Understanding Africa’s Ebola-Denying Communities

Illustration by Josh Covarrubias

From the poor preparation of many African governments to the early apathy of Western nations, the current Ebola outbreak has been a grind of slow-moving tragedy. But perhaps the most disturbing and confusing complication is the trend, emerging in hard-hit countries like Liberia and Sierra Leone, of denying Ebola’s existence outright. Over the summer, as reports trickled in of entire hot-zone communities refusing to take precautions and mobs attacking care centers and denying aid teams access to villages, it seemed like an irrational, intractable madness was taking hold. But in truth, these seemingly insane and unfathomable responses are the results of years of strife, governmental ineptitude, and a less-than-sensitive crisis-response rollout. And although there are few ideal solutions to Ebola denial, there are some significant, immediate measures we can take to control and mitigate this dangerous mistrust.

Beyond West Africa, as we watch Ebola’s death toll creep past 4,500 (with more than 9,200 reported cases at last count and up to 1.4 million feared by January), it’s hard to imagine how anyone could deny the disease’s existence. But for many on the ground, Ebola has not had a highly visible day-to-day presence: Given Ebola’s symptomatic similarity to cholera, malaria, and other common illnesses, misdiagnoses have been common. Those who were correctly diagnosed often disappeared from communities before their symptoms manifested, then died in quarantine. In communities recovering from extreme violence and prone to mistrust, these disappearances and deaths naturally abetted rumors of death squads and complex conspiracy theories. It’s a formula we’ve seen before: Think anti-vaccination conspiracies in America, anti-polio treatment in Pakistan, and anti-HIV/AIDS beliefs in South Africa. Those experiences have taught us that conspiratorial beliefs can be extremely persistent, and conventional health-awareness campaigns can accomplish little without trust.

Preparing to enter Ebola treatment unit in LIberia. Image courtesy of CDC Global

Yet as Ebola has spread through West Africa, some argue, people have so far reacted more to the disease itself than to the communities that form the context for the outbreak. Organizations send cars with loudspeakers blaring public health messages down local streets, as disbelief in Ebola is blamed on illiteracy and mocked as unsophisticated superstition, rather than the endemic, recognizable mistrust that it is. Add the sudden intervention of foreigners in alienating and anonymous quarantine suits and curfews enforced by armed soldiers, and you’ve got a recipe for denial, conspiracy, and, eventually, panic.

Ideally, swift responses by local doctors, mediating between community leaders and international physicians, could have headed off this epidemic of denial. But in nations with few provisions, weak governments, and the lowest doctors-per-capita rates in the world, this kind of measured, integrated response was impossible.

Ebola particles budding from an infected cell. Image courtesy of NIAID

Yet even in an imperfect world, there are still viable solutions to denial, panic, and the exacerbations they cause. Experiences with a polio-vaccine boycott in nearby (and recently Ebola-free) Nigeria provide a regionally appropriate playbook for engaging with local community, religious, and traditional elites so that health awareness and preventative measures can gain the most traction. Meanwhile, existing engagement with less skeptical and more media-saturated (read: Ebola-exposed and -believing) diaspora populations can be leveraged—through communication with family back home in Africa—to disseminate information through informal and trusted sources, banking on familial trust and word of mouth. And most recently, Guinea and Liberia have experienced some success in increasing Ebola belief and awareness through its insertion into local media and pop culture, through jokes and songs.

Measures like these won’t stop Ebola in its tracks. But it’ll make the disease real in doubtful communities and at least, hopefully, controllable in panicked communities. That may go a long way in helping overtaxed doctors launch forward in their bids at containment. It would also probably help if we returned global attention to West Africa’s struggling communities as well, rather than focus on America’s doubly overblown Ebola panic, which may end up requiring a round of community engagement, pop-culture education and normalization soon itself.