The Missing Ingredient in Fighting Ebola

One of the biggest obstacles in health care is something medicine cannot manufacture or distribute: trust. Without trust, we are not able to take advantage of medical science, whether it's vaccine, mental health care, or public health messaging.

This is true not just in the US, but in places like the Democratic Republic of Congo, where Ebola is spreading rapidly. The Ebola problem starts with a virus, but that's not what's driving its spread.

There are no Ebola cases in the United States, and the risk of spread here is small. But the outbreak in the DRC is now the second largest on record: as of this writing, 4,500 confirmed cases and 2,060 deaths. It's especially hard to fight because it’s caused by a strain with no approved vaccine or treatment, compounded by weak health infrastructure, limited lab capacity, equipment shortages, ongoing conflict, and violence against health workers.

Ebola began with a virus jumping from animal to person. That spillover provided the biological spark, but it was a lack of trust that helped turn the spark into a wildfire.

In affected communities, some people resist treatment centers, burial procedures, or advice from outside responders. There's a phrase in East Africa: "Ebola is a business." Many believe Americans and Europeans use Africa just to make money, pointing to a history of outsiders more interested in the continent's gold and cobalt than its health.

That mistrust has roots in colonial medical campaigns, state violence, institutional failure, and past outbreak responses that pushed communities aside. Parisa Asher, a doctoral researcher at Georgia Tech, recently wrote in the British Medical Journal (BMJ) about community trust:

"For example, previously security forces were sometimes deployed alongside health interventions. Burial restrictions disrupted important cultural practices, and as a result, many communities then perceived that they were not meaningfully involved in important aspects of the outbreak response, including decisions that would directly affect them."

Trust is a vital part of epidemic control. People who distrust institutions delay seeking care, and in an Ebola outbreak, that can mean more infections and deaths.

So what should we do differently? Parisa Asher says there are three phases of community engagement. First, before an outbreak, we need to invest in local health systems and build relationships with traditional and religious leaders.

"In the second phase during the actual outbreak, local health workers, religious leaders, and traditional leaders should help lead engagement efforts rather than simply delivering externally designed messages. For example, in the context of the DRC, burial practices should be negotiated whenever possible, so public health measures and cultural dignity can both be respected."

Third, after the outbreak, we need to maintain those relationships rather than disappearing until the next emergency. This is all harder — if not impossible — when the Trump administration's policies, including eliminating USAID, strip away support and dismantle relationships built over decades.

Outside expertise remains essential. But experts need humility, to listen before prescribing, and to treat communities as partners, not obstacles.

Whether an outbreak becomes an epidemic depends on something no lab test can measure: whether people believe those coming to help are actually on their side.

— Dr. Michael Wilkes with a Second Opinion

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