Beyond the virus: How social science shapes the response to Ebola outbreaks

As health officials respond to an Ebola outbreak in the Democratic Republic of the Congo (DRC), College of Arts and Sciences Assistant Professor of Anthropology Megan Schmidt-Sane, PhD, (GRS ’20, anthropology) is examining the social and behavioral factors that shape how communities experience and respond to public health emergencies.

Schmidt-Sane, a medical anthropologist with a background in public health, recently contributed to two policy briefs on lessons from social and behavioral science research that can inform the response to the current outbreak. Her work explores how community trust, cultural practices and local perspectives influence the success of public health efforts.

In this Q&A, Schmidt-Sane discusses what the current outbreak means for communities in the DRC and beyond, and why understanding the human side of public health is essential during times of crisis.

For readers who may not be following this closely, what should they know about the current Ebola outbreak in the DRC? How does it compare to previous Ebola outbreaks?

The main issue is that this is a less common species of the Ebola virus, Bundibugyo, and so there are no available vaccines or therapeutics. The diagnostic capability is limited as well. The outbreak center is in a gold mining area of Ituri Province in Eastern DRC, where there are multiple non-state armed groups operating, internally displaced people and a population that is strongly linked to communities across the Ugandan border—all of which makes it a challenging context to work in. However, you also have the best Ebola scientists in the world in DRC and Uganda, and they are building on past experiences.

Your policy brief emphasizes social and behavioral science lessons. Why are social factors just as important as medical interventions during an Ebola outbreak?

The medical interventions will not work without knowledge of social and cultural context. To get a vaccine (when vaccines are available) or to convince people to tell health workers that their loved one may have symptoms of Ebola—these are all social issues, not medical ones. The World Health Organization (WHO) itself has stated that the success of the outbreak response hinges on public health measures as there are limited medical countermeasures available. This is where the social piece comes in, though it is too often overlooked, and we seem not to have learnt from COVID-19.

How do local cultural practices, community networks and everyday realities shape how people respond to public health guidance?

People are complicated and their cultural, religious, social and economic needs are just as important as their health needs, which we too often forget in public health. People view public health guidance through their cultural lens—how they feel about safe burials or vaccines, for example. We learned during the West Africa Ebola epidemic that safe burials without the consultation of community and religious leaders will not work and will not have community buy-in. People started resisting safe burials—not because of the Ebola risk, but because safe burials did not respect religious needs and ceremonies. But culture can change. When anthropologists started working with communities, safe and dignified burials were designed to meet both medical and cultural needs. In DRC, we are also seeing resistance to safe burials, but there is a need to design burials with communities to build trust in the process.

What does this outbreak teach us about global health preparedness and our interconnected world?

Preparedness is a vital investment—we cannot rely on response to public health emergencies alone. It is often too late to contain outbreaks, and so it’s important to invest in preparedness that puts communities at the center. Otherwise, communities are rightly skeptical if public health attention is only brought during an outbreak. In Eastern DRC, people have asked where the money and attention was for other ongoing problems like malnutrition or conflict.

The WHO declared this outbreak a Public Health Emergency of International Concern. What does that designation mean in practice?

It means that a great deal of resources can and will be mustered, including coordination efforts at the global level. Africa CDC has declared this as a continental emergency which is also important. It means that all of these emergency response centers are activated, enabling more coordination and information sharing, as well as a heightened response.

Looking ahead, what gives you hope as communities, researchers and health professionals work to bring this outbreak under control?

The news coverage in the US has focused on the US absence in the response—our withdrawal from the WHO, the closure of the United States Agency for International Development—and it is also spreading panic. This situation is rightly concerning, but the narrative centers the expertise of US public health responders and sidelines the importance of people working locally in DRC and neighboring countries like Uganda. They are the ones who are on the frontlines of the response, including large numbers of volunteer community health workers who are quite literally putting their lives at risk. US funding should come through, but the paradigm for our engagement must change from a US-centered effort to one that uplifts and supports African scientists and communities in their response efforts.