Ebola: a crisis of coordination, communication and confidence

Monday, 27 July 2015
Waqas Haque & Samara Linton (Africa APPG guest blog)


Despite the initial claims in May that Liberia’s was Ebola-free, the return of Ebola cases in Liberia earlier this month and other spikes in surrounding regions pose a threat to our initial optimism [1, 2]. This outbreak has been deemed the most lethal Ebola epidemic in history since its inception over a year ago and the surrounding narrative has finally begun to acknowledge some of the structural challenges that make viruses pathologically salient in the first place [3].


For epidemiologists, the presence of the Ebola Zaire strain in West Africa presents a geographical anomaly, asking what is Ebola Zaire doing in a region such as West Africa. The Zaire strain, which presents mortality rates of up to 90%, has generally been confined to Central Africa [see Figure 1 below] and has not been spreading westward in recent years [4].

[Figure 1] Distribution of Ebola Strains in Africa [4]

For researchers, the outbreak can be attributed to a fruit bat spreading Ebola Zaire to Guinea’s forest regions, highlighting the role of sanitation and migration in disease control [5].

However, for policymakers the impact of this Ebola outbreak can be attributed to the inadequacy of the international response. In particular, many have noted the failure of the World Health Organization (WHO) and other international donors to swiftly respond to the outbreak [6]. Even when WHO aid eventually arrived several months late during September 2014, it was packaged in a ’militarized’, top-down logic focusing on short-term relief instead of considering the contextual needs of local areas [7].

Although building care centres and recruiting foreign doctors may work temporarily, these efforts do nothing to prevent migratory, cultural, and other institutional contributors to the epidemic. The successful efforts of many local villages and respective community health workers in containing the spread of Ebola – in spite of inadequate resources – has led to calls for developing a bottom-up public health agenda.

The community-based approach to confronting the Ebola virus seeks to incorporate the perspective of local peoples and localized knowledge [8]. So far, community engagement revolves around curtailing high-risk traditional practices and implementing behavioural and knowledge-based public health measures. Interview studies reveal that hundreds of community leaders in West Africa champion the inclusion of localized initiatives in containing Ebola, including restricting migration in and out of locales, establishing community task forces and block watch teams, and household triage [9].

Such efforts help shift attention to ‘invisible’ determinants of disease that may be cultural or psychological in nature. For example, anthropologist groups have previously worked within the tradition of local villages to mitigate the occurrence of unsafe burial rites [8]. Erasing the pervasive culture of mistrust is paramount for future cooperation, as many sampled Ugandan residents refuse to send their loved ones to Ebola care centres due to their held suspicion that such patients will be poorly treated and that their corpses might be donated to science [9].

However, the support of local programmes is fraught with challenges. Due to the complexity of coordinating international aid, the support of bottom-up capabilities is ignored due to the lack of time and money available from funding groups. This only worsens the already existent perception by ordinary citizens that aid organizations do not have the people’s ultimate interests in mind.

In many villages, the lack of generalised trust for state-based institutions and outside groups stems from decades of warfare, socio-economic ruin, and the inability of the government to deliver basic services [10]. Even when stakeholders do engage local communities, they often blame villagers. For example, a campaign in Sierra Leone involved going from door-to-door to remind residents, ‘How bad does it need to get before you take notice and start to fight this disease?’ [8].

To better understand how communities can play a role in the West African context, our group is working with the Africa All-Party Parliamentary Group on a report tentatively titled ‘Community led approaches to health systems strengthening: lessons from Ebola’. By employing our own questionnaires designed to elicit the health needs of community leaders in Sierra Leone and Liberia, the APPG report will offer a more nuanced approach to the Ebola epidemic that challenges conventional wisdom and offers a platform for new policy measures.


Waqas Haque and Samara Linton



[1] Goyal R. 2015. Africa in the news: Liberia declared Ebola-free, U.S. Senate passes AGOA, unrest escalates in Burundi, South Africa’s Democratic Alliance elects their first black leader. http://www.brookings.edu/blogs/africa-in-focus/posts/2015/05/15-liberia-ebola-senate-agoa-burundi-south-africa-democratic-alliance-goyal [Accessed 16 May 2015].

[2] WHO. 2015. Ebola Situation Report. http://apps.who.int/ebola/en/current-situation/ebola-situation-report-10-june-2015 [Accessed 18 June 2015].

[3] CDC. 2015. 2014 Ebola outbreak in West Africa. http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/ [Accessed 16 May 2015].

[4] Bausch DG, Schwarz L. 2014. Outbreak of Ebola virus disease in Guinea: where ecology meets economy. PLOS Neglected Tropical Diseases, 8(7): e3056.

[5] Baize et al. 2014. Emergence of Zaire Ebola virus disease in Guinea – preliminary report. New England Journal of Medicine. doi:10.1056/NEJMoa1404505.

[6] Roland D. 2015. Experts criticize World Health Organization’s ‘slow’ Ebola outbreak response.http://www.wsj.com/articles/experts-criticize-world-health-organizations-slow-ebola-outbreak-response-1431344306[Accessed 16 May 2015] [7] IDS. 2015. IDS practice paper in brief 17 [Accessed 16 May 2015].

[8] IDS. 2015. IDS practice paper in brief 24 [Accessed 16 May 2015].

[9] Abramowitz et al. 2015. Community-centered responses to Ebola in urban Liberia: the view from below. PLOS Neglected Tropical Diseases: doi:10.1371/journal.pntd.0003706.

[10] IDS. 2015. IDS practice paper in brief 19 [Accessed 16 May 2015].


 Image Credit: Flickr UNMEER/Martine Perret


Waqas Haque is an M. Phil. student in Innovation, Strategy, and Organisation at the Judge Business School. His research focuses on introducing evolutionary psychology as a mechanism for understanding how corporate boardrooms develop strategy. Originally from Dallas, Texas, Waqas will apply to medical schools in America this summer and conduct research on pancreatic islet auto-transplantation after completing the M. Phil.  


Samara Linton is a third year medical student and will continue her studies at University College London next year. She previously worked with Polygeia as the Marketing officer. She was the president of the university’s African Caribbean Society and works with groups such as the African Caribbean Education in Schools Youth Project. Having been born in Jamaica, Samara is particularly interested in the role the diaspora in development, as well as health in Black and Minority Ethnic communities in the UK.