Ebola response and community engagement: how to build a bridge?

Abstract

As of Dec 3, 2019,1WHOEbola virus disease – Democratic Republic of the Congo. Disease outbreak news: update.https://www.who.int/csr/don/05-december-2019-ebola-drc/en/Date: Dec 5, 2019Date accessed: December 10, 2019Google Scholar 3313 cases of Ebola virus disease (EVD), resulting in 2207 deaths, have been reported in northeastern DR Congo. Armed and interethnic conflicts, large population movements, political tensions, and community resistance have hampered the success of the response activities.2Ilunga Kalenga O Moeti M Sparrow A Nguyen V-K Lucey D Ghebreyesus TA The ongoing ebola epidemic in the Democratic Republic of Congo, 2018–2019.N Engl J Med. 2019; 381: 373-383Crossref PubMed Scopus (86) Google Scholar, 3ACAPSBriefing note: DRC - Ebola Virus Disease - Democratic Republic of the Congo.https://reliefweb.int/sites/reliefweb.int/files/resources/20180803_acaps_start_briefing_note_drc_ebola_nord_kivu.pdfDate: Aug 3, 2018Date accessed: August 3, 2019Google Scholar The lessons learned and the standard interventions seem almost to be inappropriate. Indeed, with the lack of community involvement identified as the main barrier, the strategic adjustments of response have mainly consisted of the transposition of achievements during the west African EVD epidemic to the current episode, regardless of local sociocultural sensibilities and practices. A mistrust of national and provincial governments, as well as security and humanitarian institutions, is strongly rooted in indigenous populations because of exactions that have lasted for more than two decades.4Vinck P Pham PN Bindu KK Bedford J Nilles EJ Institutional trust and misinformation in the response to the 2018–19 Ebola outbreak in North Kivu, DR Congo: a population-based survey.Lancet Infect Dis. 2019; 19: 529-536Summary Full Text Full Text PDF PubMed Scopus (245) Google Scholar Community reluctance has been fuelled by misinformation, sceptism about the disease's real existence, and speculations about the central government's involvement in the virus spreading to suppress an electorate favourable for opposition.5Hayden S How misinformation is making it almost impossible to contain the Ebola outbreak in DRC.https://time.com/5609718/rumors-spread-ebola-drc/Date: June 20, 2019Date accessed: August 4, 2019Google Scholar In addition, the community perceives that international humanitarian organisations are behind the epidemic because of large amounts of money dedicated to assist efforts to control EVD, while conflict and other health concerns have received less attention before.5Hayden S How misinformation is making it almost impossible to contain the Ebola outbreak in DRC.https://time.com/5609718/rumors-spread-ebola-drc/Date: June 20, 2019Date accessed: August 4, 2019Google Scholar Also, the militarised escorts of community intervention teams in insecure areas have pushed some communities to insulate themselves from external influence.2Ilunga Kalenga O Moeti M Sparrow A Nguyen V-K Lucey D Ghebreyesus TA The ongoing ebola epidemic in the Democratic Republic of Congo, 2018–2019.N Engl J Med. 2019; 381: 373-383Crossref PubMed Scopus (86) Google Scholar Finally, community resistance has resulted in numerous attacks on Ebola treatment centres and field response teams.5Hayden S How misinformation is making it almost impossible to contain the Ebola outbreak in DRC.https://time.com/5609718/rumors-spread-ebola-drc/Date: June 20, 2019Date accessed: August 4, 2019Google Scholar A year later, the epidemic continues. In addition, there are still pockets of community resistance. However, several teams have succeeded in managing the response and have defended that they have made every effort to involve the community, but without much success. This raises the question of whether the community engagement is understood in the same way by all stakeholders, and how will the management of the epidemic in an active conflict zone be perceived by international, national, and local actors? International and national actors have never confronted such a complex crisis, and local actors have never confronted a disease with a transmission potential as high as Ebola. What does the community think about this notion of community involvement? Deciphering the discrepancies in perceptions of community involvement between different actors and the community will lead to short-term operational consequences on the dynamics of the current EVD outbreak. Based on the new national multisectoral EVD response committee advocating a pragmatic multidisciplinary approach that is currently established, it is important to put in place an interactive consultation framework between the community, local leaders, and the other actors involved in the response. This action is to develop communication strategies and protocols focused on a community-centred approach and carried by local stakeholders. Promoting such an approach can build community confidence in the response required for social mobilisation and community engagement. We declare no competing interests.