperatures being measured in the airports and quarantine mechanisms being put in place. All these may be right, but the real right thing to do in containing a pandemic and epidemic is to act right there in the communities and in the last village where it is happening.
When we talk about pandemics, we speak of the big nasty ones, like Ebola. It is quite scary to think about the pandemics that we have had over the last five years. If you remember, we had Zika, and it still continues. We had yellow fever in Angola and the Democratic Republic of Congo. They seemed to be localized outbreaks, but one outbreak almost depleted the whole world’s vaccine stockpile. This makes us all very vulnerable, even if the bacteria or virus did not travel and find us.
We deployed a huge team plus a field hospital in Madagascar to try and contain a plague epidemic. It was one of the rare times in this day and age that an airborne, pulmonary plague broke out. It was unlike the bubonic plague, which was spread through physical contact.
In the same period, we had Lassa fever, Nile fever, Marburg fever and Dengue fever, which is becoming endemic, including in this region. All of that reminds us that pandemics and epidemics, all health challenges, are part of the challenges that we face as part of a response in natural disaster, shocks and hazards in humanitarian settings. They can also develop very easily into humanitarian situations on their own.
The World Health Organization (WHO) and the World Bank, understanding the importance of the phenomenon, have established the Global Pandemic Monitoring Board (GPMB). I have the privilege to co-chair the GPMB, together with Dr Gro Brundtland, former Director General of the WHO and former Prime Minister of Norway.
We are working hard to:
monitor how the pandemics are developing;
identify how to incentivise action by bringing together all actors that matter;
follow research and development so that vaccines will be developed on time, and ensure that those vaccines will be pre-positioned in order for us to be better prepared and have the preventive tools to address them;
make sure that national governments are equipped with surveillance systems to get early alerts and necessary contact tracing in order to contain outbreaks.
We have also realised that in most places where we work, there is a cohabitation between the formal surveillance system that does not necessarily reach out to the district level, and the places where we have the shocks and hazards. In most of those places, unfortunately, we do not even have a government structure, a doctor, or the health facilities that are required.
Communities in those settings are the best placed to detect early signs of a pandemic. Sometimes we see things through empirical observation – seeing more people falling sick than before, more animals dying than before, more funerals taking place than usual. All these are signs and alerts that are not necessarily captured as part of the formal surveillance system mechanism. We believe that community surveillance is going to be extremely important to capture that kind of knowledge and feed it into the formal surveillance system so that the response can be triggered, both in terms of prevention and response.
These outbreaks are difficult in many ways. Most of them completely overwhelm the people and communities. Even when we ask the communities to do all the right things, it happens that people pick up risky practices when there is an outbreak. In health, we promote people to care for each other, to support and accompany the sick, to hold on together as a community and care for their deceased in a dignified way. All those good practices from a social point of view become very risky practices. You can no longer shake hands, care for your sick or mourn, wash and bury loved ones like you used to before because, as we learnt during the Ebola outbreak, dead bodies were ten times more infectious than people who were living with the virus.
We had to build trust with the communities so that they could entrust us with that very important element of caring for their sick and dying, and conducting safe and dignified burials for the deceased. This is an extremely important element that reminds us that our humanitarian supporting journey does not end with the end of life: it is also to accompany people in a dignified way to their last place of rest, which contributes to the strengthening of communities and of social capital. It is also the best way of prevention and cutting the chain of transmission.
Another difficulty is about contact tracing. When you ask communities to identify those who have been exposed or those who have symptoms, and you take them to treatment centres, the expectation is that these people will be treated and will come back home safe. Unfortunately, in many of these outbreaks, people will not make it, and this can break the trust. It reminds us how important it is to pay particular attention to these types of outbreak that are haunting us.
All the outbreaks that I have mentioned are quite localized, like Ebola in the DRC or in Liberia, Sierra Leone and Guinea; Zika in Brazil, Dengue in some parts of Asia Pacific, Plague in Madagascar. The question now is: are we really prepared for a big global pandemic? This is where the biggest challenge lies.
We are all on our toes because we are getting to the 100th anniversary of the Spanish flu. It was the last global pandemic that we had, and it infected one third of the global population back in 1918, and killed 50 million people. Are we prepared for that? Do we have the tools to respond? Do we have the trigger mechanisms? Do we have the right vaccines to adapt or respond effectively to the new strains that we are seeing? Are we properly managing urbanization, water, sanitation and hygiene in all the different settings?
We know that we are not all equal in the face of disease. The place in which you were born and raised will almost always determine your state of health … except when it comes to these types of pandemics and epidemics. In those situations, none of us is safe until we all are safe. There is only one place to contain disease, and that is right there where it is happening.
We believe that the Red Cross and Red Crescent Movement is best placed to do that. We are the ones there before, during and after the outbreak. This provides us with the continuous presence to work across a continuum of preparedness, early alert, early warning and early action. At the same time, we are able to build the capacities of communities to withstand those shocks. Most importantly, we have the trust that is required to do contact tracing, to take people to quarantine and treatment centres if necessary, to recognise early signs for community surveillance, and to bridge that with the formal systems that we have.
That is the reason why – in all the consultation and situation analyses that we have made so far – we find that it is a priority to focus on and we engage in this conversation seriously to see how we can include it as an integral part of our strategies, looking ahead.
It is also a priority for us to see how we can empower local communities and actors, as well as our own National Societies, to make sure that we remain the first line responders, the trusted local actors and partners of choice of the formal health system as well as the surveillance systems in addressing the pandemics.
When we describe the situation like this, it can look quite bleak, and the perspective looks extremely negative. This is the reality, but we are not totally powerless in the face of it. The question is: what kind of measures will we take now in order to make sure that we can prevent it and respond in an efficient way?
It is important to have this conversation among ourselves and I look forward to hearing from our colleagues their perspectives from their different contexts. The responses that have been developed in those contexts can serve as best practices that we can collect and build on. They will strengthen the base for a consolidated strategy response in our Movement.
Thank you very much.