Has the pandemic reinforced what we know about disaster risk management?

Part of our Post COVID-19 Urban Futures series.

The possibility of emerging infectious diseases impacting on our societies is increasing, as our relationship with nature is changing due to climate change, land use change, and humans encroaching on the habitat of wild animals. Additionally, the global spread of emerging infectious diseases is more possible due to the increase in world travel, the global transport of food and intensive food production methods.

While this pandemic is still an ongoing emergency – it might be worthwhile to ask the question at this point – has the pandemic reinforced what we know about disaster risk management? The Sendai Framework for Disaster Risk Reduction is the international blueprint for reducing risk and responding to disasters, and includes biological hazards in its considerations.

The difficulty in preparing properly for high impact/low frequency events. Pandemic usually tops the list of national risk registers as potential high-impact disaster event that we need to prepare for. Most countries have undertaken some kind of preparedness for pandemics, or other public health emergencies. The 2017 National Risk Register for the UK lists emerging infectious diseases as an unpredictable but potentially more frequent event (see figure 1 below).

We know that the more often an event happens, the more prepared we are for future events. However, preparing for an event that is high impact, low frequency is always more difficult, as the issue seems less pressing. It has been over 100 years since the last full-scale pandemic of the Spanish flu in 1918, and many countries have been left unprepared, with weak health systems and lack of political commitment to invest in prevention, or to place pandemics at the front and centre of preparedness.

As we have seen, the countries that have had more recent experiences in responding to epidemics have been better prepared. For example, Ebola in Sierra Leone and across West Africa, and SARS across East Asian countries has prepared the medical and governance systems for swift action. Medical professionals from Cuba helped to respond to Ebola in West Africa in 2014/15, and this experience has meant that Cuba has been quicker and better able to respond to the Covid-19 pandemic at home. Taiwan, a country that has was hard-hit by SARS, brought in checks on travellers from Wuhan in late December, a day after Hubei province public health reporting of a mystery, pneumonia-like illness. The integration of public health and disaster risk management fields is an important and emerging area of research.

The pandemic has shown how crucial national-level policy-making and strong leadership is to reduce disaster risks. The lock-down actions that have been taken – or not taken—by national governments across the world have changed the trajectory of the epidemics in their countries. Very unfortunately, those who have not taken swift action have seen more deaths.

The world’s population is only as strong as its weakest link. The pandemic has underscored that vulnerability is key variable in understanding risk to a pandemic, and that poverty is a key variable in vulnerability. Thus, addressing poverty, access to basic services and safe working conditions is the most important element in reducing the risks of pandemics, as well as host of other risks.

For example, The Office for National Statistics in the UK reported in early May 2020 that the most deprived areas of England and Wales have 55.1 deaths per 100,000 people, compared with 25.3 in affluent areas. People working in lower-paid jobs are more likely to be exposed, due to needing to be at work, needing to travel to work, needing to use public transport to cover the distance from home to work. The death rate among Black and Minority Ethnic (BAME) groups in the UK is 2.5 times that of white people, some of which may be related to higher levels of deprivation, or to exposure due to types of employment as frontline or key workers.

Outbreaks of Covid-19 among people who are unable to isolate themselves brings to fore poor living standards that people face on a daily basis.  Migrant workers in the gulf region exposes the harsh living conditions, and working conditions, that people face and how lack of rights exposes them unduly to a host of hazards, including Covid-19. In the cities were I usually do research, such as Kampala (Uganda), Dar es Salaam (Tanzania) and Dhaka (Bangladesh), people living in informal settlements, who lack access to clean piped water, share toilets amongst many families, and share one room with several family members sharing are not able to self-isolate. The cash-based economy means money is needed to access basic supplies such as food, water, toilets, health care and electricity. As savings are quickly depleted, people are forced to go out to work, or wait for government or charity hand-outs, which have been very slow to come. Brutal lockdowns and police enforcement have made people more vulnerable to violence, as we have seen in India and Uganda.

The economic vulnerability of certain groups extends into the phased opening-up of society too, for example in Uganda, where they are starting to come out of a harsh lock-down. In Kampala, the capital city, driving a motorbike taxi (boda-boda) is a profession for many young men, however now this form of transport is not allowed due to social distancing measures (they can only carry packages).

The importance of risk information, and the role of science in assessing risk. Risk assessment and the role of science is a major aspect of the Sendai Framework. Many of the actions that have been taken to reduce the spread of the pandemic are related to modelling done by epidemiologists on how the virus will affect the population, and how different actions, such as social distancing, shielding the worst affected, use of masks, etc. will reduce the spread of the virus. This modelling contains many uncertainties that have to be communicated to decision-makers, and modelling requires the scientists to make a multitude of choices in developing the methodology, which may be influenced by their own cultural and personal perspectives. In order for politicians to make decisions, consensus is ideally required, based on many different epidemiological models, created by different scientists, and the sharing of methods and data.

The role of science in public policy making about Covid-19 is of crucial importance to tackling the pandemic, and the clarity upon which policy decisions are made has a massive influence on how the public perceives and acts on the policies. In the U.K. this has been a huge area of contention, with the public calling for a more transparent links between the science and policy decisions, including access to the minutes of the U.K. Scientific Advisory Group for Emergencies (SAGE) meetings. This has led to the setting up of an independent SAGE group that publishes its advice publicly.

Local governments should be on the front-line. While the pandemic is a global event, the day-to-day management of protecting people’s health happens at the local level, and more local this is, the better it is adapted to people’s needs. For example, in Freetown, Sierra Leone, organised communities in the informal settlements have been working with public health officials to convey messages about how to prevent the spread of Covid-19 and communities have been feeding back about the challenges they face in doing so, it is with these dialogues that they have been able to tailor the messages and the needed actions

In the U.K. local level ‘resilience forums’, set up in 2004 include local councils and emergency services and respond to disasters on a regular basis. While in this crisis, they have the ability to play an important coordinating role, for example on supplying personal protective equipment to care home and other community settings, they have been beset by centralised control of information.  It is often the case in disasters that power and control reverts to the centre, and local governments are left out.

Conclusion

The pandemic has certainly reinforced some of the central tenants of our understanding of disasters. Those who are most vulnerable in our societies, due to depravations and lack of access to basic services are the most vulnerable to covid-19, as they are to other hazards; that serious planning by national governments are needed ahead of time to prepare for disasters; that science and local knowledge are all extremely important in assessing risks and taking-action. The role of science in informing public policy, and the transparency of decision-making is an ongoing area of research that will require greater scrutiny following this emergency.  While emerging infectious diseases will likely become more prevalent in the future, governments will become more attuned and more practiced at responding.