With the resurgence of mpox and the World Health Organization declaring it a public health emergency of international concern (PHEIC), as well as the first-ever outbreak of Marburg virus in Rwanda, there is one question that stands at the forefront of our minds: Are we prepared now to take on these outbreaks so soon after the COVID-19 pandemic?
The only way we can go is forward, and to do so we must reflect and bring the lessons learned from COVID-19 to the outbreaks of today, to ensure that all people have access to the health care they need to stay healthy during these public health emergencies.
Leverage Expertise through Collaboration
COVID-19 gave rise to the issue of vaccine nationalism, and we are seeing this emerge again. Now the World Health Organization is calling for donor countries to share their stockpiled vaccines with the African nations most impacted by mpox. WHO Director-General Tedros Adhanon Ghebreyesus has also emphasized that a “multi-pronged approach is needed that involves strong collaboration” to increase the number of vaccines in African countries, especially with some mpox vaccination campaigns facing delays.
There are also opportunities for collaboration with the ongoing Marburg vaccine trials, as large-scale production and distribution of the vaccines could be needed if the outbreak becomes more widespread. Similar distribution techniques to those used during COVID-19 could be applied to the Marburg vaccine, as one of the candidates is being developed with technology similar to what was used with the AstraZeneca COVID-19 vaccine.
COVID-19 has taught us that we cannot solve public health emergencies alone. Vaccines were able to reach the most vulnerable through collaboration and communication with governments, partners and the private sector. For example, in Mozambique, a National Coordination Committee was set up to create a framework for effective vaccine distribution. This collaborative effort leveraged the expertise and knowledge of those involved, from government officials, experts and partners, to bring COVID-19 vaccines to the under-reached.
Because of our work in redesigning and improving vaccine supply chains in Mozambique for the past 20 years, we were able to use this experience and work alongside other partners that specialized in logistics to implement supply chain systems that facilitated vaccine distribution.
With this type of multisectoral collaboration, access to lifesaving health products and services is possible during times of crisis.
Address Community Concerns
There is a familiar echo from COVID-19 being seen with both Marburg and mpox – misinformation as well as unaddressed community concerns. Even before confirmation of Marburg in Rwanda, information was circulating on social media warning about spreading a ‘viral’ disease. And the arrival of mpox vaccines in Africa has led to the spread of rumors about the vaccine’s origins. This misinformation can easily become a barrier to vaccine uptake and preventative measures.
To ensure strong vaccine uptake, measures must be taken to combat rumors and conspiracy theories about the diseases’ origins, as well as mistrust in medical institutions and treatments. That includes addressing community concerns, especially the most vulnerable communities.
During COVID-19, boosting vaccination rates in countries and communities with low uptake required an understanding of people’s perceptions and concerns. One method to systematically monitor and respond to vaccine questions and misinformation is through social listening, which identifies the critical barriers to vaccine demand, including access and availability.
In Malawi, social listening was applied using Chipatala cha pa Foni (CCPF), a toll-free national health hotline that provides information and referrals through trained health workers or interactive voice response. Demand for the hotline spiked after it was declared a trusted source of information on COVID-19 during a presidential address. Analyzing these calls allowed the Malawi Ministry of Health to pivot public communication and messaging to address concerns about COVID-19.
Social listening can be applied to mpox and Marburg, by leveraging national health hotlines such as CCPF. This approach allows governments to address gaps in health care delivery, as we work towards more resilient health systems that respond to the needs of communities, even during public health emergencies.
Integrate Community Health Workers into Emergency Response
The rise in mpox cases across Africa has also highlighted gaps in surveillance, contact tracing and data collection, particularly at the local level. In addition, the Marburg outbreak in Rwanda has led to calls for collaboration between Africa CDC and neighboring countries of Burundi, Uganda, Tanzania and Democratic Republic of Congo to develop guidance on cross-border surveillance strategies to contain the outbreak. Community health workers have been spotlighted as potential support for collecting samples for testing and assisting in safely transporting suspected patients with Marburg to health centers.
With both of these outbreaks in mind, there is an opportunity to integrate community health workers (CHWs) into public health emergency response to support surveillance and health care delivery.
During COVID-19, CHWs were seen as a reliable source of continuous care and were critical partners for addressing COVID-19 vaccine hesitancy in Africa. They are considered a trusted source of health care delivery in Africa, and because of this trust, they were able to educate communities and reach more people in remote areas by administering COVID-19 vaccines both at fixed locations and at people’s homes in Malawi. Globally, they played an important role in the COVID-19 pandemic response by educating populations, early detection, community surveillance and contact tracing.
In the post-pandemic world, more must be done to support a trusted, capable and cost-effective part of the health workforce. COVID-19 has cemented how critical CHWs are, not just in response to health emergencies but also in maintaining essential health services and bringing us closer towards universal health coverage.
When CHWs are professionalized – salaried, skilled, supervised and supplied – they can ensure access to primary health services aren’t interrupted, including during outbreaks like mpox and Marburg. Integrating them into public health emergency response is one way to strengthen surveillance systems, so that these health services are able to adapt to shocks and stresses in times of emergency.
Looking Forward
The lessons we take from COVID-19 show that overcoming both the mpox and Marburg outbreaks requires solidarity. We can combine our expertise through collaboration, address communities’ concerns and integrate community health workers into emergency response. By keeping this in mind, we can ensure that our battle with the outbreaks of today will be won, together.
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