Insights ‘Misinformation’ and the Control of Ebola
The Ebola outbreak in the Democratic Republic of Congo (DRC) is clearly proving very hard to control. Much of the difficulty must be put down to the armed conflicts on the ground, which complicate the environment for public health efforts. However, the regular reports of action being hampered by ‘misinformation’ suggest that international interventions are also making the same errors that undermined their work in West Africa in 2013.
Ever since the beginning of the COVID-19 pandemic, the public health world has struggled with the concepts of truth and error. It has discovered that these are not simple matters of scientific fact but judgements that are deeply embedded in social institutions that confer legitimacy on some versions but not on others. Since science is claimed to proceed through the resolution of uncertainty by investigation and debate, there has been an inevitable tension between attempts to decree truth by fiat and reasonable disagreements over the interpretation of data or the inputs and algorithms used in modelling.
The claims about misinformation in the DRC Ebola response raise the same issues. They imply that there is a truth possessed by the claimants that is not acknowledged by many local people, who are, therefore, victims of error. There is no recognition that the different parties may operate with different understandings of the world, which lead to different evaluations of the interventions that are proposed by one party to control the actions of others.
I have not been able to locate anthropological work from the specific region affected by the outbreak. Instead, I am drawing on work by my colleague, Nate Sawadogo, and myself for our forthcoming book, Sickness and Social Order, examining the social management of disorders of body and mind in Burkina Faso. We have focussed on the approach traditionally adopted by the Mossi, who are the largest ethnic group in that country. This, however, has elements that are widely shared across West Africa and extend into at least some parts of the DRC.
If this is the case in the regions bordering Uganda, then the resistance to Global North models should be understood as a clash of cosmologies that furnish different accounts of the relationship between the social, the natural and the supernatural. If the parallel is not exact, then our work may still be a model for the inquiries that should accompany outbreak responses, if they are to be effective. Similar work should have been done in Sierra Leone and its neighbours in 2013. The World Health Organization (WHO) pledged to learn from its absence but does not seem to have done so.
The key issue is the way in which the Mossi understand their present lives as moments in a community of past, present and future generations. It is not a straightforward theory of reincarnation but it sees individuals as, at least partly, the expression of a vital force that is derived from their ancestors, will ultimately return to the ancestors, and will form part of the inheritance of a future child. This cycle may be broken if the deceased died an unnatural death, left no descendants or committed incest. Their spirit will be left to wander rather than rejoining the community. Funeral rites are important to maintaining continuity, securing the spirit’s reunion with the ancestors, and ensuring that it does not become a homeless, malevolent, force in the environment. Although many Mossi have now converted to Islam, it is to a rather idiosyncratic version that retains many of these elements.
Death, then, does not have the finality that comes with most Christian traditions and with the, implicit or explicit, humanism of many working in public health. Other things being equal, Mossi people may reasonably prefer life to death but not at any cost. Death is a phase in the life of a community rather than the cessation of existence and a plunge into oblivion. There is not, then, the same motivation to pay a high price to avoid, or defer, this outcome. Given the mortality rate of Ebola, there is properly a concern to ensure that death is managed correctly, even at the expense of cross-infection. This is not misinformation but a different choice of beliefs and values.
When the public health effort is insensitive to the legitimacy of this choice, it inevitably raises echoes of the colonial past, which was particularly brutal in the DRC. Even in French West Africa, it is clear that Africans saw immunization, for example, as second-class medicine. Where missionaries, military personnel, and plantation owners were treated individually, or evacuated to urban hospitals, when they were sick, villagers saw lay vaccinators escorted by soldiers to impose compliance.
The contrast with Uganda is instructive. Although Uganda does not have the complication of a weak state and armed groups competing for a share of the natural resources of the region, it has successfully contained the handful of Ebola cases that have spilled over the porous border. Uganda has a long history with Ebola and a practiced public health response. It also has an effective structure of village health workers, who are not simply recruited in times of crisis. There are periodic problems in funding their services, depending upon the state of the national economy and the shifting priorities of NGOs. Nevertheless, it means that infection control and vaccination can draw on an established framework of trust, respect, and mutual education between local residents and public health personnel.
In many respects, Uganda exemplifies the approach that WHO used to advocate, reflected in the 1978 Alma Ata Declaration, before financial crises led to its capture by the biomedical-industrial thinking of major Global North philanthropists.1
As the WHO’s own assessment of its response to the 2013 Ebola outbreak in Sierra Leone concluded, the involvement of social and behavioral sciences was essential.
On the ground this has got precisely nowhere, leading to a staggeringly insensitive response to the COVID-19 pandemic in Africa.2
How long before the leaders of responses to outbreaks of infectious disease will call the social scientists at the same time as they call the immunologists? The most sophisticated biomedical science is useless unless it can survive in the wild.
