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Local Communities’ Overlooked Role in the Fight Against Pandemics

Outbreaks of diseases like the coronavirus start and have to be controlled at the local level. National governments and international organizations aren't doing enough to foster communities' resilience.

In 2009, Hong Kong's Metropole Hotel quarantined its guests for a week, likely reducing the global spread of the deadly H1N1 flu. Five years later, traditional and religious leaders in West Africa assuaged people's fear, distrust and suspicion of government and international first responders, playing a critical role in curbing the spread of Ebola. And this past Dec. 31, a Canadian tech startup that scrutinizes digital information to predict epidemics reported a spike in coronavirus cases in Wuhan, China — a week before governmental and international agencies made the same observation.

Welcome to a different front in the global battle against pandemics. The Wuhan coronavirus global health emergency has focused attention on what the governments of China and a score of other nations are doing to halt the swelling number of those infected with and dying from the disease. That misses a key element of the solution: mobilizing communities.

Outbreaks start and have to be controlled at the local level. National governments often respond slowly because of delayed or incomplete detection and surveillance information or intentional suppression of the bad news. In contrast, community-based health workers, business leaders, veterinarians, teachers, religious leaders and traditional healers are often the first to detect a novel disease and respond while awaiting external help.

These groups can limit geographic spread and mitigate the impact on local economies and social structures by building awareness around disease prevention and educating community members. Agricultural workers can prevent and report disease threats from animals. Local sanitation crews can work to provide an environment that limits the spread of disease. Religious and civil-society actors can advocate culturally appropriate responses.

National governments and international global health organizations haven't fully recognized the key role that vulnerable communities play in addressing this pandemic and are not doing enough to foster their resilience. As a result, local and international economies are already suffering. Health care is being hit hard. Communities have seen runs on surgical masks, which may not prevent coronavirus contagion, but the shortages undermine basic health services that do need the masks.

Well-prepared communities aren't the entire answer. Many communities, particularly in developing countries, don't have a way to communicate with each other or external actors. That makes it hard to detect patterns. As a result, epidemics and pandemics often spread before anyone knows. That hinders determination of the source. Health and agriculture authorities often don't collaborate, presenting obstacles to verifying the origin of a virus that starts in an animal and passes to a human who passes it to another person.

Artificial intelligence could help bridge this gap. BlueDot, the Canadian startup, uses natural language processing and machine learning to analyze words and data in more than 100 databases in 65 languages, including news reports, animal- and plant-disease networks, official proclamations, and airline data. Applying these tools at the local level could spot the trends that show a pandemic. Agencies with a stake in pandemics could share dashboards or other forms of data visualization for close-to-real-time awareness of potential markers, making it possible to identify a virus more quickly, manufacture and distribute medication, track the success of treatments and much more.

To be sure, the role of national governments and international health leadership is critical to ensuring global health security. Beijing made the decision to lock down Wuhan and nearby cities. Hong Kong cut back heavily on travel via road, rail and ferry links between the city and mainland China. National governments finance much of the local work and research on vaccines. And the World Health Organization declared the global health emergency.

But we forget the crucial role of local communities as a source of both data and responders at our peril. In the 1918 flu pandemic, misinformed communities failed to act and bodies piled up on the streets. With an increasingly interconnected world, that could happen again — with a vengeance. If we keep the critical importance of action at the community level top of mind, our collective futures will be safer.

Head of Rockville, Md.-based Abt Associates' Global Health Security practice
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