COVID-19 pandemic: What have we learnt from a risk management perspective?

 

How has the pandemic response differed among low-middle income countries?

Chris started by asking the panel about variation in pandemic response, and in particular whether countries affected by Ebola and SARS outbreaks had reacted differently.

Nick explained that some low-income countries were coping well with their COVID-19 response, especially countries impacted by Ebola which have a recent history of pandemic and showed greater resilience. Nick also noted the different funding mechanisms for COVID-19 response.

Charity then brought a view of how informal communities were responding to the impacts of COVID-19, and the work which SDI do to try to build resilient communities in Nairobi, Kenya. In the target communities, social vulnerability is a key concern as different groups within the population may be affected differently by the pandemic e.g. women and children.

Cristina discussed the disaster risk financing aspects of COVID-19 response. She noted that GDP has not been a good proxy for efficient response and that the memory of previous pandemics helped countries respond better e.g. memory of previous outbreaks like SARS in 2003 and Ebola in 2014.

There are also lessons learned from Africa Risk Capacity and the Pandemic Emergency Financing Facility from the World Bank. Countries in SE Asia already impacted by SARS in the past responded to COVID-19 in a much more pro-active way. Cristina also noted that financing was unlikely to be sufficient alone – for global pandemics, institutional reactions and lessons learned were crucial.

 

Localisation of covid responses and vaccine rollout

Chris asked how the pandemic had affected the delivery of responses to COVID-19, vaccination rollout and other compounding disaster risks.

From the perspective of disaster risk leadership and financing, Nick suggested travel restrictions could have helped accelerate reform in the humanitarian sector. With international humanitarian responders unable to travel, the sector shifted towards leadership from a more local level. Cristina agreed that from a disaster risk financing perspective, there was greater decentralisation and localisation as funders had to rely more on government and local partners for access and to fund and deliver responses.

Nick also discussed work on the impact of covid on humanitarian response by ACAPS and OCHA; and issues with vaccine copyrighting as a wider resilience issue, with intellectual property rights hindering the capacity to develop vaccines more locally.

Charity then discussed the local challenges in Nairobi, Kenya within informal settlements. In these settlements, COVID-19 compounded existing vulnerabilities. Local people relied mainly on daily wages from working in neighbouring formal settlements. Reduced public gatherings and travel prevented people from accessing work, worsening food insecurity in the informal communities.

Additionally, government policy tended to prioritise home-based care for COVID-19; in dense, iron-sheet informal dwellings the difficulty of social distancing and isolation contributed to the spread of COVID-19, and informal settlements were perceived as COVID-19 hotspots. The vaccine uptake in some areas was as low as 5.8% and there was an abundance of misinformation around the vaccine.

 

The role of geography and data in responding to COVID-19 impacts and vulnerabilities

Charity discussed how SDI took part in a task force on informal settlements with local communities and the Ministry of Health. A key outcome was the creation of isolation centres within informal settlements, where people could access testing, isolate and get treated.

To understand the scale of vulnerabilities, they built a data driven approach using census data, and data from their informal settlement profiling. This profiling used comprehensive mapping and data collection to understand household economies in informal settlements. This helped address data gaps relevant to targeting the covid response and highlighted the importance of social vulnerability.

In the field, they worked with local communities to produce paper maps and map areas where isolation centres could be located. This data was converted to geographic information and shared with the taskforce to help site isolation centres, helping address the challenge of isolating in these communities.

Additional SDI responses also included providing PPE, civic education, handwashing stations (especially where access to water was an issue); and attempting to improve vaccination uptake.

Nick discussed the creation of MapAction’s Integrated Humanitarian Data Package in South Sudan, where at a national level MapAction were working to meet data needs to support vaccine planning. COVAX countries have national vaccine deployment plans, so MapAction examined where data gaps were affecting rollout. Challenges included population flux, out of date data, and inadequate data on informal settlements.

Additionally, Nick noted that about 75% of data analysis was in data preparation – so multiple agencies working on vaccine rollout resulted in duplication of effort on geodata collection and processing.

From the disaster risk financing/insurance angle, Cristina outlined how pandemic modelling is a relatively new discipline. Historically, pandemic risks have been considered difficult to model and uninsurable. However, in the pandemic, insurers realised their exposure to pandemic risks. Academics became increasingly involved, and real-time data collection and modelling became important.

In pandemic modelling, there is also a need to understand variation in impacts in different places and on different groups. Techniques can be used to disaggregate national data – such as using GIS with transport data to understand mobility and disease spread. Agent-based modelling – modelling on the basis of individual characteristics up to city and province level – can enable targeting of medical support and treatment.

 

Risk communication and the importance of trust

On risk communication, Cristina noted the role of institutional analysis in helping assess health preparedness, in particular focusing on quality of communication and trust in institutions. GDP was a poor indicator of preparedness: during the pandemic, high-income countries experienced lack of population trust in government, which negatively impacted trust in the vaccine.

Charity noted that communication is not only via mass media. Particularly in informal settlements, there was a sense of isolation from national-level responses, and creating a sense of belonging was important when establishing isolation centres. Grassroot-level communication and civic education were more effective in supporting vaccine uptake. By contrast, sanctions for not getting vaccinated (like reduced access to transport) tended to instil fear, and were in the context of a failure to sensitise communities to vaccine messaging.

 

Recognising the importance of culture in data collection and interpretation

Cristina discussed the creation of a Sentiment Index which used interviews in 4 locations and languages, recognising the influence of culture and past experiences on how people respond to disease outbreaks. She noted the importance of localisation – for example, by not just relying on English-language sources in social media data collection- and the possibility of using natural language processing and translation to scale beyond just using English or French.

Nick also pointed to the 2019 DRC Ebola outbreak. The Ebola vaccine programme encountered difficulties in engaging some communities, so sociologists were brought in successfully to reach the heads of communities and understand community concerns about the vaccine and response approach, such as surveillance.

 

What is one key challenge and one opportunity for the future in terms of lessons learned from COVID-19?

Nick discussed the important challenge of having ready-to-use data prepared at the outset of a pandemic to enable effective responses. As an opportunity, he noted how covid has accelerated localisation of responses – with local leadership rather than being led by high-income countries – but warned of the risk of not taking advantage of this if underlying systems were not changed.

Charity spoke on the socioeconomic challenges associated with COVID-19, particularly in informal communities, and the gap between government and local communities. In opportunities, she spoke of the possibility to build resilience in urban communities when looking towards future pandemics, focusing on the inclusion of poor urban communities in planning and the need for stronger communication.

Finally, Cristina suggested the challenge of scaling up social protection systems to reach the informal economy that aid struggles to reach. Opportunities included better local procurement of PPE, vaccines and more, with benefits for local communities and response times; and improved capabilities for disease surveillance in labs globally rather than just in rich countries.

 

Read more

• South Sudan data package to support effective and equitable Covid vaccine delivery – MapAction

• COVID 19 Vaccine Perceptions: A 15 country study – Africa CDC

• Vaccine Inequity Is Creating Conditions For New COVID-19 Variants (buzzfeednews.com)

• Disaster risk reduction in times of COVID-19: What have we learned? | Food and Agriculture Organization

• InsuResilience Centre of Excellence on Gender-Smart Solutions | Climate & Development Knowledge Network

• The power of data in a pandemic: repurposing Muungano’s data-collection expertise to fight Covid-19 in Kenya  - Global Development Institute

• Community mapping in Kenya improves state Covid-19 response - ACRC (african-cities.org)

• Response to outbreak of Ebola in DRC - Anthrologica

 

If you have any questions, please contact Chris Ewing