Ebola, risks of poor communication

What you need to know:

• People interpret health messages through previous experiences of the institutions delivering those messages.
• The distrust surrounding the current outbreak also cannot be separated from previous institutional experiences.

This week, I spent time reading the responses to the Ministry of Health’s Ebola updates on X, and as a health worker, I believe we have a serious problem. A section of the public does not trust the information coming from the ministry. Some users describe the Ebola outbreak as a “scam”. Others question whether the reported patients exist, ask why neighbouring countries have not reported similar cases, accuse the government of creating the outbreak for financial or political reasons, or state that they would refuse to comply with measures such as quarantine or lockdown. Other comments raise legitimate questions. How did an infected traveller enter the country despite enhanced surveillance? Why were healthcare workers exposed? What systems failed, and what has changed since then?

One of the greatest public health threats of our time is misinformation and disinformation, and the wider infodemic they create during health emergencies. Misinformation is false or misleading information shared without necessarily intending harm. Disinformation is deliberately fabricated or manipulated information intended to deceive. Both can interfere with outbreak control by influencing how people understand risk and how they respond to public-health advice. Legitimate public questioning, however, is part of public accountability and should be answered with evidence, transparency and clear information. If people do not trust the institutions issuing that guidance, compliance becomes more difficult and misinformation can spread more easily.

Confirmed Ebola cases in Kenya

The country has confirmed imported cases of Bundibugyo Ebola virus disease and subsequent infections among known contacts, including two healthcare workers. At the time of writing, authorities have stated that there is no evidence of wider community transmission. Yet a significant number of comments online are not simply questioning the response.

There are legitimate questions that require clear answers. For example, how did the index patient enter Kenya? The patient had reportedly been unwell before arriving in the country and had travelled through the region before reaching Nairobi. Kenya had already intensified surveillance because of Ebola outbreaks within the region. If the patient was symptomatic during part of that journey, Kenyans are entitled to ask how he passed through the surveillance systems.

Laikipia USA Ebola isolation center

There are similar questions concerning health worker protection. Healthcare workers who attended to the index patient were placed under monitoring, and some later tested positive. Occupational exposure does not automatically mean that health workers or institutions acted negligently. Nevertheless, infection among healthcare workers should trigger a rigorous review of triage, isolation, personal protective equipment, infection prevention protocols, referral systems and staff preparedness. Health workers are the first line of defence during an outbreak. 

People interpret health messages through previous experiences of the institutions delivering those messages. The distrust surrounding the current outbreak also cannot be separated from previous institutional experiences. Earlier this year, controversy surrounded the construction of an Ebola quarantine facility at Laikipia Air Base intended primarily for Americans potentially exposed to Ebola while working abroad. The project attracted questions about transparency, national priorities and sovereignty. More importantly, construction continued despite a court order stopping the project, resulting in further judicial intervention. When institutions disregard legal processes, provide incomplete information or communicate inconsistently, the consequences extend beyond that individual controversy. They affect whether citizens believe those same institutions during the next emergency.

Kenya saw aspects of this also during Covid-19. False information circulated widely about the virus, masks, vaccines and supposed treatments. Some people rejected effective public health interventions because they believed claims circulating on social media and WhatsApp. Studies in Kenya showed that distrust in government and health institutions was associated with vaccine refusal. The same has happened with HPV vaccination. Claims that the HPV vaccine causes infertility or is intended to control fertility have circulated in Kenyan communities. Such claims have contributed to hesitation among some parents despite the vaccine’s role in preventing cervical cancer.

Communication must evolve

The response cannot simply be to issue a press statement and expect the public to believe it. First, the Ministry of Health must provide information quickly and consistently. Information gaps create opportunities for speculation. Second, communication must distinguish clearly between what is known, what is suspected and what remains under investigation. Third, legitimate public questions should be answered rather than dismissed. Asking how an infected traveller passed through surveillance is not equivalent to claiming that Ebola has been invented.

Fourth, communication cannot depend exclusively on government officials. Professional associations, independent scientists, frontline healthcare workers, community health promoters, journalists and trusted community leaders should be part of outbreak communication. Fifth, Kenya needs a deliberate system for infodemic management. Finally, institutions must recognise that communication cannot compensate for poor governance. Trust cannot be created through messaging alone. It is built through transparency, accountability, competence and consistency. 

Dr Bosire is a medical doctor and lawyer. stebosi51@gmail.com