Social resistance drives persistent transmission of Ebola virus disease in Eastern Democratic Republic of Congo: A mixed-methods study

Abstract

BackgroundThe second largest Ebola virus disease (EVD) epidemic in history is currently raging in Eastern Democratic Republic of Congo (DRC). Stubbornly persistent EVD transmission has been associated with social resistance, ranging from passive non-compliance to overt acts of aggression toward EVD reponse teams.MethodsWe explored community resistance using focus group discussions and assessed the prevalence of resistant views using standardized questionnaires.ResultsDespite being generally cooperative and appreciative of the EVD response (led by the government of DRC with support from the international community), focus group participants provided eyewitness accounts of aggressive resistance to control efforts, consistent with recent media reports. Mistrust of EVD response teams was fueled by perceived inadequacies of the response effort (“herd medicine”), suspicion of mercenary motives, and violation of cultural burial mores (“makeshift plastic morgue”). Survey questionnaires found that the majority of respondents had compliant attitudes with respect to EVD control. Nonetheless, 78/630 (12%) respondents believed that EVD was fabricated and did not exist in the area, 482/630 (72%) were dissatisfied with or mistrustful of the EVD response, and 60/630 (9%) sympathized with perpetrators of overt hostility. Furthermore, 102/630 (15%) expressed non-compliant intentions in the case of EVD illness or death in a family member, including hiding from the health authorities, touching the body, or refusing to welcome an official burial team. Denial of the biomedical discourse and dissatisfaction/mistrust of the EVD response were statistically significantly associated with indicators of social resistance.ConclusionsWe concluded that social resistance to EVD control efforts was prevalent among focus group and survey participants. Mistrust, with deep political and historical roots in this area besieged by chronic violence and neglected by the outside world, may fuel social resistance. Resistant attitudes may be refractory to short-lived community engagement efforts targeting the epidemic but not the broader humanitarian crisis in Eastern DRC.

Prevention of COVID-19 in Internally Displaced Persons Camps in War-Torn North Kivu, Democratic Republic of the Congo: A Mixed-Methods Study

“…20 The chronic threats to security have long been neglected by the national government and the international community. 17 We selected 3 IDP camps (Mwangaza, Masosi, and Luvangira) located 2 to 5 km from the rural commune of Oïcha, North Kivu. These temporary settlements consisted of groups of IDPs sheltered in school buildings or mud/thatch dwellings on public grounds.…”

“…28 The choice of questionnaire items was guided by a need for contextually appropriate questions for low-income settings. We also drew on past experience from past surveys conducted in IDP camps in the area [29][30][31][32] and from the recent Ebola virus disease epidemic 16,17,33 to design questions that would be relevant and understood by the participants. A local Congolese physician (KMC) with tacit knowledge of the circumstances, culture, and language of the IDPs chose the appropriate wording of the questions and adapted the content of the questionnaire to the conditions in the IDP camp.…”

Disinformation and Epidemics: Anticipating the Next Phase of Biowarfare

“…47 A study conducted among focus groups in the DRC found that 72% of respondents were dissatisfied with and mistrustful of the public health and government response, while 15% expressed that they would not comply with public health recommendations regarding isolation, quarantine at treatment centers, and safe burial in the case of illness or death in a family member. 48 In 2019, in the DRC, Doctors Without Borders/Médecins Sans Frontières recorded 300 attacks against healthcare workers, including an arson attack against and Ebola treatment center in Katwa. 49 Similar misinformation circulated during the 2014-2016 Ebola outbreak in West Africa-largely in Guinea, Liberia, and Sierra Leone-both in these countries and internationally.…”

Model-based evaluation of the impact of noncompliance with public health measures on COVID-19 disease control

“…Hospitalization and death happen away from the public eye, and our changing understanding of the mechanism of transmission, the risk of mortality and the long-term consequences of the disease have favored the spread of misinformation. The spread of confusion and misinformation has been a common feature for other novel pathogen-induced pandemics such as Ebola (1,11,12) and the 1918 Flu (13). While the existence of pandemic denialism was easy to anticipate (14), the unique characteristics of SARS-CoV-2 amplify its effect.…”