Improving public health messaging on Ebola

In previous posts on this blog, we asked how the Ebola crisis would reflect and transform states-citizen relationships; how it would shape the authority of traditional healers; and what impact it would have on the political economy of affected countries. In this paper, Bernard Seytre explores the effectiveness of public communications on Ebola. His study in March of this year was a collaboration with Dr Atiyihwè Awesso, from the University of Lomé. Their focus was on the country of Togo and their extensive qualitative study may be the first large-scale study of Ebola communications and their reception in an Ebola-free country.

Public health communications around Ebola are crucial and can either inflame or sooth the physical, spiritual, political and economic anxieties that surround such an outbreak. In Liberia, Guinea, and Sierra Leone, abundant rumors and misunderstandings have hampered medical intervention, caused affected individuals to hide from medical staff, and have even resulted in the murder of healthcare workers. Unfortunately, it appears that some aspects of communications from the government and other international organizations have contributed rather than ameliorated the spread of misinformation.

In Togo widespread knowledge of the Ebola hotline number (111) demonstrated that the messages disseminated by national media, posters, and local radio, had reached a large part of the population. The quality of these messages, however, left much to be desired.

In his paper, Seytre moves beyond the Togo context to analyze Ebola communications, guidelines and tools provided by WHO and other international agencies throughout sub-Saharan Africa. He argues that there were several flaws in these communications. Firstly, messaging emphasized the dangers of consuming bushmeat, and various forms of hunting. However, whilst animal-to-human transmission triggers Ebola outbreaks, transmission within an outbreak are human-to-human because people’s contact with effected species tends to either be very limited or the odds of animal-to-human transmission remain slim: there is an average of 1 transmission per year among 22 millions people inhabiting the area of distribution of the bat species which are the virus reservoir. That accounts for only 3,4% of the habitants of the 22 countries where these bats are found. Entire countries, such as Senegal, Burkina Faso or Niger, are not at risk at all. Even in at-risk areas, there was no proof that hunting was the main way by which Ebola was transmitted. Despite this, Ebola communications attempted to dissuade hundreds of millions of African from eating bushmeat, which was often their main source of protein. Ultimately, however, Seytre argues, these communications were not trusted by their target audience, who continued to hunt. In short, they were both ineffective in changing behavior and undermined the efficacy of the global communications efforts.

Secondly, where messaging did tackle human-to-human transmission, guidance was confused: Some UNICEF posters, for example, included instructions to cook food thoroughly, clean out stagnant water, and bury or burn waste. In practice, however, such practices have nothing to do with Ebola prevention and crowd out important, effective interventions.

Finally, public health announcements encouraged citizens to stigmatize any apparently risky behavior. A USAID picture book, for example, encouraged communities to report any newcomers to the authorities. Meanwhile, a WHO, UNICEF and ONUCI picture book included a series of images showing a man denouncing a hunter to the police, with the caption ‘I should report all preventive measure violations to the authorities’. Even though both health workers and anthropologists have documented that stigmatization and coercion undermine efforts to control the disease, these books encourage a repressive management of the epidemic. This was only compounded by the fact that the relative degree of infection risk that people faced in particular areas was not made clear.

Altogether, these factors highlight the various areas for improvement in public health messaging. Such information does not just impact upon the technical risks of contracting Ebola: It can also have important socio-political ramifications, marginalizing those who are in most need of support and medical intervention.

For more details of the study, you can read Seytre’s paper, here.