Centering Communities in Pandemic Preparedness and Response

"When empowered, communities can support and advocate for their needs on behalf of themselves, a function that is vital to successful emergency response."

There is ample evidence that community engagement is vital for containing epidemics, as the COVID-19 pandemic has once again showcased. As the crisis unfolded, it became clear that countries increasingly understand the importance of shifting from solely focusing on providing information to communities to establishing two-way communications and accountability systems with and for them. This paper reviews existing evidence on community engagement in the context of disease outbreaks, provides examples of community engagement during the COVID-19 pandemic, explores successes and challenges of these efforts, and offers lessons learned to strengthen community resilience during future outbreaks. It was prepared as one of the background papers for the work and final report (see Related Summaries, below) of the Independent Panel for Pandemic Preparedness and Response, though the views expressed herein do not necessarily represent the views of the Panel.

Resources that contributed to this paper included desk-based literature reviews, specialist interviews, case studies, expert roundtables, and Panel member discussions.

Community involvement during COVID-19 ranged from passive actions to active engagement, either under government directives or voluntarily. These efforts were especially useful when governments did not provide basic services. The paper highlights emerging themes from community engagement efforts during the pandemic, illustrated by examples from around the world - with a more extensive list in Annex 1. Some of the themes included:

• Building on prior experiences and existing structures - e.g., in Nigeria, the "community informer model", which was a key pillar in polio eradication programmes, was used to support COVID-19 surveillance and contact tracing in the communities.
• Invoking civic mindedness - e.g., in places such as in Japan, Taiwan, and China, social norms that show signs of consideration of others, such as wearing masks when one is unwell, were in place well prior to the COVID-19 pandemic. The culture that everyone has a role to play led to high levels of voluntary compliance with government guidelines to contain COVID-19 without the need for much law enforcement in these countries.
• Engaging community health workers (CHWs) - e.g., CHWs can contribute to social protection efforts to address the social and economic impact of an outbreak, especially due to their knowledge of their communities. Annex 3 includes a case study of how CHWs were central to the COVID-19 response in Kerala state in India.
• Communities initiating preventive measures - Communities often know what they need the most, and, when empowered with knowledge, training, and material, they can initiate interventions that support governmental efforts. Communities, especially marginalised ones, can also design their own interventions when there is limited support and guidance by governments.
• Using technology and social media in innovative ways - Creative (mainly social-media-based) techniques were developed to facilitate COVID-19 response and to link people to services and resources. Social media also provided voice to people and connected communities within and across countries.
• Institutionalising risk communication and community engagement (RCCE) in country preparedness and response - e.g., in various contexts in Western Africa, lessons from the Ebola outbreak about the importance of communication channels were applied in Kilimanjaro, Tanzania, where public announcements, mass health education, and radio shows disseminated COVID-19 information in local languages.
• Utilising existing trusted organisations - Grassroot organisations are often well organised, familiar with the needs and challenges of their communities, quick to reach those who are hardest to reach, and have the trust of their communities.
• Mobilising community leaders and influencers - e.g., in Abuja, Nigeria, community leaders worked with community members to attend COVID-19 testing. At the testing sites, the government held daily meetings with community members to address their questions and concerns, and community leaders helped manage the crowd, distribute masks and sanitizers, and enforce physical distancing.

Community engagement efforts during COVID-19 have been challenged or hampered by:

• Lack of government commitment to community engagement;
• Top-down approach to community engagement;
• Limitations in engaging marginalised groups;
• Insufficient efforts to balance restrictions needed to tackle the virus and adherence to human rights; and
• Inattention to the unique impact of the pandemic on youth, including interruptions in their education, reduced employment opportunities, increased domestic violence, and strain on mental health.

Lessons learned for future pandemic preparedness and response include:

1. Communities need to be central in pandemic preparedness and response - Communities and civil societies should be early partners in the design, planning, implementation, and assessment of such efforts on the international, national, and local levels.
2. Community engagement efforts should be ongoing prior to, during, and after pandemics - Sustained community engagement efforts make communities more likely to trust governments in times of vulnerability and uncertainty, such as during the COVID-19 pandemic.
3. Risk communication is necessary but not sufficient for successful community engagement - There is a need to establish bi-directional communication with communities to understand their concerns and incorporate their feedback.
4. A community resilience approach is needed to tackle future pandemics - COVID-19 has shown that there are structural inequities in access to resources, preexisting health issues, and economic investment. These components need to be addressed in order to support the ability of a community to both mitigate adverse effects and recover from a disaster. To build resilience, there is a need for:
   • Effective risk communication - through the ongoing provision of information on preparedness, risks, and relevant resources to the public before, during, and after an outbreak. This area is increasingly important in the age of social media and mass misinformation.
   • Efforts to foster a culture of social connectedness and civic mindedness - through the empowerment of individuals and communities to assume responsibility for preparedness and response, which requires promoting participatory decision-making in response and recovery efforts.
   • Integration and involvement of communities in planning and leadership - through strong partnerships between governments and community-based entities to co-design interventions that address the specific needs of the local community.
   • Investment in social and economic well-being, and in physical and psychological health.