New England Journal of Medicine
April 4, 2019 Vol. 380 No. 14
An Epidemic of Suspicion — Ebola and Violence in the DRC
Vinh-Kim Nguyen, M.D.
… As a medical team leader for Médecins sans Frontières (MSF), I work halfway between Butembo and Goma, North Kivu’s capital city and a transport hub.
…The community outreach workers I supervise have reported that in areas where security forces accompany Ebola teams, there is substantial distrust and palpable fear, most notably of forced vaccination. In areas where the epidemic response has not involved security forces, the opposite is true: people ask to be vaccinated. The lesson is clear: guns and public health don’t mix. Epidemics thrive on fear — when they are frightened, patients flee hospitals, sick people stay away to begin with, and affected communities distrust groups trying to respond to the epidemic.
As they see Land Rovers emblazoned with the logos of nongovernmental and international organizations cruising by, people in the DRC say, “Ebola is just a business.” They note that no one seems to care about daily deaths from malaria and other infectious diseases, the lack of clean water, or surgeries that must be performed by candlelight because there’s no power. “You will leave when Ebola does,” I have heard, “but we will still be here, slowly dying from the diseases that have always killed us.”…
…The mistrust of authority in the DRC also reflects a growing global mistrust of experts and science. Vaccine refusals are a growing problem worldwide, and they have already resulted in measles epidemics in the United States and France and in outbreaks elsewhere. Mistrust of public health authorities may thus be the new norm, and smoldering epidemics merely a symptom. State-of-the-art medical interventions won’t be enough without serious efforts to rebuild trust, informed by social science rather than pious liturgies. Displays of armed force feed a vicious cycle of mistrust, infection, and violence. If we continue down that path, those seemingly fantastical dystopian outbreak movies, with their heavily armed global health forces and rebelling populations, may not be so far from reality in the near future.