Social Science Considerations for Building Trust in Epidemic Response
This briefing provides practical recommendations for improving community trust prior to, during and after Ebola outbreaks.
This briefing provides practical recommendations for improving community trust prior to, during and after Ebola outbreaks.
The current outbreak of Ebola in eastern DR Congo, beginning in 2018, emerged in a complex and violent political and security environment. Community-level prevention and outbreak control measures appear to be dependent on public trust in relevant authorities and information, but little scholarship has explored these issues. The authors aimed to investigate the role of trust and misinformation on individual preventive behaviours during an outbreak of Ebola virus disease (EVD).
Until the 2014 Ebola epidemic in West Africa, Ebola outbreaks had been sporadic, small, and largely confined to isolated rural villages in Central Africa. But the 2014 epidemic broke all the rules and killed more than 15,000 people; since then, more outbreaks have been reaching larger urban centers, sometimes resulting in uncontrolled spread. The current epidemic in the Democratic Republic of Congo (DRC) has triggered a massive international response, which has been met by violence, culminating in attacks at the end of February that partially destroyed Ebola treatment units in the regional hub of Butembo and its township, Katwa. This area is the epicenter of the epidemic, which is likely to be fueled by any breakdown of isolation and treatment efforts.
Are these urban flares the new norm? What might the ebb and flow of intervention and violence bode for future epidemics?
Trust is an essential component of successful cooperative endeavours. The global health response to the 2014–2016 West Africa Ebola outbreak confronted historically tenuous regional relationships of trust. Challenging sociopolitical contexts and initially inappropriate communication strategies impeded trustworthy relationships between communities and responders during the epidemic. Social scientists affiliated with the Ebola 100-Institut Pasteur project interviewed approximately 160 local, national and international responders holding a wide variety of roles during the epidemic. Focusing on responder’s experiences of communities’ trust during the epidemic, this qualitative study identifies and explores social techniques for effective emergency response. The response required individuals with diverse knowledges and experiences.
Responders’ included on-the-ground social mobilisers, health workers and clinicians, government officials, ambulance drivers, contact tracers and many more. We find that trust was fostered through open, transparent and reflexive communication that was adaptive and accountable to community-led response efforts and to real-time priorities.
Practitioners of traditional medicine – the first port of call for 80% of Guineans – could be invaluable in helping fight other killer diseases, such as malaria.
In Sierra Leone’s Magazine Wharf, there are mixed perceptions around Ebola response systems. Ambulance services are met with especial scepticism.
Many fear that a trip in the ambulance will end in death in an Ebola treatment centre or holding unit. Others are worried that the ambulance has not been properly disinfected.