The protracted outbreak of Ebola in West Africa in 2014-2015, many times larger than prior outbreaks, has revealed the inadequacies of traditional methods for combatting pandemics focused at the individual level. Research conducted at the New England Complex Systems Institute (NECSI) has demonstrated community level interventions and targeted travel restrictions or monitoring of travelers are much more effective.
NECSI’s strategy is to screen all members of neighborhoods with incidence of or susceptibility to infection. While compliance with screening and subsequent monitoring may not be complete, in simulated outbreaks, community screening proved effective at a compliance rate of just 50 percent. This is significant, as public health interventions in the real world have to be robust. Supporting NECSI’s analysis, community strategies were ultimately linked to the rapid decline of cases in Liberia in mid September and Sierra Leone in mid December.
NECSI also identified travel restrictions, or careful monitoring of travelers for the disease incubation period, as an effective intervention to protect areas that have not yet been infected. There is a critical threshold of long-range connectedness at which a virulent strain spreads out of control. Even if a system seems stable, it may only take a few more routes of travel to trigger widespread contagion. Additionally, travel restrictions can compensate for low levels of compliance to community interventions.
As the world becomes increasingly connected, highly lethal and rapidly spreading diseases become global risks. Preventing increasingly lethal pandemics requires adopting new public health strategies. Among these are community based care and steps such as travel restrictions or traveler monitoring that prevent widespread contagion. Counter to fears that such approaches are insensitive, community level interventions and careful contagion prevention can provide the best care by focusing resources in the areas that are affected.