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Editorial, Opinion Pieces Discuss Challenge Of Mistrust, Importance Of Community Involvement In DRC Ebola Response

The Lancet: Acknowledging the limits of public health solutions
Editorial Board

“…WHO has not declared the [Ebola] outbreak [in the Democratic Republic of the Congo (DRC)] a Public Health Emergency of International Concern (PHEIC). Although calls to declare a PHEIC are understandable in the face of a worsening and precarious situation, such a declaration, and the increased technical response that it entails, will do little to address what is principally a political problem. … [Response] efforts are being compromised by a complex and dangerous security situation compounded by misinformation and mistrust. … Nonetheless, a very real risk remains that the outbreak will cross into Rwanda or Uganda, in which case a declaration of a PHEIC would probably be needed to increase technical capacity and international coordination. For now, the focus remains on DR Congo’s government and opposition groups. Sources at WHO told The Lancet that the organization is working with the governments of the USA, the U.K., and France to influence leadership within the country to address the security situation. There are limits to what the medical community alone can achieve — if the Ebola virus disease outbreak is to be ended, DR Congo’s leaders on all sides of politics must step up and take responsibility for the response” (5/25).

The Conversation: Radical ideas are needed to break the DRC’s Ebola outbreak. Here are some.
Mosoka Fallah, deputy director general at the National Public Health Institute of Liberia and visiting scientist at Harvard Medical School

“…[T]he current Ebola outbreak is expanding, largely unabated. And there is a growing risk that it will spill over to neighboring countries with the potential of spreading internationally. … What can leaders of the response do? … First, they can incentivize community leaders (chiefs, healers, women, priests) on a fixed stipend to head the response in their respective towns or villages. … Second, food can be used to incentivize community response and volunteer self-quarantine. … Third, find all means necessary to incentivize the rebels and make them a part of the response. … If we are to win the current war on Ebola, we must employ unconventional approaches, even ones that might be considered controversial. The fact is, people who are poor and neglected are more susceptible to infectious diseases and distrustful of authority. Distrust of authority, civil war, and Ebola are a recipe for disaster even with the most costly response and medical counter measures. Time is ticking” (5/22).

Thomson Reuters Foundation: OPINION: How to tackle Ebola in DRC? Focus on the community
Agoustou Gomis, Ebola virus disease project coordinator at World Vision DRC

“…[Families] must be at the heart of a locally-led [Ebola] response, working with trusted individuals in the community … Faith leaders, local radio, youth groups, and women’s associations are all crucial structures to help drive home messages about identifying symptoms, staying safe when caring for sick people, and where to get help. … Engaging the community, working with faith leaders and other peer groups, reinforcing health systems, and getting everybody to work together on a common cause — these are powerful incentives to keep focused on seeing an end to Ebola in the DRC” (5/23).

New York Times: Letters to the editor: Attacks on Ebola Health Workers in the Democratic Republic of Congo
David Miliband, president and chief executive of the International Rescue Committee, and Joe Amon, director of global health at Drexel University’s Dornsife School of Public Health

“…You are right to highlight the gulf of political mistrust at the heart of the Ebola crisis, which is far more worrying and dangerous than realized. … The International Rescue Committee runs more than 50 health centers in eastern Congo, and the recipe for trust is to work from the ground up. That means local hires — doctors, nurses, security — drawn from the community and galvanized to defend it. There must be a new partnership where every part of the response is assigned to those with real expertise. This is already the second worst Ebola outbreak in history. Too many lives are at stake for it to become the biggest” (Miliband, 5/23).

“…It is unfortunate that deep distrust in the affected communities has led to violence and attacks on health facilities and workers. … Trust needs to be restored with communities and governments, and we must expand efforts to protect health workers. Where attacks occur, immediate investigations must hold those responsible to account” (Amon, 5/23).