Social resistance drives persistent transmission of Ebola virus disease in Eastern Democratic Republic of Congo: A mixed-methods study

The second largest Ebola (EVD) epidemic in history is currently raging in Eastern DRC. Stubbornly persistent EVD transmission has been associated with social resistance, ranging from passive non-compliance to overt acts of aggression toward EVD reponse teams. We explored community resistance using focus group discussions and standardized questionnaires. Despite being generally appreciative of the EVD response (led by the government of DRC with support from the international community), participants described aggressive resistance to control efforts, consistent with recent media reports. Mistrust of EVD response teams was fueled by perceived inadequacies of the response effort, suspicion of mercenary motives, and violation of cultural burial mores. Mistrust, with deep political and historical roots in this area besieged by chronic violence and neglected by the outside world, may fuel social resistance. Resistant attitudes may be refractory to short-lived community engagement efforts targeting the epidemic but not the broader humanitarian crisis in Eastern DRC.