With Ebola cases continuing to emerge throughout Africa, the ability for the impacted nations to manage this virus has been called into question. Since the declaration of the outbreak in May, there have been approximately 10,000 cases with 5,000 deaths. Reports of infection in France, Kenya, Nigeria, and Uganda are increasing concerns of the crisis escalating. Due to the rarity of the Bundibugyo virus, a vaccine has yet to be developed. As clinical trials and response efforts proceed, public health officials are faced with a challenging socio-political environment.
For those directing response efforts, a major difficulty has been balancing limited resources with health team demands. During previous outbreaks, international cooperation was essential to both surveillance and treatment of the virus. The continuation of the America First Global Health Strategy, along with reduced financial support from other countries, has changed the capacity of the affected African nations. This disinvestment in foreign health issues has had profound impacts on response teams as community workers are faced with unmet basic needs and unpaid wages. In protest of these conditions, some workers have gone on strike or broken Ebola protocols by allowing community members to touch the deceased. While the frustration of these response teams is understandable, these acts of objection may worsen the spread of the virus and exacerbate the public’s negative perception of health officials.
Both the healthcare workers and public health officials are met with deep-rooted distrust toward the government from the communities they serve. A survey by the International Rescue Committee in the Democratic Republic of Congo found that half of respondents felt that their trust with health authorities and frontline workers had eroded since the outbreak, and 85 percent of respondents stated mistrust of health teams as a reason they would not seek care. This suspicion toward health workers may be a contributor to the high death rate associated with this outbreak as failure to receive treatment could be fatal. Further, by not isolating in treatment facilities or following standard infection control practices, there may be a higher risk of virus transmission.
Unfortunately, the result of this distrust and fear surrounding the virus and government response has been threats and attacks against public health officials and frontline workers. On October 25th, a nurse was killed while attempting to respond to an Ebola alert in Congo. This strained relationship between community members and response teams may further disincentivize healthcare workers from continuing to serve these populations.
For the ongoing Ebola outbreak to be subdued, it is evident that public health officials must work to address the concerns of both healthcare workers and community members. Although there remain factors outside of their control, there is the potential to better support response teams in the work they do by prioritizing worker wages and encouraging community dialogues about the virus. In this response effort, it is necessary that there be a strong foundation of mutual trust between healthcare workers, communities, and the government.