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Ebola and the narrative of mistrust
  1. Eugene T Richardson1,
  2. Timothy McGinnis1,
  3. Raphael Frankfurter2
  1. 1Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
  2. 2Department of Anthropology, History And Social Medicine, University of California San Francisco, San Francisco, California, USA
  1. Correspondence to Dr Eugene T Richardson; eugene_richardson{at}hms.harvard.edu

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Summary box

  • Transmission of Ebola virus in West Africa and the Democratic Republic ofthe Congo has been traced to local people’s belief in misinformation and low trust in institutions.

  • But such analyses—and others—of Ebola transmission employ bourgeois empiricist methodologies and draw from a mental map whose contours are shaped by coloniality.

  • By tracing human rights failings to the impoverished discursive infrastructure of objectivist epidemiology, we can transform global health by transforming its representations.

They who have put out the people’s eyes, reproach them of their blindness.

–John Milton, Apology for Smectymnuus (1642)

Introduction

In March 2019, The Lancet Infectious Diseases published data from a population-based survey conducted by Vinck and colleagues in the Democratic Republic of the Congo (DRC). The study suggests that the inhabitants of eastern DRC actively avoided medical care and Ebola vaccination because they did not believe Ebola virus was real.1 International media outlets soon reported the findings and reinforced a narrative that people suffering from Ebola virus disease (EVD) may blame their own false beliefs for the outbreak’s spread. In the following months, we observed how this narrative of mistrust circulated among members of the media, the academy, health ministries and frontline response teams, reinforcing a particular paradigm of causality in the spread of Ebola that obscured the structural determinants of health.

There are many reasons that conclusions like those presented in The Lancet Infectious Diseases come to be widely reported and referenced. Analyses that attempt to isolate phenomena like ‘trust’ and ‘belief’ as measurable facts simplify complex social, political and epidemiological dynamics into fungible units that are easy to comprehend. In attributing disease transmission to things like ‘culture’, ‘misinformation’ and ‘conspiracy theories’—as if these are spontaneously arising social forces that lead people in faraway places to act in unexpected ways—these studies offer a form of discussion that is easily engaged and circulated. …

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