May 13, 2025 • 23 mins
In this episode, Qali dives into the unfolding mpox outbreaks in Central and West Africa. With new patterns of transmission, rising child mortality, and deep-rooted stigma, frontline responders in DRC and Burundi are rewriting the old playbooks in real time. Join UNICEF SBC experts as they unpack what worked, what fell short, and how communities, digital tools, and gender-aware strategies are shaping the response. This episode unpacks the opportunities taken, missed, and what must be done to prepare better for the next outbreak.
Guests (in order of appearance)
- Vincent Petit, UNICEF SBC Global Lead
- Gaoussou Nabalom, SBC and Risk Communication and Community Engagement Coordinator, UNICEF Burundi
- Norman Muhwezi, former UNICEF OIC Chief of SBC in Democratic Republic of Congo (DRC) Innovation Specialist
Resources
- Risk communication and community engagement for mpox vaccination in eastern DRC
- Mpox, mining, and vulnerabilities of women and children in eastern DRC
- Meeting report: Mpox and discrimination in African settings
- How to achieve and sustain high uptake of mpox vaccination in outbreak settings
- How to Address stigma during mpox response
- Guidance for RCCE practitioners on mpox (ENG and FRA)
- 5 Tips for CHW and Vaccinators (ENG and FRA)
The views and opinions expressed by the contributors are their own and do not necessarily reflect the views or positions of UNICEF or any entities they represent. The content here is for information purposes only.
The ABCs of SBC is hosted by Qali Id and produced and developed by Helena Ballester Bon in partnership with Common Thread.
Check out UNICEF’s latest publication on Social and Behaviour Change, Why don’t you just behave! For more information about UNICEF SBC, check out the programme guidance.
We care about what you think — you can share your thoughts on the podcast using this feedback form. For all other inquiries, please contact sbc@unicef.org.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Vincent (00:02):
We had a lot of uncertainties and unknowns
when we entered theoutbreak response phase.
These were new strains of thevirus, so what we knew about
the virus was not necessarilyaccurate for this response.
We quickly realized that wehad multiple transmission
pathways at the same time,so it means that different
viruses would transmit bydifferent types of behaviors
(00:24):
at the same time, in the sameprovinces, in the same villages.
Which made the segmentationsof geographies in
population much harder.
Child mortality was actuallythrough the roof, which was
connected with these newstrains, new transmission
pathways, and we had alot of stigma happening.
Everything we knew aboutMpox was challenged, and
(00:45):
we had to learn again.
You can't provide an efficientresponse to an outbreak
if you don't understandwhat you're fighting.
Qali (00:55):
Welcome back to the ABC's of SBC.
You just heard from VincentPetit, UNICEF's Global Social
and Behavior Change Lead,describing the challenges
that the Mpox response facedduring the latest outbreak
and the impact on communities.
Mpox is a viral zoonoticdisease that has reemerged
with new intensity in recentyears, especially across parts
(01:19):
of Central and West Africa.
Once considered a rareand self-limiting illness,
the latest outbreaks havepresented new challenges,
shifting transmissionpatterns, broader population
exposure, and increasingmortality among children.
According to UNICEF, as of mid2023, the Democratic Republic
(01:39):
of Congo alone accounted forover 80% of global Mpox deaths.
So in this episode, we'redelving into Mpox- the
opportunities taken andmissed in the response in
the Democratic Republicof Congo and Burundi.
We'll be asking what happenswhen the data is incomplete,
trust is broken, and the mostvulnerable are overlooked, and
(02:02):
how can social and behaviorchange efforts help us all
to do better next time.
We will be joined by threeexperts to help guide us.
Vincent Petit UNICEF's GlobalSBC lead, Norman Muhwezi,
UNICEF's, SBC, and InnovationSpecialist in the DRC.
First, let's hear fromGaoussou Nabalom, UNICEF's,
(02:25):
SBC and Risk Communicationand Community Engagement
Coordinator in Burundi on whyevidence is so critical and
how it all starts with trust.
Gaoussou (02:38):
Data are very crucial to the Mpox
response in Burundi.
And we need to make surethat we are not, let's
say, recreating the wheel.
We know that there are atthe country level, some
organization who used towork with the communities.
And have built a goodrelationship in term
of confidence withthese communities.
And it is important to, to makesure that all the activities
(03:01):
that we are conducting weare considering the needs
at the community level, butalso take the opportunity of
this existing relationshipto make sure that we can
have the data that we need tomove forward in the process.
Qali (03:16):
When stigma enters the data, it doesn't
just hide the truth, itcreates new blind spots.
And in a crisis, what youdon't see can hurt the most.
But in an outbreak, like Mpox,was any data on stigma being
collected and couldn't stigmaalso distort the same data?
Let's go back to Vincent.
Vincent (03:37):
We rarely capture stigma in the data.
Stigma is something difficultto measure, and when you
ask about stigma to people,the answers are obviously
extremely loaded and biased,but people would come to the
health center to report theirsymptoms and are being listed
as cases or not, would providethe occupation in a form.
(03:58):
And when they showed this dataover the first 30 or 40 weeks
of the outbreak, you would seesomething very interesting.
At the beginning, sex workerswere the vast majority of
people reporting cases at thehealth centers, and suddenly
around week 10 to 15, theproportion of sex workers
(04:21):
would decrease significantly,and the proportion of
people without O Occupation-unemployed- would go up.
And so you see two differentcurves, sex workers going
down, sharply unemployedpeople going up sharply.
And the statisticalanalysis shows that these
are fully correlated.
And when you look moreclosely at the point where
(04:42):
these two cross is a momentwhen we started seeing many
publications in scientificpapers and in newspapers about
the role of sex workers inspreading transmission, right?
And so what this communicationhas done is basically driving
sex workers underground.
They have just startedlying to the health centers
about their occupation.
(05:03):
And that's why you see so manyunemployed people and so few sex
workers when the situation wasthe opposite at the beginning.
This is important, not justbecause it shows that sometimes
our response contributes to thestigma on people who are already
vulnerable, but if sex workersstart lying on their occupations
(05:24):
you can imagine there mightbe other consequences to that.
They might be starting tothink twice about getting
treatment or reporting newcases, or talking to their
peers about reporting new cases.
Qali (05:41):
The unintended consequences of the data we
collect and how we respondto it can have massive
implications in the DRC part ofthe response, blended digital
with community feedback.
Here's Norman Muhwezi,.
UNICEF's, OIC, chief of SBCand Innovation specialist.
For Mpox in thisparticular case.
(06:03):
We collected data bothonline and offline.
Norman (06:07):
Online we use U report where people register our
needs and are able to respondto messages free of charge.
So in this particularcase, what we sent out,
what you'd call calls.
To people in communities totell us do they know how they
can prevent the transmission?
Do they know what to do ifthey actually start feeling
(06:28):
sick or start seeing signsof mpox whether we would
be able to take the vaccineif it is available to them.
At the same time, we as wellhave teams of SBC consultants,
SBC officers as well inthe field that are able to
collect information about.
The most popular rumors, themost popular misinformation
in the community, and thequestions that are coming
(06:51):
from the communities.
And this was beingtracked on a weekly basis.
The other way we are collectingdata is we have what you call
U report communities, whichwould be the offline element of
the platform in the sense that.
That these young people indown communities that come
together because they wantto create positive change
(07:12):
within their communities, andthese young people are able
to actually share informationand also report using that
platform that we created.
And even those that do nothave phones could inform
their fellow of friends thathave phones so that this
information can come through.
Qali (07:28):
So digital tools gave people a voice.
But it was the combinationwith community presence
on the ground that broughtthose voices to life.
Young people becamefact-checkers, data collectors,
and community mobilizers.
It was a kind of on and offlinecommunity surveillance, but
there was more to be done.
(07:48):
Here's Vincent again to tellus why it's so important.
Vincent (07:52):
When you want to stop an outbreak, it means that you
need to get ahead of the virus.
And the only way to do thatis what we call surveillance.
So you need an effectivesurveillance, otherwise
you're basically constantlyin reacting mode.
And surveillance is notjust about tracking numbers,
it's basically aboutunderstanding where the
(08:13):
transmission is happeningwho is the most at risk, and
how to stop further spread.
In the case of Mpox,surveillance was pretty
weak across countries.
DRC is the place I knowthe most because that's
where I was deployed.
We only had 5% of thereported cases in DRC on
an average month that werecoming from non contacts,
(08:36):
and that's extremely low.
So does that mean thatthe rest of the cases were
unknown to the response?
That means that95% of cases were.
Coming from people thatwe weren't necessarily
specifically monitoring.
In cases like that, ifyou don't prioritize
surveillance, then you'realways playing catch up, right?
Instead what we needed to dowas to invest in real time
(08:58):
community surveillance, whichmeans door-to-door visits by
community members households,skin checks, local reporting
systems to try and identifythe cases early and break
the chains of transmission.
And that was not happening.
All of the strategies forresponse are based on contacts,
so the vaccination isprioritizing the contacts.
(09:22):
So you can imagine that when youonly have so few contacts that
are reported, it's very hard tovaccinate the right people, but
it's the same for RCC responses.
Countries like DRC are enormous.
We're talking millions andmillions of people, extremely
hard to reach people.
The operational costs ofengaging communities and
families is enormous andnobody can afford it.
(09:43):
Not the government, not unicef,not the coalition of partners.
So we need very precisesurveillance so that we don't
spread ourselves too thin andwe don't spread the resources
that we have too thin.
But we target the peoplewho are the most at risk.
Qali (10:00):
And some of the most at risk in the Mpox
outbreak were women whowere vulnerable in unique
and often overlooked ways.
Here's Gaoussou in Burundiagain, we know that
at the national level,women are responsible
for example of caring.
Children and at the beginningof the outbreak, we have
(10:21):
something like 40% of thecases who are children.
Gaoussou (10:25):
So it was challenging when the kids are in the
treatment center they have tobe accommodated by the mothers.
And they were.
Challenges around howto make sure that the
mother are not infected.
And beyond that, how tomake sure that the kids
can still have some supportfrom their mothers to
(10:46):
cope with the situation.
And we know that.
There is no community casemanagement right now in Burundi.
So it's mean that children haveto be in the treatment center.
So if the women have toaccompany her children there,
it is a kind of loss ofincome because she can't work.
(11:06):
So yeah, it was a a challenge,but yeah, I think it's still
a challenge if I can say that.
Qali (11:12):
For many women, caring for others has meant
putting themselves at risk.
And too often the systemsbuilt to protect don't
always fully see them.
Let's hear from Norman inthe DRC to see how they
offered alternative forms ofsupporting their families.
Norman (11:31):
Last year I visited the province, Cassai Central
the city called Kanga.
And in Kanga I actuallyvisited a women's group
or community action cell.
And these women have doneimpressively well in terms
of setting up activitiesfor themselves, income
generating activities.
So these ladies went ahead andactually hired a piece of land
(11:53):
while they're planting maizewhere they're planting cassava.
So through these incomegenerating activities, able
to go ahead and earn somefunding that they can use to
promote these good practiceswithin their own communities.
The idea here is that we areusing seed funding to enable
these women to actually goahead and carry out activities
(12:15):
that will enable them toearn some sort of income.
The funding is always, ofcourse, never enough and it'll
not keep coming and coming.
At some point that funding willstore that is a more sustainable
approach to doing communityengagement than us trying to
keep going and supporting.
The more these activities areactually done, the better it is
(12:36):
for the different communities.
The other income generatingactivities that I wanna
talk about is we actuallyas part of that in capacity
building program you reportto, we created a special
version for young peoplethat in IDP camps in internet
displaced persons camps.
So these young people wereable to start some simple
(12:59):
income judging activitieslike, cutting hair or
baking bread or making soap.
So these are someof the things that.
We're pushing for, and to me,the more we push for these
income general activitiesas part of our community
engagement strategy, aspart of engaging with young
people it's something that issustainable and something that
can continue even when theinitial funding has stopped.
Qali (13:22):
These sorts of activities recognize the long-term economic
impacts and works to ensurethese groups aren't left
vulnerable after the attentionand funding has moved on to
the next crisis, but not allefforts met women's needs.
Let's hear a soberingexample from Vincent.
Vincent (13:42):
When you think about the role of women in
these communities, which isto care for the household
and for the children andall of that, that puts the
pressure and the burden offollowing this advice on women.
And it's unfair.
But this is not one of the mostdamaging case, I would say.
One that I was fairlyworried about was about.
One of the vaccines for Mpox,the LC 16 vaccine has an
(14:07):
administration method that wasused for smallpox in the past.
Meaning it's through multiplepuncture of the skin.
It's a different type ofimplementation modality
that has not been usedfor multiple decades.
And the government of Congo wasoffered, large batch of this
vaccine to try and curb thetransmission, which sounds quite
(14:30):
good when you think about itthis way, the problem is that
the vaccine is contraindicatedfor pregnant women.
And so in the protocol forthe runout, there was nothing
about asking or testingfor the pregnancy, right?
And widespread pregnancytesting is very impractical
in the context ofDRC, to say the least.
(14:51):
And also, women who areunknowingly pregnant may
inadvertently receivethe vaccine, right?
Including vulnerable adolescentwomen in some of the high
risk groups that w e wereworking with such as sex
workers or women living withHIV women in camps and so on.
There was also a doubt aboutthe vaccine suitability for
(15:12):
breastfeeding women becausethere was not enough evidence
about the transfer of the virusfrom the vaccination site to
the suckling child, basically.
So there was a lot of unknownaround how this particular
type of vaccine administrationmethod would be dangerous
potentially for women.
So when you remove from theequation breastfeeding women who
(15:35):
are pregnant, women who mightbe unknowingly pregnant, it's
already quite a large cohort ofwomen that cannot be covered.
And actually the risk oftransmitting the disease to
the fetus or the breastfeedingchild is very high.
So this is an example of,I think, a protocol that is
(15:56):
not necessarily consideringthe risk for women.
And in my honest opinion thebest solution would probably
have been not to vaccinategirls and adolescent girls and
women with this type of vaccine.
Qali (16:10):
So while some opportunities were taken to
support women financiallyin the outbreak, in other
respects, their needs wereoverlooked or not prioritized.
Let's move on tosystem strengthening.
Beyond the immediate crisisresponse was the program
(16:31):
benefiting from past investmentsand seizing opportunities
to strengthen systems andwork towards preparedness.
Norman tells us more about this.
Norman (16:43):
We are very big in DRC on building onto
what we already have.
The country is very big.
The, it's very complexemergencies happen all
the time, so it's really.
Paramount for us to buildonto what has already been
done, not to keep startingnew things every time.
So the way we are supportingsystem strengthening is really
mainly through these communityaction sales or the community
(17:06):
engagement pillar and as wellsome of the work that is being
done with U reporters andsome of the work they're being
done with web fact checkers.
When the training is done,these people stay there.
These people stay incommunities and they can pass
on the information to theirfriends, to their families and
actually train other people.
It's not that of all those 8million people that we have,
(17:27):
over 8 million people thathave on the platform, over
250 communities, we havereached all of them in person.
No.
Some have been reached throughword of mouth, some have been
reached by their friends.
Even right now, we are againgoing through these same
structures, the same communityaction cells, the same young
people to pass on this messageabout, not drinking dirty
(17:49):
water because we have a bigproblem with cholera right now.
Encouraging them to take theirchildren to school when the
schools open encourage them toactually go for vaccination.
And this is possible onlybecause we've been able to
actually strengthen thesesystems and set up these
systems to ensure that wheneverthere's an outbreak, whenever
there's emergency, we canalways rely on this structures
(18:10):
to actually do our response.
Qali (18:12):
So not reinventing the wheel.
Building networks andsystems that can be tapped
for the next emergencyno matter what that is.
We got a similar responsefrom GSU who spoke about
building a more resilienthealth system in Burundi.
When we spoke to VinSaul, he emphasized why
investments in health systemsalone won't do the trick.
Vincent (18:35):
The UNICEF office has been planning on supporting
the payment, supervision,and deployment of many
community health workers inSouthern Kivu to start with.
I don't rememberthe exact number.
It's between 1,002 thousand.
It's a project that obviouslycosts multiple million
dollars and it is somethingthat is highly needed.
(18:57):
Because health workers are notoften paid or not regularly
paid in places like EasternDRC, and so people were placing
a lot of hopes on the impactthat deploying additional
health workers would haveon the spread of Mpox . But
if we don't plan for anefficient articulation and
(19:19):
collaboration with communities,health workers won't be able
to achieve their objectives.
What we need for them tomeet their targets is for
local community members towork in their communities
and lies with them, to reportcases, to help spread their
(19:39):
messages to the last miles.
Going house to house, familyby family, to contextualize
the public health advice intothese communities that have,
as you can imagine their ownsocial dynamics, their own
cultural norms and so on.
And so it's the properarticulation and yeah,
(19:59):
working relationship andtrust between paid, trained,
deployed health workers.
And community members thatis gonna advance not just
the outbreak response, butbroader public health goals.
The problem is thatthe community side of
(20:23):
this partnership isvery often overlooked.
When I said that deployinga thousand health worker
in the province is notgonna stop the outbreak.
This is just oneside of the coin.
You need the other sidefor this to work, right?
And you need the trustedrelationship for this to work
Qali (20:42):
Too often, investments focus on infrastructure,
not relationshipsthat needs to change.
But I guess my follow upquestion would be, is the
other side of the coin working?
This trust and collaborationwith communities.
Vincent (20:59):
I would say that on the conceptual level, this
collaboration between theprimary healthcare system
and the community system isdefinitely considered when it
comes to investments, policies,and operationalization.
The side of the primaryhealthcare system is
prioritized, which you know,makes a lot of sense, especially
(21:20):
from the health perspective.
If you spend enough time onthe ground, you very quickly
realize that under investingon the community system side is
making the whole mechanism fail.
Qali (21:37):
Mpox exposed cracks in the system, but it
also revealed resilience.
It showed how communitieswhen trusted and empowered
can help lead the way forward.
The responses offered hardearned lessons that can be
-Don't wait for acrisis to build trust.
(22:01):
-Data must be local,inclusive, and used to
adapt to the response.
-Women and youth arenot just beneficiaries.
They are the backbone ofsurveillance and response.
-Community systems are just asessential as health systems.
(22:23):
Thank you for listening to theABCs of SBC, where we bring you
the people's stories and sciencebehind the best of social and
behavior change in UNICEF.
If you would like to hear moreabout the good work being done
on the mpox outbreak, keep aneye out for the next issue of
Change Magazine, which will befocused exclusively on mpox and
other public health emergenciescoming out later this year.
(22:46):
We'll be back soon with anew episode on community
health delivery partnerships.
Until then, catch up onpast episodes wherever
you get your podcasts.
Take care.
We had a lot of uncertainties and unknowns
when we entered theoutbreak response phase.
These were new strains of thevirus, so what we knew about
the virus was not necessarilyaccurate for this response.
We quickly realized that wehad multiple transmission
pathways at the same time,so it means that different
viruses would transmit bydifferent types of behaviors
(00:24):
at the same time, in the sameprovinces, in the same villages.
Which made the segmentationsof geographies in
population much harder.
Child mortality was actuallythrough the roof, which was
connected with these newstrains, new transmission
pathways, and we had alot of stigma happening.
Everything we knew aboutMpox was challenged, and
(00:45):
we had to learn again.
You can't provide an efficientresponse to an outbreak
if you don't understandwhat you're fighting.
Qali (00:55):
Welcome back to the ABC's of SBC.
You just heard from VincentPetit, UNICEF's Global Social
and Behavior Change Lead,describing the challenges
that the Mpox response facedduring the latest outbreak
and the impact on communities.
Mpox is a viral zoonoticdisease that has reemerged
with new intensity in recentyears, especially across parts
(01:19):
of Central and West Africa.
Once considered a rareand self-limiting illness,
the latest outbreaks havepresented new challenges,
shifting transmissionpatterns, broader population
exposure, and increasingmortality among children.
According to UNICEF, as of mid2023, the Democratic Republic
(01:39):
of Congo alone accounted forover 80% of global Mpox deaths.
So in this episode, we'redelving into Mpox- the
opportunities taken andmissed in the response in
the Democratic Republicof Congo and Burundi.
We'll be asking what happenswhen the data is incomplete,
trust is broken, and the mostvulnerable are overlooked, and
(02:02):
how can social and behaviorchange efforts help us all
to do better next time.
We will be joined by threeexperts to help guide us.
Vincent Petit UNICEF's GlobalSBC lead, Norman Muhwezi,
UNICEF's, SBC, and InnovationSpecialist in the DRC.
First, let's hear fromGaoussou Nabalom, UNICEF's,
(02:25):
SBC and Risk Communicationand Community Engagement
Coordinator in Burundi on whyevidence is so critical and
how it all starts with trust.
Gaoussou (02:38):
Data are very crucial to the Mpox
response in Burundi.
And we need to make surethat we are not, let's
say, recreating the wheel.
We know that there are atthe country level, some
organization who used towork with the communities.
And have built a goodrelationship in term
of confidence withthese communities.
And it is important to, to makesure that all the activities
(03:01):
that we are conducting weare considering the needs
at the community level, butalso take the opportunity of
this existing relationshipto make sure that we can
have the data that we need tomove forward in the process.
Qali (03:16):
When stigma enters the data, it doesn't
just hide the truth, itcreates new blind spots.
And in a crisis, what youdon't see can hurt the most.
But in an outbreak, like Mpox,was any data on stigma being
collected and couldn't stigmaalso distort the same data?
Let's go back to Vincent.
Vincent (03:37):
We rarely capture stigma in the data.
Stigma is something difficultto measure, and when you
ask about stigma to people,the answers are obviously
extremely loaded and biased,but people would come to the
health center to report theirsymptoms and are being listed
as cases or not, would providethe occupation in a form.
(03:58):
And when they showed this dataover the first 30 or 40 weeks
of the outbreak, you would seesomething very interesting.
At the beginning, sex workerswere the vast majority of
people reporting cases at thehealth centers, and suddenly
around week 10 to 15, theproportion of sex workers
(04:21):
would decrease significantly,and the proportion of
people without O Occupation-unemployed- would go up.
And so you see two differentcurves, sex workers going
down, sharply unemployedpeople going up sharply.
And the statisticalanalysis shows that these
are fully correlated.
And when you look moreclosely at the point where
(04:42):
these two cross is a momentwhen we started seeing many
publications in scientificpapers and in newspapers about
the role of sex workers inspreading transmission, right?
And so what this communicationhas done is basically driving
sex workers underground.
They have just startedlying to the health centers
about their occupation.
(05:03):
And that's why you see so manyunemployed people and so few sex
workers when the situation wasthe opposite at the beginning.
This is important, not justbecause it shows that sometimes
our response contributes to thestigma on people who are already
vulnerable, but if sex workersstart lying on their occupations
(05:24):
you can imagine there mightbe other consequences to that.
They might be starting tothink twice about getting
treatment or reporting newcases, or talking to their
peers about reporting new cases.
Qali (05:41):
The unintended consequences of the data we
collect and how we respondto it can have massive
implications in the DRC part ofthe response, blended digital
with community feedback.
Here's Norman Muhwezi,.
UNICEF's, OIC, chief of SBCand Innovation specialist.
For Mpox in thisparticular case.
(06:03):
We collected data bothonline and offline.
Norman (06:07):
Online we use U report where people register our
needs and are able to respondto messages free of charge.
So in this particularcase, what we sent out,
what you'd call calls.
To people in communities totell us do they know how they
can prevent the transmission?
Do they know what to do ifthey actually start feeling
(06:28):
sick or start seeing signsof mpox whether we would
be able to take the vaccineif it is available to them.
At the same time, we as wellhave teams of SBC consultants,
SBC officers as well inthe field that are able to
collect information about.
The most popular rumors, themost popular misinformation
in the community, and thequestions that are coming
(06:51):
from the communities.
And this was beingtracked on a weekly basis.
The other way we are collectingdata is we have what you call
U report communities, whichwould be the offline element of
the platform in the sense that.
That these young people indown communities that come
together because they wantto create positive change
(07:12):
within their communities, andthese young people are able
to actually share informationand also report using that
platform that we created.
And even those that do nothave phones could inform
their fellow of friends thathave phones so that this
information can come through.
Qali (07:28):
So digital tools gave people a voice.
But it was the combinationwith community presence
on the ground that broughtthose voices to life.
Young people becamefact-checkers, data collectors,
and community mobilizers.
It was a kind of on and offlinecommunity surveillance, but
there was more to be done.
(07:48):
Here's Vincent again to tellus why it's so important.
Vincent (07:52):
When you want to stop an outbreak, it means that you
need to get ahead of the virus.
And the only way to do thatis what we call surveillance.
So you need an effectivesurveillance, otherwise
you're basically constantlyin reacting mode.
And surveillance is notjust about tracking numbers,
it's basically aboutunderstanding where the
(08:13):
transmission is happeningwho is the most at risk, and
how to stop further spread.
In the case of Mpox,surveillance was pretty
weak across countries.
DRC is the place I knowthe most because that's
where I was deployed.
We only had 5% of thereported cases in DRC on
an average month that werecoming from non contacts,
(08:36):
and that's extremely low.
So does that mean thatthe rest of the cases were
unknown to the response?
That means that95% of cases were.
Coming from people thatwe weren't necessarily
specifically monitoring.
In cases like that, ifyou don't prioritize
surveillance, then you'realways playing catch up, right?
Instead what we needed to dowas to invest in real time
(08:58):
community surveillance, whichmeans door-to-door visits by
community members households,skin checks, local reporting
systems to try and identifythe cases early and break
the chains of transmission.
And that was not happening.
All of the strategies forresponse are based on contacts,
so the vaccination isprioritizing the contacts.
(09:22):
So you can imagine that when youonly have so few contacts that
are reported, it's very hard tovaccinate the right people, but
it's the same for RCC responses.
Countries like DRC are enormous.
We're talking millions andmillions of people, extremely
hard to reach people.
The operational costs ofengaging communities and
families is enormous andnobody can afford it.
(09:43):
Not the government, not unicef,not the coalition of partners.
So we need very precisesurveillance so that we don't
spread ourselves too thin andwe don't spread the resources
that we have too thin.
But we target the peoplewho are the most at risk.
Qali (10:00):
And some of the most at risk in the Mpox
outbreak were women whowere vulnerable in unique
and often overlooked ways.
Here's Gaoussou in Burundiagain, we know that
at the national level,women are responsible
for example of caring.
Children and at the beginningof the outbreak, we have
(10:21):
something like 40% of thecases who are children.
Gaoussou (10:25):
So it was challenging when the kids are in the
treatment center they have tobe accommodated by the mothers.
And they were.
Challenges around howto make sure that the
mother are not infected.
And beyond that, how tomake sure that the kids
can still have some supportfrom their mothers to
(10:46):
cope with the situation.
And we know that.
There is no community casemanagement right now in Burundi.
So it's mean that children haveto be in the treatment center.
So if the women have toaccompany her children there,
it is a kind of loss ofincome because she can't work.
(11:06):
So yeah, it was a a challenge,but yeah, I think it's still
a challenge if I can say that.
Qali (11:12):
For many women, caring for others has meant
putting themselves at risk.
And too often the systemsbuilt to protect don't
always fully see them.
Let's hear from Norman inthe DRC to see how they
offered alternative forms ofsupporting their families.
Norman (11:31):
Last year I visited the province, Cassai Central
the city called Kanga.
And in Kanga I actuallyvisited a women's group
or community action cell.
And these women have doneimpressively well in terms
of setting up activitiesfor themselves, income
generating activities.
So these ladies went ahead andactually hired a piece of land
(11:53):
while they're planting maizewhere they're planting cassava.
So through these incomegenerating activities, able
to go ahead and earn somefunding that they can use to
promote these good practiceswithin their own communities.
The idea here is that we areusing seed funding to enable
these women to actually goahead and carry out activities
(12:15):
that will enable them toearn some sort of income.
The funding is always, ofcourse, never enough and it'll
not keep coming and coming.
At some point that funding willstore that is a more sustainable
approach to doing communityengagement than us trying to
keep going and supporting.
The more these activities areactually done, the better it is
(12:36):
for the different communities.
The other income generatingactivities that I wanna
talk about is we actuallyas part of that in capacity
building program you reportto, we created a special
version for young peoplethat in IDP camps in internet
displaced persons camps.
So these young people wereable to start some simple
(12:59):
income judging activitieslike, cutting hair or
baking bread or making soap.
So these are someof the things that.
We're pushing for, and to me,the more we push for these
income general activitiesas part of our community
engagement strategy, aspart of engaging with young
people it's something that issustainable and something that
can continue even when theinitial funding has stopped.
Qali (13:22):
These sorts of activities recognize the long-term economic
impacts and works to ensurethese groups aren't left
vulnerable after the attentionand funding has moved on to
the next crisis, but not allefforts met women's needs.
Let's hear a soberingexample from Vincent.
Vincent (13:42):
When you think about the role of women in
these communities, which isto care for the household
and for the children andall of that, that puts the
pressure and the burden offollowing this advice on women.
And it's unfair.
But this is not one of the mostdamaging case, I would say.
One that I was fairlyworried about was about.
One of the vaccines for Mpox,the LC 16 vaccine has an
(14:07):
administration method that wasused for smallpox in the past.
Meaning it's through multiplepuncture of the skin.
It's a different type ofimplementation modality
that has not been usedfor multiple decades.
And the government of Congo wasoffered, large batch of this
vaccine to try and curb thetransmission, which sounds quite
(14:30):
good when you think about itthis way, the problem is that
the vaccine is contraindicatedfor pregnant women.
And so in the protocol forthe runout, there was nothing
about asking or testingfor the pregnancy, right?
And widespread pregnancytesting is very impractical
in the context ofDRC, to say the least.
(14:51):
And also, women who areunknowingly pregnant may
inadvertently receivethe vaccine, right?
Including vulnerable adolescentwomen in some of the high
risk groups that w e wereworking with such as sex
workers or women living withHIV women in camps and so on.
There was also a doubt aboutthe vaccine suitability for
(15:12):
breastfeeding women becausethere was not enough evidence
about the transfer of the virusfrom the vaccination site to
the suckling child, basically.
So there was a lot of unknownaround how this particular
type of vaccine administrationmethod would be dangerous
potentially for women.
So when you remove from theequation breastfeeding women who
(15:35):
are pregnant, women who mightbe unknowingly pregnant, it's
already quite a large cohort ofwomen that cannot be covered.
And actually the risk oftransmitting the disease to
the fetus or the breastfeedingchild is very high.
So this is an example of,I think, a protocol that is
(15:56):
not necessarily consideringthe risk for women.
And in my honest opinion thebest solution would probably
have been not to vaccinategirls and adolescent girls and
women with this type of vaccine.
Qali (16:10):
So while some opportunities were taken to
support women financiallyin the outbreak, in other
respects, their needs wereoverlooked or not prioritized.
Let's move on tosystem strengthening.
Beyond the immediate crisisresponse was the program
(16:31):
benefiting from past investmentsand seizing opportunities
to strengthen systems andwork towards preparedness.
Norman tells us more about this.
Norman (16:43):
We are very big in DRC on building onto
what we already have.
The country is very big.
The, it's very complexemergencies happen all
the time, so it's really.
Paramount for us to buildonto what has already been
done, not to keep startingnew things every time.
So the way we are supportingsystem strengthening is really
mainly through these communityaction sales or the community
(17:06):
engagement pillar and as wellsome of the work that is being
done with U reporters andsome of the work they're being
done with web fact checkers.
When the training is done,these people stay there.
These people stay incommunities and they can pass
on the information to theirfriends, to their families and
actually train other people.
It's not that of all those 8million people that we have,
(17:27):
over 8 million people thathave on the platform, over
250 communities, we havereached all of them in person.
No.
Some have been reached throughword of mouth, some have been
reached by their friends.
Even right now, we are againgoing through these same
structures, the same communityaction cells, the same young
people to pass on this messageabout, not drinking dirty
(17:49):
water because we have a bigproblem with cholera right now.
Encouraging them to take theirchildren to school when the
schools open encourage them toactually go for vaccination.
And this is possible onlybecause we've been able to
actually strengthen thesesystems and set up these
systems to ensure that wheneverthere's an outbreak, whenever
there's emergency, we canalways rely on this structures
(18:10):
to actually do our response.
Qali (18:12):
So not reinventing the wheel.
Building networks andsystems that can be tapped
for the next emergencyno matter what that is.
We got a similar responsefrom GSU who spoke about
building a more resilienthealth system in Burundi.
When we spoke to VinSaul, he emphasized why
investments in health systemsalone won't do the trick.
Vincent (18:35):
The UNICEF office has been planning on supporting
the payment, supervision,and deployment of many
community health workers inSouthern Kivu to start with.
I don't rememberthe exact number.
It's between 1,002 thousand.
It's a project that obviouslycosts multiple million
dollars and it is somethingthat is highly needed.
(18:57):
Because health workers are notoften paid or not regularly
paid in places like EasternDRC, and so people were placing
a lot of hopes on the impactthat deploying additional
health workers would haveon the spread of Mpox . But
if we don't plan for anefficient articulation and
(19:19):
collaboration with communities,health workers won't be able
to achieve their objectives.
What we need for them tomeet their targets is for
local community members towork in their communities
and lies with them, to reportcases, to help spread their
(19:39):
messages to the last miles.
Going house to house, familyby family, to contextualize
the public health advice intothese communities that have,
as you can imagine their ownsocial dynamics, their own
cultural norms and so on.
And so it's the properarticulation and yeah,
(19:59):
working relationship andtrust between paid, trained,
deployed health workers.
And community members thatis gonna advance not just
the outbreak response, butbroader public health goals.
The problem is thatthe community side of
(20:23):
this partnership isvery often overlooked.
When I said that deployinga thousand health worker
in the province is notgonna stop the outbreak.
This is just oneside of the coin.
You need the other sidefor this to work, right?
And you need the trustedrelationship for this to work
Qali (20:42):
Too often, investments focus on infrastructure,
not relationshipsthat needs to change.
But I guess my follow upquestion would be, is the
other side of the coin working?
This trust and collaborationwith communities.
Vincent (20:59):
I would say that on the conceptual level, this
collaboration between theprimary healthcare system
and the community system isdefinitely considered when it
comes to investments, policies,and operationalization.
The side of the primaryhealthcare system is
prioritized, which you know,makes a lot of sense, especially
(21:20):
from the health perspective.
If you spend enough time onthe ground, you very quickly
realize that under investingon the community system side is
making the whole mechanism fail.
Qali (21:37):
Mpox exposed cracks in the system, but it
also revealed resilience.
It showed how communitieswhen trusted and empowered
can help lead the way forward.
The responses offered hardearned lessons that can be
-Don't wait for acrisis to build trust.
(22:01):
-Data must be local,inclusive, and used to
adapt to the response.
-Women and youth arenot just beneficiaries.
They are the backbone ofsurveillance and response.
-Community systems are just asessential as health systems.
(22:23):
Thank you for listening to theABCs of SBC, where we bring you
the people's stories and sciencebehind the best of social and
behavior change in UNICEF.
If you would like to hear moreabout the good work being done
on the mpox outbreak, keep aneye out for the next issue of
Change Magazine, which will befocused exclusively on mpox and
other public health emergenciescoming out later this year.
(22:46):
We'll be back soon with anew episode on community
health delivery partnerships.
Until then, catch up onpast episodes wherever
you get your podcasts.
Take care.
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