Community action during COVID-19: What can we learn from Ebola response?

Liberian General Community Health Volunteers who were involved in Ebola contract tracing, case finding and Ebola awareness and prevention (Image from flickr: United Nations Development Programme CC BY-NC-ND 2.0)

Facing COVID-19, communities are trying to strike the balance between locking each other out and keeping each other safe. As government experts and political commentators examine the art of public health messaging for effective behaviour change, lessons could and should be drawn from the most devastating health emergency in recent times: the 2013-2016 Ebola Virus Disease (EVD) epidemic in western Africa. EVD had an incredibly high death rate (50%) and broke out in countries with severely under-resourced healthcare and little public health access. During the EVD epidemic, communities faced similar challenges as with COVID-19, though with even more deadly consequences.
 
Multiagency reports show that early in 2014, EVD public health messaging was understood, but failed to motivate meaningful behavioural change. For example:

• 87% understood that the disease was transmitted through blood and bodily fluids, but less than 36% were avoiding physical contact with others.
• 85% agreed that avoiding customary burials and funerals that require handling or proximity to the body of someone who died from Ebola reduces spreading the disease. Yet nearly 30% of transmission occurred during unsafe or secret burials.
• 91% agreed that if symptoms appeared, they should go directly to a health facility to receive treatment and that this would improve their chances of survival. But tragically, with the fear of being ostracized or dying alone, a significant number of patients continued to hide from the authorities or presented too late to survive.

 
Why comprehension may not result in action
During an emergency, the individual’s ability to shape what is happening to them is severely reduced. This loss of control leads to a perceived reduction in personal efficacy (an inability to produce desired effects and forestall undesired effects by their actions), leaving individuals with little motivation to act. Social psychological researcher Bandura argues that due to an increasingly interdependent world, people will turn to their communities to accomplish what they cannot individually. Perceived collective efficacy will subsequently determine how confident or discouraged they are to tackle bigger societal problems.
 
In countries with strong emergency infrastructure, however, individuals may turn to state proxies instead of the collective. They may call an ambulance, fire services, or police to assist them in overcoming a challenge they cannot, rather than a neighbour.  The proxy replaces the collective. Therefore, it may be argued that collective action during an emergency is made redundant by the state-led initiative. If this were the case with COVID-19, epidemiologists speaking from a government platform via the national broadcaster should command public compliance. Yet, in many cases they do not.
 
Similar patterns were also borne out during the EVD epidemic. Studies confirm that the disconnect between individual comprehension of public health messaging and meaningful behavioural change, was due to a failure of national and international responders to address community practices. That is, national and international leadership overlooked potential collective solutions at the community level, with fatal consequences for those communities.
 
In the latter part of 2014 community health workers and local journalists intervened. To confront EVD, these groups translated public health messaging through a community lens, directly addressing rumours and misinformation. Within six months of community interventions, humanitarian agencies reported significant improvements in prevention measures; over 95% of EVD patients presented to health facilities within 24 hours of experiencing symptoms. Emergency response organisations were able to leverage understanding of local explanatory models, history of previous emergencies, beliefs, practices, and politics through community health workers. Contact tracing and education campaigns were undertaken by local volunteers. Together with religious authorities, new burial practices were enacted.
 
Especially in countries with developed health systems, the COVID-19 response has largely overlooked community responses. The focus on unified top-down policy is important, but the efficacy may be limited as during EVD. Collective efficacy is key to mobilise to save lives and keep each other safe.

 - By Siobhán McEvoy & Laura K Taylor
 
Laura K. Taylor (PhD) is an Assistant Professor, School of Psychology, University College Dublin (Ireland) and Queen's University Belfast (Northern Ireland). Her research integrates peace studies with developmental and social psychology to study how to promote constructive intergroup relations and peacebuilding among children and youth in divided societies. 
 
Siobhan McEvoy is a humanitarian consultant specialising in social mobilisation and community engagement with people displaced due to conflict. Her work has included tackling misinformation during migration of refugees in southern Europe, understanding the use of Rohingya language in responding to health emergencies in refugee camps in Bangladesh and creating strategy for community mobilisation in South Sudan to prevent the spread of Ebola virus disease.