In the Journals

25% of respondents in DRC survey believe Ebola outbreak is not real

A recent survey revealed a high level of mistrust and misinformation surrounding the ongoing Ebola virus outbreak in the Democratic Republic of the Congo, or DRC, with more than a quarter of respondents saying they did not believe the outbreak was real and more than two-thirds admitting they do not trust local authorities to represent their interests.

The outbreak recently topped 1,000 cases — the second-largest Ebola outbreak in history behind the West African epidemic. The response has been marred by distrust and violence, including armed attacks against treatment facilities.

“For the last 4 years, we have been monitoring perception of security, governance and justice in eastern Congo in collaboration with the United Nations Development Programme. This work seeks to improve understanding [of] the situation and inform interventions to break the cycle of violence and build peace,” Patrick Vinck, PhD, research director at the Harvard Humanitarian Initiative and an assistant professor at both the Harvard T.H. Chan School of Public Health and the Harvard School of Medicine, told Infectious Disease News.

“When the Ebola outbreak was declared in August 2018, it became quickly evident that the combination of conflict dynamic and the epidemic would have disastrous effects. With my epidemiologist colleagues, Phuong Pham and Eric Nilles, we sought to provide useful information for first responders.”

Ebola survivors 
The current Ebola virus outbreak in the Democratic Republic of the Congo has topped 1,000 cases.
Source: CDC/Rebecca Hall, MPH

The survey

Vinck and colleagues surveyed 961 adults between Sept. 1 and Sept. 16, 2018, in two towns hit by the outbreak to investigate the role of trust and misinformation on individual preventive behaviors. They randomly selected 30 avenues or cells in each city, then 16 households in each avenue or cell. One adult at each location was selected to be interviewed and questioned.

Results of the survey showed that just 349 participants (31.9%) trusted that local authorities represent their interest. Belief in misinformation was widespread, with 230 respondents (25.5%) believing that the Ebola outbreak was not real, the researchers said. Additionally, “Low institutional trust and misinformation were associated with a decreased likelihood of adopting preventive behaviors,” including accepting vaccination against Ebola and seeking formal health care, they wrote.

According to the latest information from the DRC health ministry, more than 92,000 people have received Merck’s experimental Ebola vaccination during the current outbreak, and WHO Director-General Tedros Adhanom Ghebreyesus, PhD, MSc, has credited the vaccine with averting a much larger outbreak.

“Mistrust and misinformation are major barriers that need to be overcome for effectively controlling the epidemic. It is not a new idea: mistrust and misinformation plague other public health interventions, including vaccine campaigns for measles and other diseases,” Vinck said.

“However, this is an understudied area and the research is a call for action to invest in trust-building activities and research — there has been major investment and progress in the medical response, but our understanding of how individuals and communities react and behave during outbreaks remains limited and there are few insights into what approaches may actually work to build trust, especially in a context of ongoing conflict and violence.”

‘Trust cannot be built overnight’

The outbreak was announced on Aug. 1 and was classified as a “top degree of difficulty” by WHO, which has cited “misinformation and mistrust due to decades of conflict contributing to a reluctance with some local populations to allow Ebola response teams to vaccinate, conduct contact tracing and perform safe and dignified burials.”

Officials have said that it will be months or maybe even a year before the outbreak is brought under control.

“Trust cannot be built overnight, but it is important to make it a central component of the Ebola response,” Vinck said. “Luckily engagement was an important focus of the response early on. However, there is a need to better integrate the medical and social responses — engaging with communities is not just an outreach or public communication activity, it really comes down to establishing meaningful roles and respect for people on the ground.

"In a context as tense as eastern DRC, ‘outsiders’ are not just international responders, they are people from other provinces, even other villages. So, we need to understand what a hyper-localized response looks like, realizing that what works in one place may not work elsewhere.” – by Caitlyn Stulpin

Disclosures: The authors report no relevant financial disclosures.

A recent survey revealed a high level of mistrust and misinformation surrounding the ongoing Ebola virus outbreak in the Democratic Republic of the Congo, or DRC, with more than a quarter of respondents saying they did not believe the outbreak was real and more than two-thirds admitting they do not trust local authorities to represent their interests.

The outbreak recently topped 1,000 cases — the second-largest Ebola outbreak in history behind the West African epidemic. The response has been marred by distrust and violence, including armed attacks against treatment facilities.

“For the last 4 years, we have been monitoring perception of security, governance and justice in eastern Congo in collaboration with the United Nations Development Programme. This work seeks to improve understanding [of] the situation and inform interventions to break the cycle of violence and build peace,” Patrick Vinck, PhD, research director at the Harvard Humanitarian Initiative and an assistant professor at both the Harvard T.H. Chan School of Public Health and the Harvard School of Medicine, told Infectious Disease News.

“When the Ebola outbreak was declared in August 2018, it became quickly evident that the combination of conflict dynamic and the epidemic would have disastrous effects. With my epidemiologist colleagues, Phuong Pham and Eric Nilles, we sought to provide useful information for first responders.”

Ebola survivors 
The current Ebola virus outbreak in the Democratic Republic of the Congo has topped 1,000 cases.
Source: CDC/Rebecca Hall, MPH

The survey

Vinck and colleagues surveyed 961 adults between Sept. 1 and Sept. 16, 2018, in two towns hit by the outbreak to investigate the role of trust and misinformation on individual preventive behaviors. They randomly selected 30 avenues or cells in each city, then 16 households in each avenue or cell. One adult at each location was selected to be interviewed and questioned.

Results of the survey showed that just 349 participants (31.9%) trusted that local authorities represent their interest. Belief in misinformation was widespread, with 230 respondents (25.5%) believing that the Ebola outbreak was not real, the researchers said. Additionally, “Low institutional trust and misinformation were associated with a decreased likelihood of adopting preventive behaviors,” including accepting vaccination against Ebola and seeking formal health care, they wrote.

According to the latest information from the DRC health ministry, more than 92,000 people have received Merck’s experimental Ebola vaccination during the current outbreak, and WHO Director-General Tedros Adhanom Ghebreyesus, PhD, MSc, has credited the vaccine with averting a much larger outbreak.

“Mistrust and misinformation are major barriers that need to be overcome for effectively controlling the epidemic. It is not a new idea: mistrust and misinformation plague other public health interventions, including vaccine campaigns for measles and other diseases,” Vinck said.

“However, this is an understudied area and the research is a call for action to invest in trust-building activities and research — there has been major investment and progress in the medical response, but our understanding of how individuals and communities react and behave during outbreaks remains limited and there are few insights into what approaches may actually work to build trust, especially in a context of ongoing conflict and violence.”

PAGE BREAK

‘Trust cannot be built overnight’

The outbreak was announced on Aug. 1 and was classified as a “top degree of difficulty” by WHO, which has cited “misinformation and mistrust due to decades of conflict contributing to a reluctance with some local populations to allow Ebola response teams to vaccinate, conduct contact tracing and perform safe and dignified burials.”

Officials have said that it will be months or maybe even a year before the outbreak is brought under control.

“Trust cannot be built overnight, but it is important to make it a central component of the Ebola response,” Vinck said. “Luckily engagement was an important focus of the response early on. However, there is a need to better integrate the medical and social responses — engaging with communities is not just an outreach or public communication activity, it really comes down to establishing meaningful roles and respect for people on the ground.

"In a context as tense as eastern DRC, ‘outsiders’ are not just international responders, they are people from other provinces, even other villages. So, we need to understand what a hyper-localized response looks like, realizing that what works in one place may not work elsewhere.” – by Caitlyn Stulpin

Disclosures: The authors report no relevant financial disclosures.

    See more from Ebola Resource Center