The world dodged six epidemics in 2023. Here's what we learned

You probably didn't hear about last year's Lassa fever outbreak in Ghana, which came to light when a woman fell ill in Accra's Agbogbloshie Market. Or the Avian influenza outbreak that started on mink farms in Finland. Or the Neethling disease infections among wild cattle in Cambodia. That's because those potential epidemics were nipped in the bud by responsive health systems and vigilant health workers and communities.

All those cases, as well as emerging threats in Bangladesh, Vanuatu, and Somalia, are highlighted in the latest edition of Epidemics That Didn't Happen, published by Resolve to Save Lives, which aims to highlight success stories in epidemic prevention. This year's report, according to the authors, shows "how responsive health systems – and responsive health workers – enable swift and coordinated action in detecting and responding to outbreaks before they spiral into disasters."

Specifically, this year's report notes four key principles and lessons – that health systems need to listen to communities; that people prevent pandemics; that timeliness is key; and that climate change is exacerbating risks. On a broader level, the report also aims to show the value of highlighting positive outliers in preventing disease outbreaks and epidemics.

"Many of our country partners are dealing with outbreak threats every single week and we learn a lot from what they are doing right Public health is often invisible and Epidemics That Didn't Happen really shines a light on the value of public health and helps the public understand that we're doing this type of work all day, every day, and keeping them safe," said Amanda McClelland, Resolve to Save Lives’ senior vice president of the Prevent Epidemics initiative.

Exemplars News spoke with McClelland about this year's report and how highlighting success stories contributes to epidemic prevention globally.

Could you give us an overview of this year’s Epidemics That Didn't Happen report? What were some of the major successes and what did the governments and health systems do right?

McClelland: The Epidemics That Didn't Happen report is a collection of case studies from across the globe that we try to mix and match, both in terms of contexts and types of disease, to demonstrate where epidemics didn't happen and highlight those successes. In this year's report, we wanted to highlight health systems that acted swiftly to detect [outbreaks], reported and responded to threats, prioritized health care worker safety and training, and partnered with communities over long periods of time to build trust with communities.

The Epidemics That Didn’t Happen report takes a positive outlier approach by studying success stories in preventing and responding to epidemics. Why did you choose to study successes and what are the benefits of this approach?

McClelland: In public health in particular, we tend to do a lot learning from our failures because they're quite visible, especially when outbreaks get out of control – for instance the COVID pandemic or the West Africa Ebola outbreak. We spend a lot of time reflecting on what went wrong.

But many of our country partners are dealing with outbreak threats every single week and we learn a lot from what they are doing right. We're interested in making sure we can do those things more consistently. We're also interested in celebrating successes and helping buoy public health a little bit following COVID and the negative press [surrounding the pandemic] about the areas where we didn't succeed as much.

Highlighting positive outliers offers a great opportunity to reflect on and amplify what we're doing right and do it more consistently. Public health is often invisible and Epidemics That Didn't Happen really shines a light on the value of public health and helps the public understand that we're doing this type of work all day, every day, and keeping them safe.

The report notes that ‘It’s easy, and important, to focus on and learn from things going wrong. But it’s just as important to learn from things going right.’ What are some of the things that are going right in epidemic prevention globally?

McClelland: Health systems are being more responsive and have a greater understanding that people are at the center of the work we provide. They're understanding that responsiveness can't happen just when we have a big outbreak, it has to happen on a daily basis. They're making sure that primary health care is part of the health system, which is extremely important for our health security and epidemics. They're starting to build long-term connections with communities and understand that speed matters – thinking about our systems and redesigning our systems so that we can move more quickly. I also think we're getting better at being able to maintain essential health services while we're in emergency mode. There are very few sectors that have to be able to respond – fight fires, so to speak – while still doing their day-to-day activities.

One of the main takeaways of this year’s case studies is that ‘health systems need to listen.’ Could you tell us more about that and what concrete steps you would recommend health systems take right now to listen better and build stronger relationships with communities?

McClelland: There are some great examples in this year's report we can look at. For instance, there was a case study with the Finnish health authorities around mink farming. The Finnish health authorities understood there was a potential risk for outbreaks [at mink farms]. They worked with the Finnish Food Authority before any outbreaks occurred and talked to them about how to prevent that risk – but also what they would do if something occurred, including looking for unexplained deaths in their animals and immediately sending samples to health authorities. They realized that there would be a big economic impact for the farmers during a disease outbreak because one of the first things we tend to do is cull the animals. All those things were negotiated and clear before an actual outbreak of Avian flu occurred on a fur farm in western Finland. Economic risk is a real and viable thing that we need to manage. The Somali Red Crescent Society case study is another great example where they used community health volunteers to explain the risk of dengue from mosquitoes. When they had a surge in dengue, the community volunteers were activated to clear the mosquito breeding grounds.

These instances of explaining risk, understanding community contexts, and then being responsive to new outbreaks are great examples of how health systems need to listen. It's really about building that trust outside of emergencies – it’s not about when communities need something but when we need the communities' help to stop outbreaks when communities need something. It's about having the mechanisms in place to listen and respond to what communities need both during peacetime and emergencies, which requires some measure of foresight.

Another lesson is that timeliness is key – and that a combination of strong leadership and emergency funds are critical to enabling effective action in the early days of an outbreak. Could you tell us more about how Ghana leveraged these to contain an outbreak of Lassa Fever?

McClelland: Sometimes we overlook the simple things that enable us to be successful. We saw that when we looked at positive outliers versus failures, sometimes simple things like having small amounts of money to react quickly were really important. Ghana is a great example of that – they identified a Lassa fever outbreak, and as a result, we were able to provide rapid outbreak financing very quickly, within two days. That allowed teams to get out very, very quickly and support accommodation and transport, communication, and material for staff to conduct outbreak investigations. It also allowed for strong leadership – the funds allowed health leaders across Accra to mobilize and support 150 health officers to stop the spread of the outbreak. Five thousand dollars in the first week can be much more impactful than $50,000 at the end of the first month of an outbreak.

A final takeaway is that climate change is exacerbating the risk of epidemics – what can health systems do right now to offset some of this heightened risk?

McClelland: Again, it's about understanding the context that your health system is operating in and understanding the risks to your health system, as well as the risks and vulnerabilities of your community. As part of our work, we have a project called Enhanced Situational Awareness, which is about using data, including climate data, to understand the risks that communities and health systems encounter when they face triggers. Cholera is a good example. Sometimes it comes when there's too much rain. But sometimes, in some communities, cholera comes when there's drought. So, you need to understand your context, the impact of different climates, climate hazards, etc. An example from the report is when Vanuatu experienced two cyclones in just a few days and was paying attention and responding to climate signals to be prepared for a potential outbreak of leptospirosis. Those early warning systems of climate hazards are important, but they're only helpful if you take action. And the Vanuatu case study is a great example of that.

What has Resolve to Save Lives learned through multiple iterations of Epidemics That Didn't Happen reports?

McClelland: The first thing is the appetite for success stories. So much of what we talk about is fear-based, or crisis-based. We get a lot of positive feedback for Epidemics That Didn't Happen from donors, partners and media – they really find value in showcasing positivity and best practices. That's one of the big takeaways. People are asking us when the next one comes out.

But there's also been a lot of change over the past three reports – the conversation and the messaging is becoming more advanced. We started this project before COVID, and the message used to be 'not if, but when.' And we don't really have to make that case anymore. People know the risk COVID poses. Now, we're getting granular on the 'what to do,' and it's not always super complex. It doesn't have to be advanced science in genomics and vaccine development. There are some really core, basic things that everyday people, communities and health systems can do to make sure that epidemics don't happen.