Perspective: Epidemics“Working in Silos Doesn’t Work for Outbreak Response”: Localizing Social Science Response Efforts in West Africa

A year into the Ebola outbreak in North Kivu, Democratic Republic of Congo (DRC), over 3000 people have been infected and more than 2000 have died. The outbreak was declared a Public Health Emergency of International Concern by the World Health Organization in July 2019, the outbreak’s eleventh month.

The North Kivu Ebola outbreak – DRC’s tenth – is eclipsed in size only by the 2013-2016 West African outbreak (during which upwards of 28,000 people were infected, and 11,000 died) and has been a particularly complex operational environment. The people of North Kivu have endured conflict and instability for more than 25 years, and local politics is influenced by a fluctuating array of armed groups. The relationship between the province and DRC’s central government in Kinshasa is highly fractious, and after decades of neglect by both central government and the global health community there is a deep – and understandable – mistrust of outsiders.

Despite the deployment of new tools such as vaccines and experimental treatments, the contextual complexity has made it extremely challenging for local and international response partners to implement standard Ebola containment strategies. These challenges have contributed both to the growth and spread of the outbreak, and to a very dangerous and dynamic environment for those working in the response.

Hana Rohan, Gillian McKay, Baindu Agatha Khosia write in PLOS Blogs that in the years since the West African Ebola outbreak, there has been a plethora of “lessons learnt” conferences, events, and reports (including by WHO, ODI, The Lancet, the IRCand GOAL), many of which committed the global public health community to ensure that future outbreak response would be more sensitive to the needs and perspectives of local communities. “To support this localization agenda, social science has been identified as a necessary outbreak ‘discipline’ alongside epidemiology, clinical medicine, microbiology, and public health to help ensure that outbreak response is designed in locally appropriate ways,” the three write. “The DRC outbreak has realized some of these lessons, with a dedicated team of cross-disciplinary social scientists embedded and working with other analytical colleagues.”

The add:

However, it remains that when social scientists are recruited for outbreaks they are often brought in from outside the country or region for complex institutional, structural and systemic reasons. This can be due to poor recognition or a shortage of local social scientists; at other times this reflects the dominance of the Global North in public health activities in the Global South. This means that even the best quality social science research can sometimes miss local context and history, and the scientists themselves must work through translators, losing some of the nuance that local scientists would bring to the table.

It is critical that local, experiential knowledge forms the basis of recommendations provided to response staff. As well as helping to ensure that data are locally grounded, this also helps to structure and maintain community collaboration and participation, and avoid top-down, ‘consultative’ approaches to data collection and response design. Engaging local social scientists allows them to draw on their established social networks that can facilitate data collection activities, especially when timelines are short or access is difficult.