Survey: Social Resistance is Prevalent Among DRC Citizens

IDWeek 2019 is officially underway in Washington DC.

There are dozens of talks and presentations occurring this week but 1 particular abstract caught my eye which tackled how social resistance was fueling the transmission of Ebola in the Democratic Republic of the Congo (DRC). This abstract and its discussion was particularly poignant as the outbreak in the DRC is still underway, more than 1 year after it was declared. According to recent estimates, there are over 3191 cases of Ebola and public health responders are working to investigate 425 suspected cases. From vaccination efforts with the experimental Ebola vaccine to a grim reality of an outbreak that has already killed 2129 people, international and local response efforts have faced a barrage of challenges. This particular abstract, presented by Qaasim Mian, MD, MBA, of the University of Alberta, focused on the social dynamics within the outbreak that have made response and prevention so difficult.

Social resistance is not a new concept for outbreak response; this challenge was also pressing during 2013-2016 Ebola outbreak in west Africa. The authors of the abstract emphasized that there is a range for social resistance from passive non-compliance to acts of aggression towards Ebola response teams and workers. Understanding these subtle differences is critical in developing effective response measures.

The research team studied community resistance through focus group discussions and then studied the prevalence of resistant views within the questionnaires. “Despite being generally cooperative and appreciative of the foreign-led Ebola response, focus group participants provided eyewitness accounts of aggressive resistance to control efforts, consistent with recent media reports. Mistrust of Ebola response teams was fueled by perceived inadequacies of the response effort (‘herd medicine’), suspicion of mercenary motives, and violation of cultural burial mores (‘makeshift plastic morgue’),” the authors wrote.

The investigators found interesting results from the survey. The majority of those who responded had compliant attitudes towards Ebola control measures in general, but 12% (78 out of 630 respondents) believed that Ebola was a fabrication and was not exist in the area. Sadly, 72% were dissatisfied with Ebola response, while 9% ultimately sympathized with those who engaged in overt hostility. Additionally, 15% of the respondents expressed non-compliant intentions in the event they had a family member become ill or die due to Ebola. These non-compliant intentions included hiding from health responders, touching the body, or refusing an official burial team to safely bury their loved one.

The analysis of the survey responses found a statistically significant association in denial of the biomedical discourse and dissatisfaction or mistrust of the Ebola response as indicators of social resistance.

From these findings, the researchers noted that there is an undeniable prevalence of social resistance in this Ebola outbreak. The authors noted, “Mistrust, with deep political and historical roots in this area besieged by chronic violence and neglected by the outside world, may fuel social resistance.” This research shed light on many of the suspected social dynamics that challenge response efforts but also delved into detail of what is needed to refine education and community outreach to truly be effective.

The abstract, Social Resistance Fuels Ebola Transmission in the Eastern Democratic Republic of Congo, was presented in an oral abstract session on Thursday, October 3, 2019, at IDWeek 2019 in Washington DC.