Working in a Hot Zone: Building Trust With Local Communities, Addressing Gaps In Preparedness

We are continuing our new series, Media Day, where we spotlight individual medical institutions and their infectious disease (ID) programs. This episode profiles Emory Healthcare.

A hot zone encompasses a geographical area where there are extremely contagious pathogens creating an outbreak of high-consequence infectious disease (HCID). For example, back in early September, a hot zone appeared in the Democratic Republic of Congo (DRC) when the country declared an Ebola outbreak in that country. In that outbreak, there were 64 people with confirmed or probable Ebola, and 45 deaths, as of November 5, 2025.

On December 1, DRC declared the end of the outbreak. However, it took 3 months of work to get the outbreak contained utilizing personnel and treatment resources.

Gavin Harris, MD, associate medical director, Serious Communicable Diseases Program (SCDP), Emory University, has been in these hot zones and he says there is much more complexity in navigating these environments.

“It's not as simple as hopping on a plane and coming into a so called Hot Zone, treating patients and then leaving,” Harris said. “We have to understand the cultural positions of these patients, their ethnic backgrounds, their languages, because it's really about establishing trust. We have to be very careful about how we approach their perceptions of, say, a foreigner who's coming from a potentially so called ivory tower with all this knowledge and equipment. We have to be very careful how we insert ourselves in those environments. And so treating these patients really encompasses engaging with local communities, engaging with trusted sources of information, engaging with families. Of course, the local governments are often important, but in a lot of these regions, there's distrust of higher level governments.”

Along with gaining trust, Harris says you need to assess where there are gaps in preparedness including everything from bare necessities like potable water, and hand hygiene, to the ability to immunize people against the HCID to having personal protection equipment to creating specific biocontainment isolation areas.

Harris points to carrying out a comprehensive approach that takes into account the local culture, communicating to the people in that area so they know what is going on, and leaving behind education and resources so locals can address potential future outbreaks. And it is in that last part about protecting against future outbreaks that is one of the biggest lessons Harris says they need to impart—building sustainable medicine capabilities with those areas.

“[You need to be] bringing in specific education that's tailored to the specific needs of these communities on the ground. It is so important to help them fight these infectious diseases in the future.”

In the next episode, Harris discusses more about the specifics around the gaps in preparedness and how to addressing them.

Reference
1. Ebola Outbreak in the DRC: Current Situation. Africa CDC. December 4, 2025. Accessed December 22, 2025.
https://www.cdc.gov/ebola/situation-summary/index.html