Harvard University Center for Population and Development

January 20 2006

This article published in The Boston Globe discusses the importance of building trust with communities when developing health programmes, exploring particularly how this relates to avian influenza (avian flu or bird flu) and lessons learned from the campaign to eradicate polio.

The article points to Nigeria, where distrust has caused reluctance and boycotts towards vaccinations, as an example of how distrust can hamper health programmes. The article says that one of the biggest lessons from the polio eradication effort is the importance of building trust with communities, particularly marginalised, underserved communities. Populations that are marginalised for political, religious, and socio-economic reasons, or where health service delivery is weak or non-existent generally will not easily collaborate with a state-driven agenda, unless there is clear understanding of why it matters to them.The article states that at the same time, isolation or ''social distancing" measures to minimise the spread of a lethal flu are not going to be easily adhered to in the current environment where many feel that their civil liberties are being over-impinged upon.

The article proposes that trust between health authorities, communities, and local businesses needs to be built through transparent, early, and candid information sharing and that trust is not built in a time of crisis or emergency. The article proposes that technical strategies, vaccines, and political will is not sufficient in coping with a possible influenza outbreak, but that social will is vital.

According to the author, an investment in building public trust, before the vaccine delivery ''push," might have saved the polio eradication effort millions of dollars. An earlier effort was needed to understand the local sociocultural and political risks, and to look for opportunities for positive engagement with communities. The author proposes that such advance analysis could save resources and lives should a human avian flu pandemic occur. As a vaccine will likely not be available, and if so there will likely not be sufficient stock for everyone, it is important to have an informed public that understands what they need to do in order to protect themselves and their community to whatever extent possible and to build community-resilience networks. The article concludes that it is necessary to prepare for an outbreak by assessing where the weak points in the system will be and starting to address them, beginning community dialogues, and seeking to understand the fears as well as strengths of local communities to respond.