Washington, D.C., October 5, 2014 (AMG) – As the first case of Ebola in the United States is confirmed in Texas, the hysteria surrounding the current Ebola outbreak is reaching fever pitch. Of course, Ebola is a terrifying disease. It threatens to indiscriminately wipe out entire families and stretch a healthcare workforce already at breaking point, but it has also ushered in another, possibly more deadly epidemic that must be contained.
Eight people murdered: It has no pathogen or laboratory test, and its methods of transmission cannot be broken down into an easy-to-read chart. Yet, it is the apparent reason that eight health workers, local officials and journalists lost their lives in the small village of Wome in Southern Guinea last month, while on a mission to raise awareness about Ebola. This other epidemic, is fear.
It was fear that apparently motivated local citizens to attack and kill the group on arrival, stowing some of their bodies in a septic tank in a nearby school after attacking them with clubs and machetes. While no motive has been given, correspondents say that people in the area are deeply suspicious of officials’ attempts to control the disease and that many doubt Ebola’s existence.
Wome was the first place that the world’s deadliest Ebola outbreak was recorded, and it is where fear has festered for the longest. Other attacks reported by the Red Cross have occurred throughout the region as people look for answers amid confusion of grief.
The current death toll stands at over 3,300, far more than the eight who died in Wome. But fear has had far-reaching consequences beyond this one tragic incident. It has prevented people from coming forward for quarantine when showing symptoms of infection, from reporting their dead and from caring for orphans left behind.
Reports detail demonstrations in Kenema, Sierra Leone where local protestors have gathered at an Ebola treatment centre with the intent to free patients from isolation. They proclaimed Ebola a lie and accused clinicians of stealing patients’ blood. Rumours include the suspicion that Ebola can be caught through motorbike helmets and can be cured by eating two large onions.
The implications of this are clear: there is no incentive for those infected to seek treatment if they do not trust the people who are there to care for them, or if they believe they can cure it by following the remedies of healers whom they trust and who are not dressed in frightening space-suits.
Lessons from the past: This epidemic has parallels in history. The HIV epidemic shook the continent to its core in every aspect and continues to be a part of daily life for families, health services and the economy. Fear gripped the world in its attempt to respond to HIV, whose narrative also includes shunned orphans, demand for access to experimental drugs, unrealistic expectations of the appearance of a cure and stigmatization of those infected.
In another development last week, Dr. Gorbee Logan of Liberia began treating patients who had contracted Ebola with the HIV drug lamivudine out of desperation after reading about the similarities between the two viruses. Of the 15 who he has treated with the drug, two have died – a far lower fatality rate than is being seen in treatment centers elsewhere. Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases, says that there is logic in the approach given the similarities in the way that the two viruses replicate inside the body. Additionally, drugs currently being tested for Ebola treatment belong to the same class as lamivudine.
This week at the African Center’s discussion ‘Combating the Ebola Outbreak: Lessons Learned from and Prospects for the International Response’ held in Washington, D.C., Colonel Nelson Michael, Director of the US Military HIV Research Program, warned that public health emergencies “tended to become epidemics of fear.” He also reminded the crowd that a strong and consistent emphasis on community participation at every step is key to a successful intervention.
Lessons can be learnt from the response to HIV so long as healthcare workers have the local knowledge to address the terrifying epidemic with familiar strategies and messages. Rashid Ansumana, a researcher at Mercy Hospital Research Lab in the city of Bo, Sierra Leone points out that HIV prevention messages can be used to communicate how Ebola is transmitted through blood and other bodily fluids. This knowledge is well established following years of HIV awareness campaigns.
The Guinea government has now announced plans to send 2,000 young people to areas of greatest need to explain Ebola in much the same way that peer educators and community health workers have been used to effectively combat HIV. Churches and mosques have lent their authority by endorsing Ebola awareness campaigns, a development light years ahead of where those battling stigmatization and misinformation stood at a similar stage during the fight against HIV. The beginnings of a community response can be felt amidst the most urgent need for medical supplies and logistical coordination.
Cautious optimism: At the African Center discussion, Donald Shriber, Deputy Director for Policy and Communication at the Centers for Disease Control and Prevention Center for Global Health, commented; “we’re all hungry for good news but we must not be complacent. At the first sight of good news we can’t give up, we have to pursue with the same vigour.”
As dire as the situation appears now both on the ground and in the media, health professionals and policy makers must use all resources to hand. They cannot be complacent about the lessons learned from other epidemics of the last few decades, including HIV. The level of mistrust felt by communities cannot be ignored in the development of a comprehensive response. Traditional beliefs and mechanisms of self-defense should not be scoffed at or dismissed; they are deep seated and important. As the response progresses and widens it must include a desire to understand and respond to communities’ fear so that this second deadly epidemic can be contained as well.
Resource: UNAIDS Guidelines for HIV community prevention trials which can be adapted for the Ebola response.