Ask a member of the public what they know about Ebola and they may describe the disease from what they’ve seen from film, TV and books.
They may also recall hearing about the 2014-16 West Africa outbreak, and especially for members of the US public, the case of Thomas Eric Duncan who died in Texas in late 2014 after returning from Liberia. The case of nurse Pauline Cafferkey, who returned to Scotland from Sierra Leone having contracted Ebola after helping in the aid effort, may also be familiar to people in the UK. At the time of that outbreak, Ebola virus made major headlines across both broadcast and print media.
However, questioning the same public on the current outbreak spreading in the Democratic Republic of the Congo may raise eyebrows, despite following a roughly similar pattern of spread as the previous West Africa outbreak. Without examining how newsworthiness is measured, public awareness of an event can dramatically influence how aid is delivered, the extent of aid and funding, the breadth of research analysis and dissemination and the worldwide communication of relevant data.
One of the biggest lessons learnt from the West Africa outbreak was the necessity for open and effective communication, both with communities in order to identify cases and treat patients, as well as to create a collaborative environment between humanitarian agencies, state agencies, and local communities in the fight against Ebola.
There are some fears that many of the important lessons learned in regards to collaboration and community engagement during the 2014-16 outbreak are not being effectively applied to the current outbreak in the DRC, however the reasons behind this are multifaceted. Conflict in the affected region has meant that many large international agencies such as Médecins Sans Frontières (MSF) and the US CDC have withdrawn their presence in some areas. Communities seeing attacks on aid workers, and/or the disappearance of assistance can easily drive further scepticism about Ebola, an issue which the WHO already struggles with (see Ebola Virus in the Democratic Republic of the Congonews post, 15th July 2019).
Understandably, security issues will affect how easily information is communicated within the region and disseminated beyond, for both news and scientific data. Sierra Leone, Liberia and Guinea were not conflict zones in 2014-16, and in general, delivery of aid was not the challenge currently seen in the DRC. This, in turn, allowed news media and scientific data to be more easily accessible to responding organisations, local affected communities and the general public. The availability of more information and resources creates a positive feedback cycle of data and news output.
Part of the success of the application of community engagement methods in West Africa was taking an anthropological approach to the outbreak. Cultural considerations (e.g. the desire to see and wash the dead), superstitions, mistrust (e.g. the belief that Ebola is brought by Western aid organisations) and the processes of hunting and gathering (e.g. interaction with animal reservoirs for Ebolavirus) were seen as secondary considerations compared to biological disease containment in some of the, albeit far smaller, historic Ebola virus outbreaks.
Furthermore, many interdisciplinary collaborative efforts between groups involved in the 2014-16 humanitarian response had to be developed de novo. Collaborative working in an outbreak creates new challenges (e.g. the means by which anthropologists reported their findings differed in structure and timing compared to the output by epidemiologists and medics). Whilst a quicker approach may be favourable to address the immediate issues during a rapidly changing outbreak, the means to understand why communities hold certain beliefs, and how to ensure they get the most effective and comprehensive aid, proved crucial to disease containment in West Africa.
The current slow rate of information dissemination from the DRC in regards to community perspectives and engagement may be due to the ongoing armed conflict in many areas, with many anthropological and sociological aid projects only able to operate in larger towns and cities. However, as we learned from the West Africa outbreak, we must find a way to continually engage remote affected communities in eastern DRC and facilitate open communication and effective information dissemination. There are many organisations working hard to achieve these goals and it is hoped that their success will facilitate outbreak containment and subsequent community recovery.
