Rachel Thomas maps out the various institutions involved in the response and reviews communication challenges.The ongoing outbreak of Ebola in West Africa is the largest and longest since the virus was discovered four decades ago. Many organisations have been fighting this epidemic and grappling with social, cultural and political factors. The need for social science and effective communications when responding to outbreaks is clearer than ever, as is the need to look critically for lessons that can guide future efforts. The resources below summarise the various institutions helping to fight the epidemic and highlight communication efforts.
The UN, the WHO and governments
The outbreak is being fought by more individuals and institutions than can ever be listed. But there are a few key players.
At the international level, the World Health Organization (WHO) is primarily responsible for coordinating the overall response. Its dedicated website publishes data about the status of the epidemic and other information such as advice and official health messages. Its ‘situation reports’ summarise how the epidemic is progressing and the challenges currently facing responders. The organisation’s involvement is detailed in its Ebola Response Roadmap designed to help responders make and implement operational plans. A report by the WHO director-general published in early January outlines the challenges for the international response and addresses criticisms by the medical charity Médecins Sans Frontières (MSF) that reaction to this outbreak has been irresponsible and too slow.
The role of the UN is broader than that of the WHO. Its involvement includes technical and logistical support. The UN secretary-general has created the Global Ebola Response Coalition, with representatives from affected areas, NGOs, donors and other agencies, which holds weekly meetings to help maintain operational consistency. The secretary-general also appointed a special envoy to direct response policies and strategies, and to strengthen support for the affected areas. For this crisis, the UN set up its first emergency health mission, the UN Mission for Ebola Emergency Response (UNMEER), which is helping with activities such as managing cases of infection, tracing infected people’s contacts and conducting safe and dignified burials. Other UN organisations, such as the World Food Programme (WFP) and Unicef, are supporting the response with activities such as distributing food, health supplies and infrastructure.
The governments of Guinea, Liberia and Sierra Leone are actively fighting Ebola. Together with the WHO, they have devised a plan to coordinate the response at different levels, create public awareness about risky and safe behaviours, prevent and control Ebola’s spread and put in place clinical interventions. Nigeria and Senegal also had cases but tackled them quickly, thanks to a response including swift testing of all suspected cases in Senegal and rapidly establishing an Emergency Operations Centre in Nigeria.
Several developed nations have also contributed to the response, in particular those governments with colonial links to the three affected countries. In Guinea, France has helped train healthcare workers, establish treatment centres, support research and strengthen healthcare systems. Across the region, but particularly in Sierra Leone, the United Kingdom has provided funding, medical experts, healthcare personnel training, emergency supplies and scientific support. It has also helped with logistics through its military. The United States is involved in many aspects of response such as sending medical staff and supplies, constructing treatment centres and training healthcare workers. The website of the US Centers for Disease Control and Prevention (CDC), a federal public health agency, provides information on the disease and regular updates on the response.
International NGOs, volunteers and researchers
MSF, which provides front-line medical care in crisis-hit areas, sounded the alarm about the Ebola epidemic before it reached the world stage, and its staff have remained on the ground throughout. The charity’s webpages dedicated to the Ebola emergency provide information on the disease, MSF’s activities and updates from the field including a blog written by staff working in affected countries. A recent report released one year after the start of the outbreak takes a hard look at the response, criticises global inaction and warns that the epidemic is not yet over.
Several other international NGOs are involved in the response — USAID’s Center for International Disaster Information (CIDI) provides names and contact details. NGOs have varied roles. For example, the charity Save the Children is building and managing clinical treatment units, running awareness campaigns and training community healthcare workers. Other NGOs with major involvement include Oxfam, the International Rescue Committee and Plan International, which are providing support in areas such as coordination, early warning systems, water and health infrastructure, and food aid.
Volunteers and researchers also play a part. Many medical personnel have travelled to work in West Africa, helped by organisations such as USAID, UK-Med and the International Medical Corps.
Scientists and public health experts such as Peter Piot, who codiscovered the Ebola virus in the mid-1970s, have been advising governments and agencies or undertaking research projects, such as those funded by the Research for Health in Humanitarian Crises (R2HC) programme. In addition to the medical and public health experts normally involved in health crises, the outbreak has involved anthropologists, some of whom outlined the value of local knowledge and the importance of challenging perceptions of African ‘otherness’ even before this outbreak. Anthropology can offer insight into how human interactions and social practices influence the epidemic and control measures. The Ebola Response Anthropology Platform is a network of social scientists providing advice on the outbreak’s social, cultural and political dimensions.
Poor coordination and mixed messages
A briefing paper by MSF has highlighted poor coordination between key players at the beginning of the outbreak. And a report by the CDC describes communication as a continuing challenge, especially where people resist interventions and where minimal infrastructure in rural areas hinders response efforts, such as tracing contacts of infected people and reporting unsafe burials. Reports and briefings by social scientists offer insight into the context of people’s resistance to public health messages, including examples of good communication and guidance on how to successfully adapt medical interventions.
The epidemic has received much attention in the mainstream media and academic literature. Various institutions, as well as the agencies, governments and NGOs highlighted above, are helping to transmit accurate information about the epidemic via reports and blogs on their websites. These include the medical journal The Lancet, Science magazine and the UK’s Institute of Development Studies. But communication has also been criticised for fear-mongering and sensationalism, mixed messages and local misreporting, which, in some cases, led to government restrictions on journalists.
Social media channels initially fuelled misinformation about the outbreak and about treatments, but they also disseminate accurate information and offer a useful reflection of how people make sense of the outbreak. Sierra Leone’s Ministry of Health has used its Facebook pages to boost morale by reporting discharged cases. Digital technologies such as Unicef’s U-report system offer access to information and services via a mobile phone. Musicians have put Ebola messages to song, and a radio drama, developed by BBC Media Action, is one example of radio’s powerful role in keeping people informed.
As the outbreak eases, those involved are asking what can be done better in future health emergencies. The WHO has highlighted the need for basic health infrastructure, coordinated action and learning from success stories. MSF has pointed to the failure of multiple institutions to act effectively, including poor leadership from the WHO on coordination. Research on this and previous outbreaks has also found it is crucial to actively engage the people affected, beyond merely correcting misinformation, if epidemics are to be contained. But the process of reflection and learning is far from over.
Rachel Thomas is a medical doctor and writer. She can be contacted at [email protected]
This article is part of our Spotlight, Managing health crises after Ebola.