The low-tech approach to Zika

Op-ed: Eradicating Zika, like malaria, will require more of a social than technical marvel.

Even though Zika virus is unlikely to be spread by mosquitoes in Maryland, its arrival here this month is a wake-up call to restore our strength in public health — something we were much better at in the last century.

Look at how the country eradicated malaria in 1951, for example. (We had already gotten under control typhoid, cholera, smallpox and diphtheria decades earlier in Baltimore, Boston, New York and the surrounding populations.) Dr. L. L. Williams of the Centers for Disease Control rallied public health departments from 13 states, and they rallied their citizens to declare war on the mosquito.

Community engagement is the bedrock of public health practice, and eradicating malaria was more of a social marvel than a technical marvel. It required things that are socially and culturally unthinkable now, including over 4 million houses sprayed with DDT, aerial spraying of insecticides on whole towns and citizens maintaining vigilant removal of standing water from their property.

Public health professionals still know the science of stopping such diseases, but public health is science in a value-rich environment. That environment makes the letters D-D-T jump from the page. DDT is just unthinkable now. So is knocking on any door in the city with the world's safest insecticide and saying, "Hello, I'm from the government and I want to spray your home with this chemical. Trust me." Getting neighborhood residents to cooperate to eliminate pools of standing water requires the sort of neighborhoods that are vanishing.

Public health officials must communicate health threats to community stakeholders in a manner that can be understood and acted on, but they earn a reputation for preachiness whenever they speak (or tweet) without listening. The human ability to trust is local, and the solutions for many of our health problems require us to trust each other face to face. Dr. Williams' malaria campaign relied on trust in government, but the campaign built trust too. Today, such trust-building is seldom taught in schools and finds little financial support in the block grants that pay most of the bills in a public health department.

Getting more Maryland public health departments accredited would ensure that they earn the public's trust and get us ready to take on whatever our coming health challenges may be. The Public Health Accreditation Board offers voluntary accreditation for local health departments that supports ongoing exercises to help improve the quality of practice in a health department. Accreditation builds strength at collecting health data and communicating it to the public in a way that engages everyone and builds the trust ready to take decisive action on a community's leading health threats.

The approach is simple. Give health officers a checklist to determine what their strengths and weaknesses are in public health practice and coach them in strategies that they co-plan with experienced and committed supervisors. Checklists in public health practice keep reminding health officers about the need to reach out to the people they serve and to build partnerships with other sectors of society and government.

Effective health officers are convening and coordinating with law enforcement, schools, private industry, hospitals, as well as their own staff. They share the results of their own monitoring and outbreak investigations and collaboratively develop policy. With a checklist insisting on good public health practice and the expectation that they will be held accountable for improving their performance, health officers can steadily improve their ability to protect our communities.

Accreditation builds the excellence that builds the trust that makes it politically possible for public health to lead the efforts that make us healthy. Local health departments of 87 communities including Newark, Philadelphia, and New Orleans are accredited. In Maryland, Allegany, Frederick, Harford and Worcester counties are accredited. But the health departments of Baltimore City and Baltimore, Montgomery and Prince George's counties are not; neither is the Maryland Department of Health.

The global war on Zika virus will take advantage of 21st century surveillance systems, and the latest breakthroughs in molecular entomology and virology. Sure, a vaccine would be nice. But history shows that controlling epidemics is possible though low-tech means when we work together and trust each other.

A government and neighbors that aren't trusted makes us sick. And no, there is not a pill for that.

David Bishai (dbishai1@jhu.edu) and Clive Shiff (cshiff1@jhu.edu) are professors at the Johns Hopkins Bloomberg School of Public Health.

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