Involving local communities: the Ebola case

The report published in March 2015 by Medecins sans frontières speaks out clearly against the “global coalition of inaction” and the “vacuum of leadership” in the Ebola crisis in West Africa. Those who were struggling in the field against a huge and out-of-control emergency, without the necessary resources, list the main causes of such a situation: lack of political will, inexperience, and, sometimes, simply fear.

At the beginning of 2015, WHO director Margaret Chan acknowledged that her agency was totally unprepared to face such a threat, promising the deepest reform of the organization since its foundation, in 1948. This change should transform a technical and advisory agency into an operative body, equipped with stable funds for emergencies and with a ready-to-go team made up of doctors, healthcare assistants and epidemiologists.

A similar promise had already been raised after the controversial pandemic alarm in 2009, but now it could really be the right time to realize that supranational institutions must be enforced and provided with more independence, not weakened and subordinated to special interests.

Coherently, WHO recognized its own mistakes by stating – with humility and an unusually straightforward language – eight main lessons through which the organization could improve its activity and “play its rightful place in disease outbreaks, humanitarian emergencies and in global health security”. It also called all world leaders to do what is necessary in order to ensure that such a disaster will not happen again.

Of these lessons, two are of particular interest for the development of the activity of the ASSET project, since they are related to communication and community mobilization(1).

In the regions stricken by the Ebola outbreak, people spontaneously mobilized, rallying groups of volunteers to provide surveillance, spreading information, identifying infected persons and establishing checkpoints at many communities’ access points. According to several observers, such voluntary initiatives have played a major role in the containment of the epidemic, even more than the huge investments for the late construction of centres for patients. In Liberia, the American army set up eleven centres with hundreds of beds, which were completed only around Christmas 2014, when the spread of the disease was already declining: in the end, only 28 patients have been assisted in two of these centres, whilst the others remained completely empty.

The Italian NGO Emergency had a well-established presence in Sierra Leone for more than ten years, since the Civil war. It could therefore give a prompter response, thanks to a long-lasting dialogue with the local community, enabled and strengthened by trust and knowledge established in the previous years. For instance, in Waterloo – a former refugee camp from the time of the civil war, two hours away from the capital – Emergency supported several local volunteers by establishing a stable outpost equipped for training, information, triage and transfer of suspected cases with an ambulance.

Similar activities, in cooperation with those raised by spontaneous mobilization, manage to prevent resignation and despair, and help to build trust. However, international authorities often disregarded them, even if, by giving space and consideration to such a kind of intervention, it would have been possible not only to prevent several deaths, but also to lay the basis for a faster “reconstruction” of the region.

Contact and communication with the local communities would have also facilitated to implement clinical trials for potential experimental therapies.

Even in this field mistakes were made. First of all, in some of the few studies launched, no randomized controls were included, since they were considered unethical (while the contrary is true, in case of uncertainty). Without comparison with current treatment, in fact, results from trial cannot be significant, thus representing a waste from every perspective, including the moral one.

Then, priority should have been given to test well-known drugs, already in use for many years to treat other diseases, and supposed to be potentially useful in Ebola as well. This approach could avoid unknown risks for patients and, in case of positive result, a solution immediately available without restriction and at a lower cost. However, such an opportunity was not grabbed.

Finally, one of the objections raised against randomized clinical trials was the impossibility to obtain a proper informed consensus. It is indeed a difficult task, also in less dramatic and more developed contexts, but not only for clinical trials. Every kind of individual or collective treatment – be it experimental or not – during the course of a tragic event like the Ebola epidemic, would require an extraordinary effort to inform and involve patients and their families.

One more time, dialogue, listening, communication, along with people and community mobilization, are the keys not only to achieve success against health threats, but also to fulfil our duties as human beings.

Roberto Satolli


(1) The author has been in Sierra Leone in November 2014 at the Emergency Centre, and participated to the efforts aimed at launching a clinical trial against Ebola based on amiodarone.

MMLAP and other EU Projects

Health system analysis to support capacity development in response to the threat of pandemic influenza in Asia
Making society an active participant in water adaptation to global change
Public Participation in Developing a Common Framework for Assessment and Management of Sustainable Innovation
Engaging all of Europe in shaping a desirable and sustainable future
Expect the unexpected and know how to respond
Driving innovation in crisis management for European resilience
Effective communication in outbreak management: development of an evidence-based tool for Europe
Solutions to improve CBRNe resilience
Network for Communicable Disease Control in Southern Europe and Mediterranean Countries
Developing the framework for an epidemic forecast infrastructure
Strengthening of the national surveillance system for communicable diseases
Surveillance of vaccine preventable hepatitis
European monitoring of excess mortality for public health action
European network for highly infectious disease
Dedicated surveillance network for surveillance and control of vaccine preventable diseases in the EU
Modelling the spread of pandemic influenza and strategies for its containment and mitigation
Cost-effectiveness assessment of european influenza human pandemic alert and response strategies
Bridging the gap between science, stakeholders and policy makers
Promotion of immunization for health professionals in Europe
Towards inclusive research programming for sustainable food innovations
Addressing chronic diseases and healthy ageing across the life cycle
Medical ecosystem – personalized event-based surveillance
Studying the many and varied economic, social, legal and ethical aspects of the recent developments on the Internet, and their consequences for the individual and society at large
Get involved in the responsible marine research and innovation
Knowledge-based policy-making on issues involving science, technology and innovation, mainly based upon the practices in Parliamentary Technology Assessment
Assessment of the current pandemic preparedness and response tools, systems and practice at national, EU and global level in priority areas
Analysis of innovative public engagement tools and instruments for dynamic governance in the field of Science in Society
Public Engagement with Research And Research Engagement with Society
Computing Veracity – the Fourth Challenge of Big Data
Providing infrastructure, co-ordination and integration of existing clinical research networks on epidemics and pandemics
Promote vaccinations among migrant population in Europe
Creating mechanisms for effectively tackling the scientific and technology related challenges faced by society
Improve the quality of indoor air, keeping it free from radon
Improving respect of ethics principles and laws in research and innovation, in line with the evolution of technologies and societal concerns
Investigating how cities in the West securitise against global pandemics
Creating a structured dialogue and mutual learning with citizens and urban actors by setting up National Networks in 10 countries across Europe
Identifying how children can be change agents in the Science and Society relationship
Establishing an open dialogue between stakeholders concerning synthetic biology’s potential benefits and risks
Transparent communication in Epidemics: Learning Lessons from experience, delivering effective Messages, providing Evidence