Community trust of government and non-governmental organizations during the 2014-16 Ebola epidemic in Liberia

Abstract

The West African Ebola Virus Disease epidemic of 2014-16 cost more than 11,000 lives. Interventions targeting key behaviors to curb transmission, such as safe funeral practices and reporting and isolating the ill, were initially unsuccessful in a climate of fear, mistrust, and denial. Building trust was eventually recognized as essential to epidemic response and prioritized, and trust was seen to improve toward the end of the epidemic as incidence fell. However, little is understood about how and why trust changed during Ebola, what factors were most influential to community trust, and how different institutions might have been perceived under different levels of exposure to the outbreak. In this large-N household survey conducted in Liberia in 2018, we measured self-reported trust over time retrospectively in three different communities with different exposures to Ebola. We found trust was consistently higher for non-governmental organizations than for the government of Liberia across all time periods. Trust reportedly decreased significantly from the start to the peak of the epidemic in the study site of highest Ebola incidence. This finding, in combination with a negative association found between knowing someone infected and trust of both iNGOs and the government, indicates the experience of Ebola may have itself caused a decline of trust in the community. These results suggest that national governments should aim to establish trust when engaging communities to change behavior during epidemics. Further research on the relationship between trust and epidemics may serve to improve epidemic response efficacy and behavior uptake.

An analysis of COVID-19 information sources

“…Higher compliance rates and reduced death rates may be linked to trust [29]. However, during the Ebola pandemic in Liberia in 2018, a study found that community trust in non-governmental organizations (NGOs) was stronger than in government [30]. People seek information from various resources to update their knowledge and become more prepared in the face of COVID-19 [31].…”

The lasting influence of Ebola: a qualitative study of community-level behaviors, trust, and perceptions three years after the 2014-16 Ebola epidemic in Liberia

“…Without common recognition of an epidemic, perceived threat is non-existent, and behavior change is not viewed as important or warranted [ 15 ]. Widespread denial reflects deep-seated distrust of the government held by many Liberians [ 12 , 13 ] and represents an unsolved problem that is likely to re-emerge during future public health crises. This study provides insight into drivers of distrust and denial that continue to undermine community readiness for future epidemics in Liberia.…”

“…We purposively selected three Liberian locations (as previously described [ 13 ]) for their distinct experiences during the Ebola epidemic: Duazon in Margibi County with a high level of exposure to Ebola response activities and low incidence of Ebola; Careysburg in Montserrado County with low exposure to response activities and low Ebola incidence; and Tubmanburg in Bomi County with high exposure to response activities and high Ebola incidence. In each of these study sites, we partnered with local leadership to first conduct pre-mobilization meetings to notify the community.…”

“…This study is part of a large mixed methods investigation of perceptions, beliefs, and behaviors during and since the Ebola epidemic in Liberia. In a previously published large-N household survey conducted in three Liberian communities with different Ebola experiences [ 13 ], our team found that trust decreased during the peak of the epidemic in the most Ebola-affected region, indicating that trust may be most compromised when it is most needed. In the present qualitative study, we conducted nine focus group discussions in the same three communities.…”

“…Distrust of the government was commonplace [ 12 ], and alternative explanations for the disease and its origins circulated widely [ 13 ]. These beliefs included ideas that the government had manufactured the crisis in order to receive international monetary aid, that witchcraft was the cause of Ebola-like symptoms, and denial that the Ebola epidemic was real [ 9 , 11 , 14 ].…”