CDC Engagement With Community and Faith-Based Organizations in Public Health Emergencies

In 2005, when Hurricane Katrina exposed troubling gaps in areas with inadequate resources, it also highlighted the ability of community and faith-based organizations (CFBOs) to respond quickly to the needs of vulnerable communities. However, these organizations were not well integrated into the federal response (see the box on page S275).¹ In the years since Hurricane Katrina, there has been substantial progress in integrating CFBOs into public health preparedness, response, and recovery. We provide an overview of the Centers for Disease Control and Prevention’s (CDC’s) engagement with CFBOs in domestic responses to pandemic influenza (2009), Ebola (2014), and Zika (2016).

Box 1— Excerpts From “The Federal Response to Hurricane Katrina: Lessons Learned”.

“Faith-based, non-profit, and other non-government and volunteer organizations continued to provide essential support to Hurricane Katrina victims.” “However, faith-based and non-governmental groups were not adequately integrated into the response effort.” “These groups often encountered difficulties coordinating their efforts with Federal, State and local governments, due to a failure to adequately address their role in the (National Response Plan).” “HHS working with DHS should work to include faith-based, community, and non-profit organizations in the emergency planning, preparedness, and delivery of human services.”

Note. HHS = US Department of Health and Human Services; DHS = US Department of Homeland Security.

Source. The White House.¹

THE 2009 H1N1 INFLUENZA PANDEMIC

In 2008, in the aftermath of the federal response to Hurricane Katrina, the CDC and the Association of State and Territorial Health Officials (ASTHO) developed the At-Risk Populations Project. This initiative was designed to help state and local public health officials to protect at-risk people during a severe influenza pandemic and other public health emergencies.² The project included several components. First, the CDC conducted reviews of 2008 Pandemic Influenza Goal 5 State Operational Plans, showing that 62% of the plans had outlined a process to identify and reach out to at-risk populations and 64% had advised local health departments to work with CFBOs to meet the needs of vulnerable households (CDC, unpublished data, 2008). Second, the CDC and ASTHO developed and disseminated a resource document and conducted six in-person trainings and webinars to help state and local health departments to engage CFBOs and reach at-risk populations. Third, the CDC and ASTHO collaborated on a 10-step approach for health communications with community and faith-based organizations during public health emergencies. This emphasized engaging with organizations that could reach vulnerable communities, incorporating them into an overarching public health strategy, and maintaining relationships over time.² The At-Risk Populations Project helped to prepare the state and local response to the 2009 H1N1 influenza pandemic.

A related project, Engaging Communities in Response to Pandemic Influenza, begun in 2005 by the CDC, the US Department of Health and Human Services (HHS), and Emory University. Nine US sites were selected on the basis of leadership, links to trusted local networks, and the capacity to reach vulnerable communities.³ One example of this effort was the Minnesota Immunization Networking Initiative (MINI). Working with the Minnesota Department of Health and Fairview Health Services, MINI collaborated with community and faith leaders to reach African American, African-born, Asian/Pacific Islander, Hispanic/Latino, and American Indian communities.

During the 2009 H1N1 influenza pandemic, MINI organized vaccination clinics in churches, mosques, a Hindu Temple, a Buddhist monastery, and Sikh, Vietnamese, and Ethiopian faith-based organizations. These community-located clinics helped to address difficulties caused by limited access, transportation, scheduling, and mistrust. MINI continued to serve the Minneapolis–St. Paul area by providing free seasonal influenza vaccinations after the 2009 H1N1 influenza pandemic ended. From 2006 to 2018, MINI provided more than 80 000 free influenza vaccinations in vulnerable communities.³

THE 2014 DOMESTIC EBOLA RESPONSE

The first US case of Ebola was identified in Dallas, Texas, on September 28, 2014. Contact tracers from the CDC, the Texas Department of State Health Services, and Dallas County Health and Human Services actively monitored 179 contacts for Ebola symptoms. The initial case patient lived in Vickery Meadow, a three-mile-square neighborhood with 25 000 residents who spoke a total of more than 40 languages. During monitoring, contacts reported difficulties meeting daily needs such as food, diapers, and routine prescription refills. Six out of seven monitored households needed help with utilities, rent, or other necessities. More than three quarters reported stress, social isolation, and stigma.⁴

Contact tracers engaged CFBOs and charitable foundations, who provided food from the local food bank, toiletries, and other essential household items. A local charitable foundation purchased 10 tablet computers and 10 cell phones for contacts to speak with friends and family for emotional support. Another foundation helped contacts to coordinate with employers and children’s schools when they needed to be away, provided rental and utility assistance, and obtained furniture for contacts whose apartments were affected by hazmat operations. Trained professionals offered counseling services to supplement emotional support provided by contact tracers. Meeting the basic needs of Ebola contacts was essential to successful contact tracing, which is critical to interrupting transmission of the virus.⁴

Health officials met with key business, civic, and religious leaders to enlist their support in decreasing Ebola-related stigma. For example, a city councilwoman told the press: “We are pleased to see the faith community working in solidarity with the Vickery Meadows neighborhood. Everyone deserves to be treated with dignity and respect. The residents are being unfairly targeted by those who don’t understand they are not at risk of passing on the Ebola virus.”⁵

Following the Dallas response, the CDC’s Joint Information Center organized a series of national calls with community and faith leaders to help other US cities prepare for Ebola. The strategy involved sharing accurate Ebola information, countering negative social media messages that promoted stigma, and supporting those with family or loved ones in affected areas.⁶ Participants included more than 2000 individuals from diverse Christian, Jewish, Muslim, Hindu, Buddhist, and secular organizations, as well as state health officials from across the United States.

THE 2016 ZIKA RESPONSE

When Zika virus reemerged in 2016, HHS, the CDC’s Joint Information Center, the Florida Department of Health, and the Office of the Governor of the Commonwealth of Puerto Rico organized a webinar series to engage CFBOs.⁷ The webinars’ strategy involved eliminating mosquito habitats, distributing insect repellent, and addressing misinformation about Zika.

Cultural sensitivity was particularly important. Pregnant women and their partners needed to know how to prevent sexual transmission of Zika virus. However, although condoms can decrease the risk of Zika virus sexual transmission, some faith communities do not endorse them. The timing of conversations about sexual transmission depended on the local situation. In some settings, it was acceptable for clergy and other leaders to speak candidly with women and their partners about condoms. In other environments, it was more appropriate for religious leaders to encourage pregnant women with concerns about Zika to discuss them confidentially with a knowledgeable health care provider.⁷ The Zika response showed that local response leaders could find common ground with religious leaders.

CONCLUSION

We conclude by considering remaining challenges.

First, federal planners can consider making engagement with CFBOs a standard part of CDC Emergency Operations Center exercises and activations. The CDC’s engagement with CFBOs in domestic responses to pandemic influenza (2009), Ebola (2014), and Zika (2016) typically occurred through ad hoc projects or were later additions in responses. Making CFBO partnerships a standard part of response efforts could help ensure that engagement occurs early and permit training for CDC staff to work with diverse communities and religious groups.

Second, federal planners can continue to develop the science around integrating CFBOs into emergency preparedness and response. This might involve collaboration between the federal government, academic institutions, and the APHA’s Caucus on Public Health and the Faith Community, aimed at assisting with evaluations of CFBOs partnerships and identifying evidence-based best practices.

Third, ongoing commitment by state and local public health leadership can help to sustain existing partnerships. Although maintaining relationships with local networks is time-consuming, it is preferable to developing partnerships de novo during a crisis.

Although much has been accomplished in terms of engaging the CDC and state and local public health with CFBOs in domestic responses, this effort remains a work in progress. We hope this summary will help to galvanize future efforts.