Turbocharged by Climate Change, Malawi’s Cholera Outbreak Is Worsened by Covid-19 Misinformation

Community Engagement is the Antidote

The February confrontation also pointed clearly to the importance of community engagement to build trust, noted Rachel James, who serves as Interagency Risk Communication and Community Engagement Coordinator for Collective Service in east and southern Africa.

Collective Service, whose work in Malawi is backed by a grant by The Rockefeller Foundation to the United States Fund for UNICEF, supports collaboration between organizations to increase the scale and quality of community approaches, particularly in response to public health crises in underrepresented communities.

The Collective Service is a partnership between the International Federation of Red Cross and Red Crescent Societies, United Nations Children’s Fund (UNICEF), the World Health Organization and the Global Outbreak Alert and Response Network, and as well as key stakeholders from the public health and humanitarian sectors.

“We have found that, by and large, people in Malawi know how to prevent cholera,” said James, based with UNICEF. “But mistrust and misinformation around Covid-19 has impacted their willingness to take any vaccine, or even seek medical care.”

That’s why Collective Service’s work is so critical, noted Estelle Willie, The Rockefeller Foundation’s Director, Health Policy and Communications.

Climate Change Triggers and Worsens Cholera Outbreak

Cholera, an infectious bacterial disease of the small intestine, is relatively easy to treat if caught in time, but can kill within hours if untreated. Malawi’s outbreak, worsened by climate change, has touched all of the country’s 29 districts in this country of 20 million, causing more than 1,600 deaths and more than 51,000 cases.

Malawi is a hotspot for cholera outbreaks in Africa. Communities located along Lake Malawi, Lake Chilwa, and in the flood plains of the Shire Valley, as well as urban centers of Lilongwe and Blantyre, are regularly affected. Globally, cholera transmission has been linked with seasonal trends in rain, and especially extreme weather events such as abrupt and heavy rainfall. Rising temperatures, both ambient and water temperatures, also increase the growth of Vibrio Cholerae.

“It’s the worst outbreak in our history. It is something we have never seen,” said Dingaan Mithi, a Malawi journalist who is part of AVAC’s Media Science Cafés program, which is supported by The Rockefeller Foundation. “It is worsened because there is a lot of misinformation, and that is something we need to work on.”

To better understand community mindsets, Collective Service traveled to cholera hotspots to listen to religious leaders, local leaders, youth, older Malawians, women, and healthcare workers.

The team discovered generally high levels of knowledge about how severe cholera is and how it is transmitted. But major myths and misinformation were revealed around the effects of vaccines.

During her recent listening session in Lilongwe, James said, “every single person knew people who had died. One person said, ‘my neighbor died yesterday and we couldn’t go to the funeral.’ This makes them wary.” Traditional Malawian funerals often involve entire villages and are a shared time of mourning.

In response to information gathered in the focus groups, the Collective Service team suggested focusing on religious and community leaders as trusted influencers, and moving beyond basic messaging to address specific concerns and questions. The team is also working to collect, collate and analyze interagency feedback from various engagements to deepen shared understanding on current and evolving community concerns.