Building trust is essential to fight the Ebola epidemic

A disaster is running smoothly in the Democratic Republic of Congo (DRC), where the Ebola virus has infected nearly 1,000 people and killed more than 600. This is the second-largest epidemic in the world. disease – and epidemiologists fear that it will not develop. the virus could spread without being detected. New cases are diagnosed late, which means the virus has ample time to spread.

Lack of trust is at the heart of this problem. Many people in North Kivu province, in north-eastern Kivu, are not seeking care because they do not believe that those who intervene in the disaster will be able to help and protect them. Stakeholders and clinics are receiving death threats, assaults and attacks and rumors are legion. When anthropologists conducted surveys in North Kivu between November 2018 and February 2019, many community members told them that they considered Ebola a government program designed to marginalize people. that it is a business that benefits humanitarian workers, researchers and public servants; or that the government's health system was unable to help.

Researchers should think about the reasons for this skepticism, to help them reduce it – because, without confidence, the tools they have developed to fight the disease will not contain this urgency.

North Kivu and the surrounding region have been affected by wars since 1997, killing about six million people and millions of displaced people. The DRC government, the United Nations and humanitarian groups have failed to restore peace in the region or provide sustainable health care. Maternal and child mortality rates are among the highest in the world. Thus, after years of neglect – and a long history of rich countries using the DRC to raise resources – communities are naturally suspicious of the authorities that suddenly appeared to fight Ebola.

More acutely, Ebola-affected communities in the DRC have seen few clear benefits for research. Experimental Ebola vaccines, treatments and diagnostic tests – many of them resulting from studies conducted during the last epidemic – are currently being deployed and successfully studied in the DRC, and they are helping out. Nevertheless, the epidemic is now in its ninth month and the mortality rate is as high as in previous epidemics, around 60%. Mistrust means that some people refuse the vaccine and many come too late to clinics to be saved by drugs.

Further research is crucial in the current epidemic, but members of the international research community can do more. They can help sound the alarm and highlight wider issues affecting colleagues, health officials and world leaders. Specifically, researchers can lobby politicians in the richest countries to further fund the efforts of the World Health Organization (WHO) and their national partners in North Kivu. Unlike many other international groups, WHO staff remain in North Kivu and, among other things, hold long talks with community leaders to build trust. At the end of February, WHO announced that it was urgent to mobilize US $ 148 million to continue its work, but that less than US $ 10 million had been announced.

Researchers can also play a role in strengthening the DRC's biomedical and health institutions, thereby helping to build community confidence in the country's health system. For the moment, many people seek help elsewhere, for example in private clinics or traditional healers. After the 2014-2016 Ebola crisis in West Africa, donors around the world began investing in the creation of national public health agencies across Africa. Researchers conducting Ebola research can better support these agencies and local scientists by providing long-term mentorship, salary increases from their grants, study grants for conferences, exchange programs and the writing of publications. This will help develop a local scientific workforce capable of detecting and fighting infectious diseases before they degenerate.

The DRC epidemic could continue for a year. At that time, the virus could spread across porous borders in fragile countries such as Rwanda, Uganda, South Sudan and the Central African Republic. The opportunity to act is now.