Misinformation Can Be Key Driver of Deadly Ebola

ebolagrafittiEarlier this month Christopher Graves, CEO for Ogilvy Public Relations*, wrote that “managing Ebola will take powerful communication.” It’s a sensible and thoughtful blog about a horrible disease that is such a public health nightmare for the people of West Africa. His point that the “world’s scariest outbreak of Ebola […] may come down to communications” really struck a chord with me, as did his methodical unpacking of the tough barriers that messaging needs to overcome to tackle and help stop this particular outbreak. It’s recognition that complex diseases require solutions that go beyond the standard portfolio of responses.

While HC3 does not focus on Ebola, the disease highlights key challenges in the public health займ на любую карту communication realm that the project seeks to enrich, and it’s certainly been trending as a discussion topic. I first read about how local artists are using music to help people protect against and prevent the spread of Ebola on HC3’s online platform,Springboard. Since then, I’ve come across several stories about songs used as a means to raise awareness of the disease. The Atlantic’s Uri Friedman’s “How to make a hit song about Ebola” is well worth the read, as is one that NPR recently posted, “’Shadow’ and ‘D-12’ sing an infectious song about Ebola.” Both stories use multi-media to tell important stories for their intended audiences and both do what is so important in the field of health communications – they amplify the messages as part of their storytelling.

The last few weeks have presented health agencies with unusually acute challenges around how best to design and deploy communications and media interventions that can make a real and rapid difference to the progression of the Ebola outbreak. In conversations with colleagues working in Guinea and Sierra Leone, it’s clear that despite the recent proliferation of messaging and other social mobilization efforts by multiple agencies, the complexities of a dynamic information environment continue to play a powerful part in determining to what extent people and communities engage with treatment and/or behavior change options. It is if course well recognized that information about prevention and treatment of spread is vital, and that rumor, misinformation, superstition and cultural factors (that thrive on word of mouth information flow) have all been significant obstacles to containing the epidemic. As the key messages about prevention and treatment options are relatively simple and finite, and as campaigns reach more and more of the population, the key test will be to see whether saturation messaging is sufficient to reverse the tide of the epidemic.

Graves specifically advocates for the kinds of messaging that plays out well as drama and storytelling, citing research that shows how audiences empathize with characters and how this can drive behavior change. Yet he recognizes that “creating such stories takes time”, and even more importantly that a “Western style of doing a media campaign … is not what is needed on the ground. What’s needed is really direct communication that begins by identifying key community leaders.” I would also add the media as an important actor in direct communication, and in particular radio, which is still how many people get their information.

I’ve been working with Alison Campbell, Internews’ Global Initiatives Director, on the organization’s Ebola response, and she reminded me that in countries like those affected by Ebola in West Africa, word of mouth through trusted social networks clearly has enormous potential to affect the progress of the epidemic for better or worse. “In remote ‘information ecosystems’ bad information can travel faster than good information merely by travelling through a trusted network, or by emanating from a locally trusted source,” she said, and added that it was “worth noting that connectivity (mobile, internet, SMS) now acts as a powerful amplifier of the grapevine.” Getting the message right does not necessarily mean it will be accepted or acted upon. As Campbell noted: “If you want to transform the nature of the grapevine (real or virtual), it becomes really important for health communicators to pay as much attention to community perceptions of the source and transmission of the information as to the integrity of the message.” When it comes to radio, its unique ability to mimic the power of the grapevine “enhances, illustrates and engages action by bringing local voices, stories, advice and news into people’s homes in the vernacular they understand, from local sources, peers and community members and/or through trusted interlocutors ranging from leaders to popular on-air hosts.”

Engage the media. Work with journalists and talk show hosts and support them in understanding the disease and the science behind prevention and treatment. Use the media to amplify the message, dispel rumors and superstitions, and stop the spread of misinformation, which in this instance, can only add to the deadly spread of the disease.

Reprinted with permission from the Health Communication Capacity Collaborative on September 4, 2014

Respond Quickly to Ebola with Community Mobilization


UNICEF and partners took to the streets of Conakry today to combat the Ebola outbreak with information on how to keep families safe and to prevent the spread we distributed soap and chlorine. Courtesy of UNICEF Guinea

At this stage of Ebola outbreak, health communication is important but it must include a heavy social mobilization component if we expect quick results. Looking at all three Ebola countries (Guinea, Liberia and Sierra Leone), we know the rapid spreading of the disease can be attributed to risky behaviors performed by people due to lack of information about the cause of the sickness, denial and rumors.

In some cases, the information delivered was plain wrong, such as in Guinea where people were officially informed at the beginning of the outbreak that Ebola could not be treated. This misinformation prompted people to keep the sick at home, a risky practice that likely contributed to further spread of the disease.

Ebola countries need accurate information about its transmission (human interaction, nonhuman contact). With the right information, we can define key practices to be promoted at the community level regarding prevention and care seeking.  Then, we can identify appropriate communication channels to spread this key information.

Knowing that in all Ebola countries people do not always trust the governing bodies, it will be important to identify trustworthy sources of information that are able to convey messages and convince people to act very quickly. A strong community mobilization approach will be needed to collaborate with community  leaders who have the power to quickly influence other people.

In Guinea for instance, groups of “wise people” known as “les hommes sages” are located in the capital city to represent the interests of their constituents back home and continually seek resources to contribute to the development of their regions or counties. These  groups do not have any political bias and are comprised of political leaders, civil society, religious leaders, women leaders and youth. They can play a key role in Ebola fight, from relaying messages to the constituencies back home to facilitating a dialogue with those who want to air their concerns and respond to questions about Ebola disease. Other influential leaders to be considered are tribal and religious leaders. People listen to them more than they do government appointed leaders. This social mobilization effort should be backed by other communication materials including radio, written materials, mHealth and TV.

Since we know today that all people suffering from Ebola do not die, personal stories from people who cured after suffering from Ebola being presented on TV may help to convince people that early isolation can help to manage and treat the disease. These stories could be part of an overall strategy that also includes community mobilization activities. That is assuming the services and manpower needed are available to take care of the people who then rush to the health facilities.

Communication Plays a Critical Role in Ebola Crisis

© 2005 Emmanuel Esaba Akpo, Courtesy of Photoshare

© 2005 Emmanuel Esaba Akpo, Courtesy of Photoshare

During a capacity building workshop in Freetown, Sierra Leone, this past June, the mood was understandably tense as Ebola continued to spread from the East. Tea-break conversations became heated about regional responses to it. While no one agreed on how long it would last or the toll it would ultimately take, one thing was universally accepted: there was a strong need for social and behavior change communication (SBCC) in communities.

One of the workshop participants, Reverend Alimamy Kargbo of the Inter-religious Council of Sierra Leone and Chair of the Global Fund Country Coordinating Mechanism in Sierra Leone, put it this way, “We are troubled and confused about the rate of the spread and the major reason for the spread has been denial [of Ebola]  and not taking heed of instructions issued by the Government and other health workers,” he said. “Now that many people have accepted the reality of its existence and its deadliness, it is as they say ‘out of control’ and still beyond the scope of government to contain it.”

The SBCC challenges related to Ebola are many: the virus can be transferred through local customs and practices such as funerary preparations, including washing the dead, and by eating bush meat that carry the virus. Improper handling of Ebola victims by family members and health workers and avoidance of hospitals and health centers are also major causes of the spread.

“People are too afraid to go to the hospital or health facilities for fear that they will be diagnosed with Ebola,” Kargbo continued, and since there is no known cure, going to a health facility is not an attractive option for many. “Besides, some nurses and health workers are running away for fear of contracting the disease as little or no protective gear are available in some health facilities.”

The Harvard Business Review (HBR) and the World Bank blog both ran articles this week on the critical need for SBCC in Guinea, Liberia, Sierra Leone and other countries in the region where Ebola may be spreading, highlighting entertainment-education (EE) as one approach that helps people consider changing current behaviors and attitudes. As the articles point out, EE has been used with good results for other health issues such as HIV/AIDS, malaria, and nutrition.

The HBR cited drama theory research from Lawrence Kincaid, a health communication expert with Johns Hopkins Bloomberg School of Public Health Center for communication Programs (JHU.CCP), which is a leader in the field of SBCC and entertainment-education. Kincaid has found that “audiences empathize with characters and vicariously live their conflicts through them, even riding with them through their change of mind.” Like many communication strategies, the ones for Ebola, according to the World Bank article, include a variety of communication vehicles such as text messaging via mobile phones, community mobilization and door-to-door outreach.It also reported that UNICEF and partners are engaging in participatory theater to spread messages, giving message-driven theater performances in communities and bus terminals.

“The more that people are transported into the world of the narrative, the more they feel immersed in the story, the more likely they are to change their beliefs to be more consistent with those expressed in the world of the narrative,” said researcher Melanie Green, in a quote from the HBR.

As of August 4, there have been 1,711 infections and 932 deaths from Ebola in these countries, and even more have been affected by the toll the virus is taking on people’s everyday lives. Last week, the World Health Organization declared the outbreak a global health emergency. SBCC must be a critical component of any global public health strategy to stop Ebola from spreading further in the region – or the world.

“I hope that we start our communication programs sooner rather than later in countries that may be affected in the coming days such as Nigeria, before people are too fearful or panicked,” said Caroline Jacoby, Senior Program Officer with JHU.CCP who teaches a course called Entertainment Education for Behavior Change and Development in Johns Hopkins Bloomberg School of Public Health. “Shifting long-held practices and behaviors is difficult, but once people start taking the appropriate actions to keep themselves, their families and their communities safe, these actions can start becoming the ‘norm,’ and have an impact on lives.”

Reprinted with permission from the Health Communication Capacity Collaborative on August 14, 2014