A Canadian research project in Congo centred on how to build trust in communities could help efforts to fight the spread of Ebola, measles and many other diseases around the world.
The project aims to engage with ordinary people in the Ebola outbreak zone and enlist respected members of the community to work with health officials, in part to combat inaccurate information that has been circulating about the deadly disease.
"Rumours are going around about that, 'Oh the vaccine is actually – you get injected with the virus.' Or that it's a 'government conspiracy,'" says Harris Ali, a sociologist at York University and principal researcher leading the project. "The whole 'Ebola is a money-making opportunity in order to attract funds from outside the country into the Congo so that certain individuals can profit from it.'"
Reluctance to trust outsiders
With Congo racked by ongoing conflict, Ali says people in the outbreak zone are reluctant to trust outsiders. That has created fertile ground for misinformation to spread, and sometimes makes people afraid to report when they or their family members are infected.
Ali is partnering with doctors from the Congo, as well as from Liberia and Sierra Leone — both countries that overcame the deadliest Ebola outbreak that lasted from 2014 to 2016.
"The idea was to take the lessons from that and apply it in the Congo," he says. "Why the response was so successful in West Africa was because it was based on a community-based approach."
That involves recruiting respected members of communities, gaining their trust, teaching them about the disease and training them to identify and monitor people who may have been exposed.
That's much different from the usual approach, where aid workers show up to villages in protective equipment and imposing vehicles.
"Oftentimes there's some arrogance in their response — that we in the West know better. There's no sort of attention to the local knowledge, to the local practices. It's oftentimes dismissed as backward," Ali says.
Need for community engagement
"A successful response to Ebola will only occur if there's community engagement. Without that it will be a failure."
Ottawa Valley mother Mallory Olsheski likes the sound of that approach, too. She sees similar levels of medical mistrust among parents in her community over the issue of vaccinations.
"There's a lot of speculation going on that the doctors work for pharmaceutical companies and that the doctors are getting paid to put this message out there," she says. "It doesn't hold as much weight as a mom who has a little girl or a little boy who has been vaccinated."
Olsheski's seven-year-old son, Riley, is immuno-compromised and can't receive certain vaccines – such as those given for chickenpox and measles. So for her, it's extra important for other children to be vaccinated.
Anti-vaccine rhetoric everywhere
"School is kind of a cesspool, if you will, for these eradicated diseases when children don't vaccinate," she says. "So sending him to school is very scary for us."
Olsheski blames anti-vaccine rhetoric.
"There is just a massive amount of misinformation out there currently. Websites that aren't credited are kind of spewing out this information that isn't always accurate or has just enough accuracies to make us think that it's valid," she says.
"It's everywhere. And then, you know, some moms won't vaccinate. And then other moms won't vaccinate because this mom didn't."
Olsheski thinks engaging other people in the community to talk about public health and immunization, similar to the approach of the program in Congo, could have a positive impact on vaccination rates here.
At Toronto Public Health, Associate Medical Officer of Health Dr. Vinita Dubey agrees.
"There's no question that that kind of an intervention could definitely have an impact here in Canada," she says.
In order to effectively stop measles outbreaks from occurring, through what's known as "herd immunity," the vaccination rate needs to be 95 per cent. Currently, Toronto's Public Health statistics show only 92 per cent of school-age children have received the MMR vaccine.
Dubey studies a phenomenon known as vaccine hesitancy and says about 20 per cent of parents are on the fence when it comes to getting their children vaccinated, and that number is rising.
Peers can deliver a message
"They've heard enough misinformation that they're questioning vaccines, but they still don't want to throw them out altogether," Dubey says.
"So having more formal interventions where we can use peer groups – trusted leaders – to have the scientific message that they can then share in a trusted way with their other members is definitely something that I think could be a benefit in Canada."
The Ebola research project in Congo is still in its early stages. Ali conducted workshops with public health officials there to teach them about the disease. In the next few months, he hopes the project will move into villages at risk of Ebola to co-ordinate its approach with that of NGOs working there.
He says afterwards he and others will look at data and interviews with villagers to determine what impact the approach has on stemming the spread of the disease.