Inoculating against misinformation

The disease has struck a mineral-rich region along Congo’s border with Rwanda and Uganda, which has experienced long-running unrest. It was the site of two pan-Africa wars in the 1990s and early 2000s, and ongoing fighting between the Congolese Army and well-armed militias ever since.

Between October and December, there were 313 incidents of violence in North and South Kivu provinces, including attacks against Ebola responders, abductions, and massacres of civilians by armed forces, according to the New York University–based Kivu Security Tracker. The violence was reflected in the survey data, in which local residents listed “banditry” and “ongoing armed conflicts” among their highest concerns. In response to one question, 29 percent said they’d been robbed in the previous year alone.

“You’ve got massacres, you’ve got violence, and nobody’s paying attention to that,” Vinck said, “so it fueled the mistrust early on. Ebola is very deadly. … We might imagine that violence would [fall] in the interest of solving the health crisis, but because so many people believe in rumors, it’s not happening.”

After Ebola was detected last August, international health workers drew on experience gained in the 2013 West Africa Ebola epidemic and arrived in force, armed with new treatments and a vaccine developed in response to the earlier outbreak.

Despite the robust response and new tools, health care workers were repeatedly assaulted and, in March, Doctors Without Borders was forced to withdraw from Ebola treatment centers in two cities after the centers were attacked and partly destroyed. According to statistics cited by the organization, 40 percent of Ebola deaths still happen outside medical centers — an indication that many of the ill are not seeking treatment — and 35 percent of new cases can’t be linked to existing ones, meaning a big part of the transmission network remains unknown.

“We have a striking contradiction,” Joanne Liu, Doctors Without Borders’ international president, said in a March 7 statement. “On the one hand, a rapid and large outbreak response with new medical tools such as vaccines and treatments that show promising outcomes when people come early, and on the other hand, people with Ebola are dying in their communities, and do not trust the Ebola response enough to come forward.”

So far, the disease has sickened more than 1,000 and killed more than 600, according to the World Health Organization. The massive 2013 outbreak killed more than 11,000.

The surveys that Vinck, HHI’s research director, and Pham, director of its Program on Evaluation and Implementation Science, led in collaboration with colleagues at three Congolese universities over the past three years were begun to better reflect public opinion about security in the region, which, in addition to fighting, has seen widespread atrocities and the systematic use of rape as a weapon of war.

When the outbreak began late last summer, researchers added questions about Ebola to their regular quarterly poll in September. Responses showed that roughly a quarter, 230 of the 961 respondents, didn’t believe Ebola was real and almost 40 percent, 372, wouldn’t accept a vaccination that protected against it.

Other results show that 33 percent believe the outbreak was fabricated for financial gain; 36 percent believe it was fabricated to destabilize the region; and one-fifth, 171 out of those polled, believe it was fabricated for both reasons and that Ebola wasn’t real. More than a third, 36 percent, didn’t trust local authorities to represent their interests.

“So [the lack of trust] is not entirely surprising, but what’s surprising is how quickly it became violent, especially against health actors,” Vinck said, “In general, on the political side, you have low trust, but when it comes down to health actors, trust is higher. So the fact that it became violent just shows the importance of political trust and having an understanding of the broader context.”

The most recent survey, conducted in December, shows the potential impact of public education campaigns done in conjunction with local partners. In the city of Beni, in the epidemic’s epicenter, public knowledge about Ebola has increased dramatically since September, and 82 percent said they’d accept vaccination. Along with that change, Pham said, the number of new cases dropped to near zero.

By contrast, in two other cities at the epidemic’s epicenter, Butembo and Katwa, public knowledge about the virus remained low. Acceptance of a vaccine is also low — just 38 percent in Butembo — and infection rates high.

“I think the success in Beni was because people worked really hard,” Pham said. “But also people in the community started to cooperate, they started to understand.”

— Read more in Patrick Vinck et al., “ Institutional trust and misinformation in the response to the 2018–19 Ebola outbreak in North Kivu, DR Congo: a population-based survey,” Lancet Infectious Diseases (27 March 2019) (doi: org/10.1016/S1473-3099(19)30063-5)

Alvin Powell is a Harvard staff writer. This articleis published courtesy of the Harvard Gazette, Harvard University’s official newspaper