Story highlight: Development practitioners can learn from the current coronavirus outbreak. First, understanding trade and consumption of wild animals/’bush meat’ requires legal and economic approaches. Relatedly, climate change and its impacts on disease outbreak is at the heart of the current debate about public health that needs to be treated with urgency and intensity. Second, effective response to disease outbreak calls for strengthening primary healthcare systems through funding basic facilities, prioritizing research and addressing public health workforce shortage. Third, individual behaviors like handwashing matter for containing the spread of disease by embedding hygiene interventions into schools, households and communities.
I want to start with a big disclaimer: I am not a self-appointed expert of anything related to health. And this isn’t my intention in this blog post, either. Yet, I am enough an advocate of learning from other disciplines and the need to look at the bigger picture.
A lot has been said and written about the coronavirus, known officially as COVID-19, both from experts and pundits. The topic is dominating media headlines, financial markets, politics and office chats. The issue isn’t new, but only the scale and speed. Remember the Middle East respiratory syndrome (MERS), the Severe Acute Respiratory Syndrome (SARS) and Ebola?
What really motivated me to write this blog post, however, is the lack of serious discussions on the causes that have led all of us to this mess. It also bothers me when I think about the risk of losing sight of the bigger picture, because of the media-driven panic, for effective responses in the future.
Getting to the bottom of the problem
Two days ago, I was listening to Dr. W. Ian Lipkin, an internationally recognized authority on epidemiology and disease outbreak response. He is known as ‘master virus hunter’ and worked with Chinese officials during the SARS epidemic in 2003 and consulted on the movie ‘Contagion’. Lipkin pointed out two key issues that have unfortunately been lost in the panic and uncertainty around the world.
One of the issues is trade in and consumption of wild animals. Even though the current outbreak is believed to have started in a ‘wet market’ in Wuhan (China), trade and consumption in wild animals is widespread in other countries in Asia and Africa. The World Health Organization (WHO) says that coronaviruses are ‘zoonotic’, which for non-experts like me, means they are transmitted between animals and people. Research shows that three out of every four new or emerging infectious diseases in people come from animals, and that our immune systems don’t yet know how to fight.
In an increasingly interconnected world, we cannot ignore this issue. While Dr. Lipkin and others are in favor of banning trade and consumption of wild animals, this doesn’t seem to be simple. China implemented a sales ban on 54 species of animal in 2003 after the SARS epidemic. It didn’t work and the ban rather drove the practice deeper underground.
I think we need to understand in the first place why people trade and consume wild animals: from cultural norms and traditions to important source of protein and food security for poor people living in rural areas and preferences for the taste. It’s perhaps more helpful to strengthen the legal framework and its enforcement (e.g. regular sanitation checks of wet markets) together with designing livelihood support for those who would lose their source of income and access to quality food because of a total ban. We don’t have to reinvent the wheel but learn from and improve existing programs. A good example is payments for ecosystem services (PES).
The other big issue is climate change and its impacts on the intensity of transmission of diseases, the frequency of outbreaks, and emerging and re-emerging of infections. Owen Jones, writing for the Guardian, rightly asked ‘why don’t we treat the climate crisis with the same urgency as coronavirus?’ Climate change doesn’t terrify us the same way as an outbreak of diseases even though there’s strong evidence showing links between changes of climatic conditions and infectious diseases like Zika, malaria and dengue fever.
As warming rises, it pushes mosquitos beyond their current habitats, increasing the incidence of mosquito-borne parasitic and viral diseases. A good case is clearance of the Amazon rainforest that contributed to the spread of malaria. Also, after Hurricane Katrina hit New Orleans, cases of West Nile disease doubled the next year. In some African countries also, bloodsucking insects – including ticks, fleas and sandflies as well as mosquitoes – are emerging and re-emerging due to climate change.
The point that I’m trying to make is, tackling climate change should also be at the heart of the current debate about public health and it has to be treated with the same urgency and intensity –now and not tomorrow. It’s, unfortunately, the poor and other vulnerable groups who contribute the least to climate change (e.g. greenhouse gas emissions) but are the ones who suffer the most from climate change and its consequences. For this, in the words of the OECD, the only way forward is increasingly aligning development cooperation and climate action.
Policy-led actions exposing vulnerabilities in healthcare and other support systems
The current outbreak should also be a wake-up call, if it isn’t too late, for having a hard look at weakening health and primary healthcare systems. One of the reasons is many years of budget cuts to public health. According to the WHO, 50% of the word population lack some or essential health services. Mortalities from the coronavirus infection are higher among senior citizens and those with long-term medical condition (e.g. lung disease, diabetes, HIV-AIDS).
What is worrying is the economic impact of the current outbreak will worsen healthcare and other services. According to the OECD, the coronavirus outbreak presents the global economy with its greatest danger since the financial crisis of 2008. The hope, mainly in countries with weaker healthcare systems like Sub-Saharan Africa, is the experience from the Ebola outbreak and the existence of isolation facilities may help contain large-scale infection.
Yet, solutions will for sure be slower to come in terms of funding basic facilities and prioritizing research, as well as addressing the long-running issues of public health workforce shortage. There’re emerging and good examples of strengthening municipalities for more investments and better services, which can be improved and scaled up.
A related area that is also affected is school closures and its social and economic costs, mainly for working women who lack basic childcare support. Working parents, especially in countries where there is no affordable service for childcare, are more likely to miss work when schools close in order to take care of their children, incurring wage loss.
The importance of sustained behavioral changes
Like the bigger policy issues that I mentioned above, individual behaviors also matter for containing the spread of the coronavirus. There’s a lot of advice going around, some good and others unhelpful or misinformed. Perhaps what remains relevant and helpful is something our teachers or grandparents might have suggested: wash your hands!
I wrote a blog post few weeks ago together with my colleague Daya Moser on why changing behavior is challenging with few equals. It’s good that the coronavirus outbreak is highlighting the importance of simple activities like washing hands. In most cases, the impulse is just to inform individuals or communities about the risk associated with contamination and how to prevent falling sick.
Sounds pretty simple? Not necessarily. Handwashing and other hygienic activities should happen daily and continue well beyond the coronavirus is addressed. From our experience in many countries, a behavior change occurs not because a person is told or educated how to wash hands. We need to consider many psychological and social behavioral factors. A good example is embedding hygiene interventions into schools, households and communities in which people spend their time and live their lives.
- Cracking the Nut: Stimulating Behavioral Change in Water, Sanitation & Hygiene
- Rich but Disadvantaged: The Tale of Women in Japan & Switzerland
- Environment and Climate Change
Cover picture: @thedotter