Ebola In The Congo And Bad Info: A War On Two Fronts

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One-quarter of adults surveyed in Ebola outbreak areas of the Democratic Republic of the Congo said they didn't believe there is such an outbreak.

Moreover, only 32% of the 961 respondents living in the cities of Beni and Butembo said they trusted that local authorities represented their interest, reported Patrick Vinck, PhD, of Harvard Medical School in Cambridge, Massachusetts, and colleagues, in the Lancet Infectious Diseases.

Mistrust in authorities has been a theme of this ongoing Ebola outbreak. In October 2018, Mary Choi, MD, of the CDC reported in a session at IDWeek that there were "pockets of resistance" in trying to treat this outbreak, where high-risk contacts were refusing to be traced and actively fleeing from tracers. Rumors circulating around the community included "the illness is due to witchcraft" and "Ebola is a sham conducted by doctors and NGOs [non-government organizations] to make money."

"Ebola responders are often from outside local communities, so building trust via local leaders and service providers should be a cornerstone of efforts to engage with people to control outbreaks," Vinck said in a statement. "Medical responses alone are not enough to stop the spread of Ebola."

Indeed, at a recent press conference, World Health Organization Director-General Tedros Adhanom Ghebreyesus, PhD, emphasized the importance of community engagement in helping to combat the ongoing Ebola outbreak.

An accompanying editorial by Joe Trapido, PhD, of the London School of Economics, provided some context, stating that the cancellation of the presidential election in Ebola-affected regions of the country is "strongly linked in the public mind with the rigging of the national ballot."

"The Congolese people have been taught by bitter experience to distrust authority, in ways that make it difficult to sustain public health interventions," Trapido wrote.

Trapido warned against engaging with "locally trusted leaders" who act as intermediaries between local populations and the outside world, because of their history of double-dealing and exploitation. "[D]ifferent performances for internal and external audiences by local leaders are common," he said, citing the example of Butembo's business class.

"The so-called Nande traders have carefully presented themselves and been accepted by outsiders as entrepreneurial problem solvers, practical people who offer a model for the wider DR Congo," Trapido commented. "In fact, research shows that the business class have repeatedly used violence to sabotage or hijack development projects to preserve their trade monopolies and political power."

Vinck and colleagues surveyed adults in Beni, one of the former epicenters of the outbreak, and Butembo, where many of the cases are now concentrated. Mean age of respondents was about 34, and there was equal representation of men and women, per the study design.

Nearly all respondents heard about the outbreak in the past week, and a large majority had received information about how to protect themselves, where to seek care, and symptoms of Ebola. Not surprisingly, government trust score was significantly higher among those who said they would "seek care from formal sources." Government Ebola virus disease (EVD) trust score and health professional EVD trust score were significantly higher among respondents who said they would seek care from formal sources versus those seeking care from informal sources, the authors said.

Overall, 92% of respondents had heard at least one of three "misinformation statements" about the Ebola outbreak:

• Ebola does not exist
• Ebola is fabricated for financial gains
• Ebola is fabricated to [destabilize] the region

A little under half of respondents said they believed any of the three statements, with "Ebola is fabricated to [destabilize] the region" being the most commonly believed (36.4%), followed by "Ebola is fabricated for financial gains" (32.6%) and "Ebola does not exist" (25.2%). However, 18.2% of respondents believed all three misinformation statements.

About two-thirds of respondents believed the Ebola vaccine worked, and 63.3% (95% CI 58.0%-68.3%) said they would accept the Ebola vaccine. Of those who said they would not, about 72% believed it was "unsafe," followed by about 23% who said it "did not work." Only a quarter of those who believed all three misinformation statements would accept the vaccine, the authors said.

Limitations to the data included that the survey was done in urban settings, and may not be generalizable to rural areas, and asked about trust in health workers, but did not specify government, private or humanitarian, and NGO providers. In addition, the authors noted the data was self-reported, which could lead to social desirability bias.

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