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A member of UNICEF’s Ebola outreach team addresses the public in Beni, Democratic Republic of the Congo.

© UNICEF/UN0228985/Naftalin

Fighting Ebola is hard. In Congo, fake news makes it harder

The Ebola epidemic in the Democratic Republic of the Congo (DRC) is providing a natural experiment in fighting fake news. Occurring in a conflict zone, amid a controversial presidential election, the epidemic has proved to be fertile ground for conspiracy theories and political manipulation, which can hamper efforts to treat patients and fight the virus’s spread. Public health workers have mounted an unprecedented effort to counter misinformation, saying the success or failure of the Ebola response may pivot on who controls the narrative.

Tensions are expected to rise again in the wake of the 10 January declaration by the DRC’s election commission that opposition leader Felix Tshisekedi won the election, held on 30 December 2018. Foreign observers and the Roman Catholic Church’s monitors say Martin Fayulu, another opposition figure, garnered more votes, and his supporters are alleging fraud. Health workers know rumors thrive amid uncertainty.

“I usually tell my teams that we fight two outbreaks, Ebola and fear,” says Carlos Navarro Colorado of the United Nations International Children’s Emergency Fund (UNICEF) in New York City. “It is all about information.” For the first time in an Ebola outbreak, UNICEF and other agencies have joined forces as a single response team, which answers to the DRC’s Ministry of Health and includes dozens of social scientists, who use the airwaves, social media, and meetings with community and religious leaders to fight misinformation. Responders also foster trust by making their work more transparent—in some cases literally. A new biosecure tent, called the Biosecure Emergency Care Unit for Outbreaks (CUBE), allows relatives to visit and see Ebola patients during treatment.

With 600 confirmed cases and 343 deaths recorded since August 2018, the outbreak is the second largest ever after the massive epidemic that struck West Africa 5 years ago and killed more than 11,000. Conflict has smoldered for years in North Kivu, an antigovernment stronghold, and some at-risk areas are inaccessible because they are controlled by armed rebels or can’t be reached by road or rail. The outbreak has already reached several urban centers, including Butembo, a city of almost 700,000. An experimental vaccine developed by Merck and given to nearly 60,000 people so far, has likely slowed the virus’s spread but hasn’t stopped it.

In West Africa, fear kept people away from clinics, meaning Ebola cases, as well as diseases such as measles and malaria, went untreated. Mistrust of governments and aid workers ran high and rumors were rife. That’s even more true in the DRC now. In September 2018, an opposition politician, Crispin Mbindule Mitono, claimed on local radio that a government lab had manufactured the Ebola virus “to exterminate the population of Beni,” a city that was one of the earliest foci of the outbreak. Another rumor has it that the Merck vaccine renders its recipients sterile. On 26 December 2018, the national electoral commission decided to exclude Beni and Butembo from the polls because of the epidemic; the following day, an Ebola evaluation center was attacked during protests.

The CUBE, a transparent biosecure tent, allows health workers to treat Ebola patients without wearing protective gear.

ALIMA/Anne-Gaelle Borg

Although opposition organizations condemned the commission’s decision, they called for the Ebola response to be protected—which health workers saw as a small but significant victory. “We’ve managed to get communities to separate in their minds Ebola control from the broader political agenda,” says Michael Ryan, who directs the World Health Organization’s role in the campaign in Geneva, Switzerland. “That’s been really helpful.” Ryan hands much of the credit to social scientists working for the various agencies involved in the response. Along with community engagement workers, they make up one-third of the workforce.

Part of their role is to chart the social networks through which the virus spreads, but they also gather information about communities’ perceptions, which is entered within days into an online “dashboard” created by the International Federation of Red Cross and Red Crescent Societies (IFRC) in Geneva. The government has also recruited young people to report misinformation circulating on WhatsApp, a major information channel in the DRC, says Jessica Ilunga, a spokesperson for the DRC’s Ministry of Health in Kinshasa.

As rumors surface, communications experts rebut them with accurate information via WhatsApp or local radio. They take care not to repeat the misinformation; research has shown this is the best way to help the public “forget” false news and reinforce the truth. The vocal support of Ebola survivors has helped as well. Grateful for their care, some have become volunteers at Ebola treatment centers (ETCs).

So far, the responders believe they are winning the information war. People who think they might be ill are now far more willing to accept a referral to an ETC than they might have been early on, says IFRC’s Ombretta Baggio. The CUBE, used for the first time in this outbreak, is also a big help, says Tajudeen Oyewale, UNICEF’s deputy representative in the DRC. In the past, visitors were kept at a safe distance from patients within an ETC or not permitted at all. Designed by a Senegal-based organization called ALIMA, the CUBE, with its transparent walls and external arm entries—like those in a laboratory glove box—allows patients and their relatives to see and speak to each other up close. The €15,000, reusable units also improve care, because health workers don’t need to wear cumbersome protective gear that limits their movements and can only be worn for a short time.

Organized tours of the ETCs for members of the local community have helped, too, as have creches for the children of sick mothers, located close to the centers. Ambulances in North Kivu no longer use sirens when transporting suspected Ebola patients, as the sound was judged stigmatizing in West Africa.

Burial practices keep evolving as well. In early Ebola epidemics, victims were often buried unceremoniously, sealed in opaque body bags, without allowing relatives and friends to say farewell. That bred resentment and stoked rumors about corpses being stolen to sell their organs. In what are called “safe and dignified” burials, introduced in the West Africa epidemic, families are given more opportunities to see and spend time with the body. For the current epidemic, responders procured transparent body bags, allowing families to see their loved one until the coffin is closed.

“One of the starkest lessons we learned in West Africa is that we don’t need to change everything about a traditional burial,” says anthropologist Juliet Bedford, director of a U.K.-based consultancy called Anthrologica in Oxford. “We just need to make sure it is medically safe.” Even touching the body is sometimes allowed, provided relatives wear protective clothing.

Contingency plans are in place in case of further unrest, and the partner agencies have bolstered preparedness in neighboring areas not yet touched by the epidemic. Ryan says the political problems may have an upside: “Communities that resist are energetic,” he says. “If you can turn that negative energy into positive energy, then it becomes a force for good. You just have to know how to pick that lock.”