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 Medical scientists, prompted by a devastating West African Ebola
epidemic between 2013 and 2016, have worked fast to develop cutting
edge vaccines, treatments and antibody-based therapies they hoped
would prevent or halt future outbreaks of the virus. That includes
an Ebola vaccine developed by Merck & Co Inc that proved more than
95 percent effective in clinical trials.
But the current Ebola outbreak has continued to spread relentlessly
since it began in August 2018 in Democratic Republic Congo's North
Kivu province.
It has infected more than 2,000 people, killing at least 1,400 of
them. And, in recent days, it reached Uganda, where several cases
have been recorded, all in people who had come across the border
from Congo.
Public health experts say this underscores the importance of factors
beyond medicine - such as trust in authority, engagement and
accurate information - in successfully controlling outbreaks of
infectious diseases.
"Even in the presence of sensitive rapid testing, drugs and a
vaccine, this Ebola outbreak has continued to burn on," said Ian
Mackay, a virologist and associate professor at the University of
Queensland in Australia.
"The core drivers are all key human issues of trust, habits, fears
and beliefs. That is the mix that now underpins the spread of any
disease."
SOCIAL BARRIERS
Those seeking ways to end the Congo Ebola outbreak's longevity and
persistence say the issues it raises go to the heart of what public
health means in the 21st century for countries across the world,
rich and poor.
The World Health Organization cites mistrust of authorities in
Congo, with attacks on healthcare workers and patients avoiding
treatment centers, as major factor in the failure so far to contain
the Ebola outbreak. Similarly, it cites anti-vaccine misinformation
campaigns in the United States, Ukraine and elsewhere as allowing
measles to spread furiously among people who are fearful and
confused.
Jeremy Farrar, director of the Wellcome Trust medical charity and a
specialist in global health, draws parallels between the challenge
of containing Ebola in Congo and issues elsewhere, such as the surge
of cholera in Yemen and the spread of measles in Ukraine, the United
States and the Philippines.
The barriers are more social than scientific, he says.
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"No public health can work without the support of the society it's
in. The science is clear in all of these things, but unless it has
not just tacit support, but engaged support, then public health
really struggles," Farrar said.
A key factor has been greater international travel, and the
increased information sharing that comes with it. That is "a
double-edged sword", says Daniel Bausch, director of the UK public
health rapid support team and an expert on the Ebola virus.
While improved communication flows can help public health
authorities track diseases and spread messages to people about how
to protect themselves, greater access to a vast range of information
can make the public become more skeptical of authority and can
spread misinformation, including about vaccines, Bausch said.
"There is so much information flowing, it gets very difficult to
pick out the truth. This is not unique to Ebola or Africa — it's a
global problem," Bausch said.
BUILDING TRUST
Emmanuel André, a doctor and professor at Leuven University in
Belgium who has been working with people in Congo affected by
tuberculosis - another infectious disease - says the way to counter
distrust is to engage with people directly affected by a disease or
who have direct experience of a medicine to harness their
experience.
"Medicine and public health have not yet learned how to deal with
humility and mistakes," he said.
"How can we ask trust from the people in the North Kivu when
political authorities, United Nations agencies and international
NGOs have jointly failed to provide primary services - including
health? How can we ask them to expect that these same actors now
would be able to provide a solution?"
A study André conducted in Congo in 2014-2016 found in the detection
of tuberculosis - a disease that can spread widely if people with it
don't come forward for treatment - training volunteer screeners from
local communities, mainly people who had themselves been treated for
TB or had a family history of the disease, improved diagnosis rates
and engagement.
"Building trust with the people is critical," he said.
(Reporting by Kate Kelland. Editing by Cassell Bryan-Low)
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