Evidence and Lessons on Efforts to Mitigate the Secondary Impact of Past Disease Outbreaks and Associated Response and Control Measures

This rapid literature review finds limited evidence and lessons on responses to the secondary effects of disease outbreaks. The secondary effects are explained in more detail in a companion paper (Rohwerder, 2020). They include disruption of livelihoods and markets, disruption to communities, disruption to services (especially health), stigmatisation, psycho-social problems, human rights violations and weakening trust in governance. The report finds evidence on a number of efforts to counter the secondary effects of disease outbreaks. The majority of the literature is focused on Ebola. However, it should also be noted that many programmes focused on controlling outbreaks, rather than their effects, meaning there is less evidence on the latter. Several evaluations point to a lack of funding, consideration and action to combat these effects as a failing or learning point, and guidelines recommend such action is taken (WHO, 2008; Elmahdawy et al., 2017). Therefore, many of these lessons are general and do not go much beyond pointing out the need to address particular secondary effects and recovery priorities (UNDG, 2015; UNDP et al., 2015). Nevertheless, broad lessons on funding, prioritisation and co-ordination can be drawn from this. Causality between epidemics and some of their secondary effects is bi-directional, and secondary effects such as distrust of health authorities and disruption to health services are seen to make it harder to fight the disease. Therefore, a large number of programmes indirectly acknowledge the secondary effects and the need to address them, even if their primary reason for addressing them is to better control the disease (Lamoure and Juillard, 2020). Evaluations and programmes often focus on social, cultural, political and economic factors as barriers to better management of the epidemic, insights from which can also be used to mitigate secondary effects (Alcayna-Stevens, 2018). Some programmes made recovery efforts more central. In West Africa, many development programmes sought to support those affected by the disruptions of Ebola by supporting livelihoods (Adams, Lloyd and Miller, 2015; Hempel, 2016). The report also finds examples of programmes to support survivors and healthcare workers affected by stigma and psycho-social problems. Studies have also looked at the effects of specific measures such as the cessation of user fees for health services. Several programmes have focused on health systems strengthening in the face of disease outbreaks. Not all of these programmes have been fully evaluated, but are nevertheless included as evidence of the approaches taken.