Ebola: Five best practices when planning for an outbreak

ebola outbreak

The Ebola outbreak in West Africa has changed the way society at large considers, prepares, plans and responds to health emergencies and the threat thereof. Francesca Viliani, head of public health consulting services and community health programs at International SOS, explains.

There has been a realisation that health security is an issue of global concern, and preventing the spread of infectious disease requires complex and multi-sectoral preparedness and response. Several new initiatives have emerged recently in response to the lessons learnt about how to better prepare for the future.

The increase of business travel, cross-border labour migration and trade, as with all global mobility, can assist in spreading infectious diseases across a wide geographic area in a short amount of time. Regardless of where a company does business, if they have employees, they have possible risk.

Organisations with staff who travel frequently or companies with projects in places where public health systems may be limited should review their own policies and procedures to help mitigate the impact of the next infectious disease outbreak.

What is a pandemic?

A pandemic is a worldwide disease outbreak. It can occur when a “new” virus emerges that has the following properties:

  • humans have little or no immunity to it;
  • the virus can cause significant illness or death; and
  • the virus can be spread easily from person to person.

The severity of a pandemic depends not only on the gravity of the illness that it causes, but also on the impact it has on communities. If these three criteria are met, the new virus is likely to spread globally.

Regardless of whether or not a disease gets to pandemic proportions, emerging infectious diseases like severe acute respiratory syndrome (SARS), Ebola, and the Middle East respiratory syndrome coronavirus (MERs-CoV) can still seriously disrupt an organisation’s ability to fulfil their objectives, if careful consideration has not been placed on mitigating risks to their staff and the communities in which they work.

The Ebola outbreak in West Africa has demonstrated that when such events occur, they do so with devastating effects. Likewise, this crisis has shown that preventing, preparing for and responding to public health emergencies are not the responsibility of a single stakeholder but such efforts require a coordinated and collaborative approach.

Public health regulations

All countries are signatories of the International Health Regulations 2005 (IHR 2005), which is a legally binding agreement whose purpose is “to prevent, protect against, control and provide a public health response to the international spread of disease in ways that are commensurate with and restricted to public health risks, and which avoid unnecessary interference with international traffic and trade”.

These Regulations moved away from a list of a few diseases to encompass all possible public health threats, including non-communicable diseases, chemical spills and nuclear accidents. The focus is on identification and containment at source and no longer on border control, therefore adding new responsibilities to all state parties to develop national core capacities. The strategy is not based on sanctions, but on strengthening international partnerships among all actors for early detection and in the management of all health hazards.

These Regulations are binding for the state parties and do not provide any guidance or allocate responsibility to the private sector. However, public health security is a pre-requisite and a key dimension of economic development, and therefore should also be a top priority for private companies.

The latest Global Risk Report (2015) of the World Economic Forum ranks the “spread of infectious diseases” as the second highest risk worldwide. Other risks in the top 10 that could directly lead to public health emergencies include: extreme weather events; natural catastrophes; failure of climate-change adaptation; water crises; biodiversity loss; and ecosystem collapse.

Not all countries are compliant with the IHR 2005, as yet. Therefore, the degree of preparedness and the extent to which all sectors of society are included in national efforts and plans varies greatly. Especially vulnerable are organisations that operate in, or have travellers to, developing countries. These countries are likely to have limited public health systems and be less prepared for outbreaks of infectious diseases.

Authorities have urged everyone, including the business community, to prepare for the next health crisis. A much closer partnership with regional, national and international stakeholders including multilateral health agencies is essential in order to reduce the risks presented by health emergencies.

Risk preparation

The Centre on Global Health Security at Chatham House is coordinating one such multi-agency initiative focused on the extractive industry. The Infectious Disease Risk Assessment and Management project aims to understand, assess and prepare for the risks posed to the sector by infectious disease outbreaks, in collaboration with other key stakeholders involved in disease outbreak preparedness and response.

Their findings so far suggest that disease control and prevention strategies, including those for emerging infectious diseases, benefit not only the organisation, but the wider community in which it operates. In addition, the coordinated investments and cooperation in preparedness planning results in more effective, and less expensive, responses to health emergencies.

The goal of planning for public health emergencies is to embed resilience in the way that companies operate. The time and resources invested in the preparation phase will make the company better able to assess, respond to, and recover from the event.

Business continuity is the result of carefully prepared plans to act on the risks and trained teams who can manage and communicate risks. An initial assessment should consider the potential health risks to their workers as part of the duty of care agenda and to the local communities as part of the social responsibility commitments. One lesson from the Chatham House research is that focusing only on the business is not enough.

Environmental, health, social and economic changes generated by industrial development are key drivers in disease emergence and outbreaks. Current knowledge on the links between biodiversity, ecosystem services and human health is far from complete; however the interactions among all these factors are leading to infectious disease emergence and they will not diminish over the coming years.

Business continuity

Infectious disease and pandemic preparedness is therefore a necessity for business continuity and the long-term viability of operations. From a business perspective, these aspects are an integral component of any business continuity and risk management strategy. Organisations are advised to consider the economic and non-monetary consequences of outbreaks; and to think about industry collaboration as part of core business strategy.

During an outbreak, limited information about the threat – or potential threat – can lead to speculation and rumour. Staying informed and having an up-to-date pandemic business continuity plan provides a clear roadmap to reduce your risks in the early days of the unknown.

A health emergency plan should be an organisation-wide initiative, involving risk managers, HR, occupational health practitioners, and the boardroom. Healthcare practitioners, like all first responders, are the most exposed group. Comprehensive training is essential (not exclusively focused on the issue of concern, but also about local culture and norms).

Best practice

While the immediate response can be carried out very rapidly, protracted crises like Ebola need careful consideration regarding the psychosocial burden on staff, to avoid burning them out and putting the response at risk. Organisations are advised to consider the following five best practices when reviewing or developing their response plans:

  • Anywhere, anytime: A new pathogen can spread quickly. It is important for an organisation’s health emergency plan to encompass all geographies, not just those where outbreaks have occurred.
  • Fast-moving: Outbreaks can evolve rapidly. Develop a plan that is responsive and adaptive, so you can quickly and consistently communicate with staff.
  • Severity informs response: Assessing the severity of an outbreak can be a challenge. Media reports and community sentiment can have a significant impact on perception of risk. Develop processes and guidelines to assess severity in your communities, and communicate that information to your employees.
  • Responding to the unknown: there can be confusion and a lack of definitive information about the nature of a new illness. The challenge for health authorities is to communicate the unknown in a balanced, appropriate and tailored manner, focusing broadly on practical, actionable steps that everyone should take and, where necessary, enacting more severe measures to protect specific, affected populations. An organisation’s pandemic plan should further tailor the information based on employees’ needs as individuals or small groups, rather than as an entire population.
  • Variable capabilities: Some countries are better prepared to respond to an infectious disease outbreak. Organisations are encouraged to examine the responses to recent outbreaks in the countries where they operate and develop plans that incorporate the global variations.

International SOS, a medical and security risk services company, began monitoring emerging pandemic threats during the SARS outbreak in 2003. Since then, they have assisted many global organisations in developing pandemic preparedness plans to support their overall business continuity and risk mitigation efforts. For more information about pandemic planning and mitigating risks caused by infectious disease, visit the pandemics preparation part of their website


About Francesca Viliani

Francesca Viliani is head of public health consulting services and community health programs at International SOS.
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