In the lawless eastern provinces of sub-Saharan Africa’s biggest country, an Ebola outbreak that has quietly become history’s second-largest epidemic may wind up turning not on drugs or quarantine, but on a third, often underappreciated factor: trust.
Though it’s known that gaining the confidence and cooperation of local people is a key to successful epidemic response, the long, terrible history of violence in the eastern Democratic Republic of the Congo has elevated it from one element among many to a matter of paramount importance, according to survey work led by Harvard researchers Drs. Patrick Vinck and Phuong Pham.
The pair, both assistant professors at the Harvard T.H. Chan School of Public Health and Harvard Medical School and researchers at the Harvard Humanitarian Initiative (HHI), have worked with Harvard Medical School’s Dr. Eric Nilles, an infectious disease expert and director of the initiative’s Program on Infectious Diseases and Humanitarian Emergencies, and partners at three local universities to survey thousands of residents of the affected region.
Their results, published recently in The Lancet Infectious Disease, show that near the epidemic’s epicenter there is widespread distrust of local politicians, doubt whether Ebola even exists, and concern that the outbreak was fabricated for financial or political gain. The results of their survey, Drs. Vinck and Pham said, indicate that educating the public and gaining its trust in this case is even more critical than in epidemics elsewhere.
“When the outbreak started, [responders] were approaching Ebola the same way they approached previous outbreaks,” Dr. Pham said. “What complicates this response, compared with other outbreaks, is that there is an ongoing [violent] conflict.”Friday Letter Submission