Ebola and the narrative of mistrust

Richardson, Eugene T; Frankfurter, Raphael

doi:10.1136/bmjgh-2019-001932

Cited by 35 publications

(25 citation statements)

References 22 publications

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“…14 Significant underreporting of cases is likely the result of a high prevalence of minimally symptomatic disease in a younger demographic coupled with under-resourced systematic surveillance in the setting of legacies of distrust of authorities and foreign interventions (resulting in the avoidance of testing). [15][16][17][18][19][20][21][22][23] Indeed, Mwananyanda and colleagues found significant underreporting of cases in Zambia through postmortem surveillance. 24 Furthermore, 1) limited testing capacity, 2) low natural immunity, 3) and less than 0.2% of Sierra Leoneans being fully vaccinated as of 21 May 2021 is extremely concerning in that it presents a very large population of susceptible individuals at risk for future variant waves.…”

Section: Discussionmentioning

confidence: 99%

SARS-CoV-2 antibody prevalence in Sierra Leone, March 2021: a cross-sectional, nationally representative, age-stratified serosurvey

Barrie

Lakoh²,

Kelly³

et al. 2021

Preprint

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BackgroundAs of 26 March 2021, the Africa CDC had reported 4,159,055 cases of COVID-19 and 111,357 deaths among the 55 African Union Member States; however, no country has published a nationally representative serosurvey as of May 2021. Such data are vital for understanding the pandemic’s progression on the continent, evaluating containment measures, and policy planning.MethodsWe conducted a cross-sectional, nationally representative, age-stratified serosurvey in Sierra Leone in March 2021 by randomly selecting 120 Enumeration Areas throughout the country and 10 random households in each of these. One to two persons per selected household were interviewed to collect information on socio-demographics, symptoms suggestive of COVID-19, exposure history to laboratory-confirmed COVID-19 cases, and history of COVID-19 illness. Capillary blood was collected by fingerstick, and blood samples were tested using the Hangzhou Biotest Biotech RightSign COVID-19 IgG/IgM Rapid Test Cassette. Total seroprevalence was was estimated after applying sampling weights.FindingsThe overall weighted seroprevalence was 2.6% (95% CI 1.9-3.4). This is 43 times higher than the reported number of cases. Rural seropositivity was 1.8% (95% CI 1.0-2.5), and urban seropositivity was 4.2% (95% CI 2.6-5.7).InterpretationIgM positivity was elevated as of March 2021 suggesting the second wave had not yet fully abated. Although overall seroprevalence was low compared to countries in the Global North (suggesting relatively successful containment in Sierra Leone), our findings indicate enormous underreporting of active cases. This is concerning because it may reflect significant underreporting of incidence and mortality across the continent. The low level of natural immunity is also worrisome in that it presents a very large population of susceptible individuals at risk for future variant waves—in a country with only 0.2% of people fully vaccinated.FundingThis study was supported by NIAID K08 AI139361, the Sierra Leone Ministry of Health and Sanitation, the Africa CDC, and the UCSF Institute for Global Health Sciences.

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Section: Discussionmentioning

confidence: 99%

SARS-CoV-2 antibody prevalence in Sierra Leone, March 2021: a cross-sectional, nationally representative, age-stratified serosurvey

Barrie

Lakoh²,

Kelly³

et al. 2021

Preprint

Self Cite

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“…COVID-19 infections increased more rapidly in densely populated areas in Nigeria such as Lagos, Abuja and Kano. Indeed, dense populations are more vulnerable to the spread of major viruses in West Africa (Ebenso & Otu, 2020;Lawanson, 2020;Richardson et al, 2019). Table 6 shows the effects of political distrust on the spread of COVID-19 in Nigeria.…”

Section: Impact Of Political Distrust On the Spread Of Covid-19 In Nimentioning

confidence: 99%

Political distrust and the spread of COVID-19 in Nigeria

Ilo

Ezeibe

Oguonu

et al. 2020

Global Public Health

104

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While studies have explored how health sector corruption, weak healthcare system, large-scale immune compromised population, misinformation and prevalence of highly congested slums contribute to the spread of COVID-19 in Nigeria, they have glossed over the impact of political distrust on the spread of the virus. This study explores the impact of political distrust on the spread of COVID-19 pandemic in Nigeria. The study utilised qualitative dominant mixed methods approach comprising telephone interviews and a survey of 120 educated Nigerians purposively selected from four COVID-19 most affected states including Lagos, Oyo, Kano and Rivers as well as the Federal Capital Territory, Abuja. The study also relied on secondary data on the spread of COVID-19 in Nigeria sourced from Nigeria Centre for Diseases Control from 27 February to 31st August 2020. The study found that political corruption motivates large-scale political distrust. This undermines public compliance to government protocols, limits the outcomes of government responses to COVID-19 and facilitates the spread of the virus in Nigeria. The paper concludes that improving government accountability in the public sector management is relevant for building public trust, promoting citizens' compliance to COVID-19 safety measure and mitigating the spread of the pandemic in Nigeria and beyond.

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“…Political, (para)military, and other untargeted violence may act primarily through mechanisms associated with instability, for instance by causing displacement of communities, interrupting vaccination efforts, and reducing the ability of aid workers to effectively identify, isolate, and trace cases and to vaccinate contacts. In addition, attacks on civilians by armed groups reduces trust in the United Nations and DRC forces mobilized to protect them, mistrust which extends to Ebola containment efforts [ 29 ]. Ville morte and other untargeted events have been documented to completely interrupt vaccination and contact tracing efforts for several days, which may impact the timeliness and efficacy of such control efforts [ 30 , 31 ].…”

Section: Discussionmentioning

confidence: 99%

The Impact of Different Types of Violence on Ebola Virus Transmission During the 2018–2020 Outbreak in the Democratic Republic of the Congo

Kelly

Wannier

Sinai

et al. 2020

The Journal of Infectious Diseases

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Background Our understanding of the different effects of targeted versus nontargeted violence on Ebola virus (EBOV) transmission in Democratic Republic of the Congo (DRC) is limited. Methods We used time-series data of case counts to compare individuals in Ebola-affected health zones in DRC, April 2018–August 2019. Exposure was number of violent events per health zone, categorized into Ebola-targeted or Ebola-untargeted, and into civilian-induced, (para)military/political, or protests. Outcome was estimated daily reproduction number (Rt) by health zone. We fit linear time-series regression to model the relationship. Results Average Rt was 1.06 (95% confidence interval [CI], 1.02–1.11). A mean of 2.92 violent events resulted in cumulative absolute increase in Rt of 0.10 (95% CI, .05–.15). More violent events increased EBOV transmission (P = .03). Considering violent events in the 95th percentile over a 21-day interval and its relative impact on Rt, Ebola-targeted events corresponded to Rt of 1.52 (95% CI, 1.30–1.74), while civilian-induced events corresponded to Rt of 1.43 (95% CI, 1.21–1.35). Untargeted events corresponded to Rt of 1.18 (95% CI, 1.02–1.35); among these, militia/political or ville morte events increased transmission. Conclusions Ebola-targeted violence, primarily driven by civilian-induced events, had the largest impact on EBOV transmission.

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Ebola and the narrative of mistrust

Cited by 35 publications

References 22 publications

SARS-CoV-2 antibody prevalence in Sierra Leone, March 2021: a cross-sectional, nationally representative, age-stratified serosurvey

SARS-CoV-2 antibody prevalence in Sierra Leone, March 2021: a cross-sectional, nationally representative, age-stratified serosurvey

Political distrust and the spread of COVID-19 in Nigeria

The Impact of Different Types of Violence on Ebola Virus Transmission During the 2018–2020 Outbreak in the Democratic Republic of the Congo

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