Webinar Series Week 4 Summary:  Lessons learned from HIV, Ebola and other epidemics & how can behavioral research help us respond to COVID-19

Webinar Summary Compiled by Ashley Scott, IGHN Key Correspondent/MSc Global Health TCD

Anchor Ruairi Brugha Update:

Described the being used for suppression around Asia such as contact tracing with mobile phone which enhances ease of tracing contacts that individuals with Coronavirus have been exposed to. This can be through monitoring aggregated behaviour or through individual behaviour surveillance. He asked whether these are measures that we want to consider? We need to start having these debates.

Kate Thompson

Kate described her experience with being diagnosed with HIV in 1987 and feels like she is having to survive another plague. HIV was a new disease, with lots of questions and the feeling was similar to what is being felt now. People were dying alone, intimidating PPE was being used, there was inappropriate distancing and misinformation being spread. A large difference was that there was no internet access leading to less space to spread false news. Stigma and discrimination were rife, with breaches of human rights, generally towards groups that were marginalised, criminalised and excluded from society. The power of communities was immense with creative solutions coming through the community itself. Speaking about their experiences was important, with peer support through tough times. Around 1996, when HIV treatment became available, access to health in the global north vs south shifted, and she is mindful of the possibility of this with Covid-19. We need to maintain gains made in terms of HIV and TB, while being mindful of supporting the Covid-19 efforts. We need to be mindful of lessons learned in gender and human rights involved, and not let go of rights that have developed from HIV crisis.

Margaret Fitzgerald

Margaret described her experience in 2014, when she travelled to Liberia just before the peak of the Ebola outbreak and she said that the situation was chaotic. The President at the time had enforced a notice of quarantine in West Point, which is a densely populated low-income area. NGOs provided treatment centres to support the collapsed health services. Healthcare workers started to become infected and fearful, with many mortalities and there was not not enough support for the healthcare workers. The coordination of the response was insufficient, with reduced communication and collaboration between government systems and NGOs. An important lesson learned was that we need a strong message in what to do when you are sick and we need to be able to back it up with testing and availability in healthcare. In terms of healthcare in LMICs, those who need it most, can access it least. How do the most vulnerable self-isolate? The Covid-19 outbreak is showing Ireland’s weakest link in society, in term of healthcare and we are working hard to connect these pieces, but it is a big challenge.

Dr Allam Alhuda abu Kalib

Described how this will be the defining global health challenge of our time. South Sudan has 15 cases, 2 deaths and 2 recoveries with more than 200 suspected cases. Policy makers are in the process of deciding on measures to control the virus, while simultaneously managing the fragile economy. He is also mindful of other illnesses such as Cholera, which put pressure on their healthcare system. He is concerned about this “poison” spreading through Sudan. He reported how a health system collapse is possible. The population works hard, while healthcare facilities are far away or not functional with added problems such as a reduced employment rate, civil war and shortage of basic resources such as water and food.

Professor Fr. Michael Kelly

Zambia 39 confirmed cases and 1 death, however the virus has not yet moved into the local population. Fear is beginning to spread and protective measures are difficult to enforce. Easter poses difficulties in social distancing as the Zambian population is very religious. There is also a low number of health personnel with 1 Dr to 12 000 people in Zambia, compared to the WHO recommendation of 1:1000. Zambia would not be able to respond with personnel, resources, infrastructure. Zambia is already experiencing an adverse economic effect due to changes in demand of Copper by China. Tourism, which is a large source of income is at a stand-still, with access to Victoria Falls being closed. HIV prevalence is at 11.3% with the majority being on treatment however, if the country has to deal with a Coronavirus outbreak, they will not be able to provide universal access to healthcare.

Pete Lunn

Pete described how he explores human decision and behaviour and realised that his expertise was relevant to the Coronavirus outbreak. He described how simply providing information and education does not change behaviour. Changes to physical and social environment are required to assist people to behave. E.g. handwashing. Grabbing people’s attention at the right time with the relevant message is required to change behaviour. He described how you can change people’s willingness to self-isolate if you do some planning beforehand, making them better prepared. Collective action is important in that people need to behave to make changes to everyone, not just themselves. As such, clarity of the message for why the behaviour is best for all is vital, as well as building a degree of team spirit. There also has to be a degree of disapproval by those who are engaging well towards those who aren’t. Ireland is behaving well around the virus and has an advantage of being a small, cohesive country.

Sian White

Sian described factors that enable or prevent washing hands. She described the determinants of hand washing, including a universe of factors including, cognitive and environmental factors as well as societal norms. We need to consider why people don’t wash their hands. It is easy to be condescending towards people who are not able to cope with the situation, without considering why they aren’t washing their hands. There is no link between knowledge about handwashing and behaviour. The most powerful driver is having universally accessible, convenient access to soap and water. We are seeing renewed call to ensure that hand washing facilities are easily available in places where people gather.