Ali S Harris, Wells Kathryn, Rose Jarrett Robert
Department of Sociology, Faculty of Liberal Arts and Professional Studies, Keele Campus, York University, Toronto, ON M3J 1P3, Canada.
Int J Environ Res Public Health. 2021 Mar 22;18(6):3270. doi: 10.3390/ijerph18063270.
The 2014-15 Ebola Virus Disease (EVD) outbreaks in Western Africa became widespread in primarily three countries, Guinea, Liberia, and Sierra Leone. Unlike all previous outbreaks in Central and East Africa, which were confined to rural areas, the virus spread rapidly through West Africa as a result of transmission through high-density urban centres coupled with the effects of public distrust in outbreak response teams and local government officials. In this study, we examine the EVD epidemic in Liberia, the first country to implement a community-based response that led to changes in the trajectory of the epidemic. The focus on the role of community-based initiatives in outbreak response is often neglected in conventional epidemiological accounts. In this light, we consider the manner in which community-based strategies enabled a more effective response based on the establishment of better trust relations and an enhanced understanding of the risks that EVD posed for the community. We conducted qualitative research in five distinct communities in Liberia three years after the outbreaks subsided. Data collection procedures consisted of semi-structured interviews and focus group discussions with residents. We found that the implementation of a community-based response, which included the participation of Ebola survivors and local leaders, helped curb and ultimately end the EVD epidemic in Liberia. As community members became more directly involved in the EVD response, the level of trust between citizens, local officials, and non-governmental organization response teams increased. In turn, this led to greater acceptance in abiding to safety protocols, greater receptiveness to risk information, and changes in mobility patterns-all of which played a significant role in turning the tide of the epidemic.
2014 - 15年西非埃博拉病毒病（EVD）疫情主要在几内亚、利比里亚和塞拉利昂这三个国家广泛传播。与以往在中非和东非的所有疫情不同，以往疫情局限于农村地区，而此次病毒在西非迅速传播，原因是通过高密度城市中心传播，再加上公众对疫情应对团队和地方政府官员不信任的影响。在本研究中，我们考察了利比里亚的埃博拉病毒病疫情，该国是首个实施基于社区的应对措施并导致疫情发展轨迹发生变化的国家。在传统流行病学报告中，往往忽视了基于社区的举措在疫情应对中的作用。有鉴于此，我们思考基于社区的策略是如何通过建立更好的信任关系以及增强对埃博拉病毒病给社区带来的风险的认识，从而实现更有效的应对。疫情平息三年后，我们在利比里亚五个不同社区开展了定性研究。数据收集程序包括与居民进行半结构化访谈和焦点小组讨论。我们发现，包括埃博拉幸存者和当地领导人参与的基于社区的应对措施的实施，有助于控制并最终结束利比里亚的埃博拉病毒病疫情。随着社区成员更直接地参与到埃博拉病毒病应对中，公民、地方官员和非政府组织应对团队之间的信任水平有所提高。这反过来又导致对安全协议的遵守度更高、对风险信息的接受度更高以及流动模式的改变——所有这些都在扭转疫情局势方面发挥了重要作用。
