Latest Case Studies/ Field Note

Prioritizing Trust As Much as Technology to Prevent Pandemics

Habib Yakubu is talented at straddling divides. That make him valuable in the fight against pandemics.

Though raised a Muslim, he attended a Christian school. Growing up in a low-income community without running water, he went on to study in Ghana, the United Kingdom and the U.S., earning his Master of Science in Public Health in Environmental Science and Engineering. He has led trainings and research in sub-Saharan Africa and Asia, spearheaded advocacy efforts in his home country of Ghana, and simultaneously worked in low-income urban communities globally.

Currently the Associate Director of Research Projects at Emory University in Atlanta, Yakubu has recently used his 20-plus years of experience to unite community members and government leaders in health and the environment on a mission to track SARS-CoV-2 in sewage.

A prominent driver of his success? His ability to listen to, translate, and build trust with people from a wide variety of backgrounds, and to respond respectfully to community fears and doubts while generating support for science-based solutions.

Yakubu is the kind of connector central to all pandemic prevention work, especially as trust becomes even more challenging in an age of misinformation when social media often serves as a falsehood super-spreader.

“Yakubu is important as a cross-cultural communicator with great instincts for how to talk to different stakeholders both at international fora and in local settings,” notes Dr. Christine L. Moe, Director of the Center for Global Safe Water, Sanitation and Hygiene at Emory University.

Stakeholder meeting with local officials in Tema on Ghana’s coast. (Photo courtesy of Habib Yakubu and Emory University)

  • A lot of people focus on wastewater monitoring technology. But without that hard work of bringing together the stakeholders, all the rest is really useless.
    Dr. Christine L. Moe
    Director, Center for Global Safe Water, Sanitation and Hygiene at Emory University

Technicians sampling Ghana public latrines. (Photo courtesy of Habib Yakubu and Emory University)

Fostering Collaboration and Communication

The Rockefeller Foundation’s Pandemic Prevention Institute (PPI) is supporting Yakubu and Dr. Moe in their work in Accra, Ghana, to bring wastewater monitoring for multiple pathogens to a complex environment with a large number of onsite sanitation systems and very few connected sewage systems.

Shared public toilets is the most common form of sanitation in Ghana, a West African country of just over 32 million people. Ghana also has a history of using wastewater surveillance to look for poliovirus.

The country was polio-free for a decade but suffered an outbreak in 2019. In May 2022, vaccine-derived poliovirus was detected in drains in two northern districts and one Ashanti district. A single case of vaccine-derived polio was reported from the Savannah region in July. The wastewater detections spurred public health officials to launch rapid interventions, including vaccination drives.

Fig 1. Access to toilet in Ghana, by facility type1. (Photo courtesy of Fraym)

The Pandemic Prevention Institute’s mission is to swiftly detect and support containment of disease outbreaks by integrating data from diverse sources, including genomic, syndromic, and data not traditionally used in public health decisions (such as environmental, consumer and mobility data) and provide health officials at the local and national level with access to the information they need to quickly respond.

As part of its undertaking, the Institute is supporting multiple efforts to expand wastewater monitoring around the world. An exponential growth in wastewater surveillance programs during the Covid-19 pandemic has shown it can be an important public health tool for a growing list of pathogens.

Stakeholder meeting with Officials in City of Tema on Ghana’s coast. (Photo courtesy of Habib Yakubu and Emory University)

Simultaneously, the PPI team is focused on building trust as much as technology through its “network of networks” approach aimed at fostering public/private collaborations to create actionable insights locally and globally.

“Respect, empathy, and communication are key to building trust. Along with our global partners, we strive to center equity, be transparent, listen, and respond to local and regional needs and concerns,” says Dr. Rick Bright, the Institute’s CEO.

  • Trust is as important a priority to us as anything we do.
    Dr. Rick Bright
    CEO, Pandemic Prevention Institute, The Rockefeller Foundation

Local Ownership Fosters Trust

Fighting a pandemic involves centering long-term collective benefits, and this contributes to making trust such a critical component. A peer-reviewed study published earlier this year in The Lancet showed that measures of interpersonal trust and trust in government directly impacted SARS-CoV-2 infection rates: the higher the trust, the lower the infection rates and the higher the vaccination coverage.

Improved pandemic preparedness and response, the study concluded, would benefit from greater investment in community engagement strategies.

Often, that means supporting locally led engagements. In Ghana, the work brings together partners from the Ministry of Health’s Ghana Health Service, the Water Research Institute, and Training Research and Networking for Development (TREND), each bringing unique expertise.

Yakubu’s Long Interest in Water’s Hidden Secrets

 

 

Yakubu has a long relationship with water access and quality. “As a child, I fetched water every single day and thought that was normal,” he recalls. “But as I started growing up and saw people could easily get water piped directly into their homes, I thought, wow, I’ve wasted a lot of time before school and instead of doing homework.”

When he went to university, he had more questions than answers about the water his community was drinking. “I got interested in the quality of water that you could buy on the streets in plastic bags,” he recalls. “The vendors were saying it was filtered. For my thesis, I picked up street water and tested it. Most of what I collected was contaminated.”

What the vendors meant by filtering, it turns out, was passing the water through pieces of foam. “But the foam pieces were not cleaned, so in fact this served as a point of social contamination,” says Yakubu. His work gained attention and resulted in new ground-breaking regulations in Ghana. “Now the vendors have to use machines to filter the water and are subject to regular government monitoring,” he notes. “They also have to register, and the machines are inspected.”

Targeted Approach to Wastewater Monitoring

Of course, trust is not the only challenge Yakubu and Dr. Moe face in their work, which also supports U.N. Sustainable Development Goals 17, 3 and 6 around partnership, health, and clean water and sanitation that are among those being discussed at the 77th U.N. General Assembly in September.

Most people in Ghana use on-site sanitation systems that are not connected to one another, and this presents a challenge for wastewater surveillance. “With disconnected sewage systems,” Yakubu notes, “you can’t cover everywhere, so you really have to think strategically about which sampling sites provide the most useful information about the population.”

“Wastewater surveillance has huge potential, but it also requires a much more thoughtful approach than is sometimes used,” Dr. Moe agrees. “If we just focus on disease hotspots, there are big gaps where we don’t know what’s going on. We have to figure out how to get representative samples from places where only a small part of the population is connected to a sewage system.”

Fig 2. Ghana; 2021; 5,068,903 urban households; 3,288,063 rural households. (Photo courtesy of Statista)

In Ghana, the team decided to employ wastewater monitoring in boarding schools, which are the main venue for secondary education. To get buy-in, Yakubu spent significant time meeting with public health officials, school administrators, and parents. Once he explained how preventing outbreaks will keep schools open, while closed schools adversely impact students and families in multiple ways, the project gained support.

“Our colleagues in Ghana have been strong leaders in demonstrating what a thoughtful wastewater program looks like,” says Megan Diamond, Director at the Pandemic Prevention Institute. “They have done extensive stakeholder engagement and mapping and ensured that key partners were brought in from the project’s onset and felt like they had ownership too. From a scalability and sustainability perspective, this trust-building is essential.”

What’s ahead? Yakubu is also interested in exploring wastewater monitoring for managing regional cross-border outbreaks. “This is already used in some airports, but in our context, most people cross by land, and cannot afford to pay for tests. So, for much of the past two years, land borders were closed. Officials didn’t know what to do. Wastewater surveillance might be useful here. These are possibilities worth exploring.”

Technicians sampling sewer manholes in Ghana. (Photo courtesy of Habib Yakubu and Emory University)

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