Via Nature News & Comment, a long, must-read review by Peter Piot: Public health: Beating Ebola. Excerpt:
Ebola: How a People's Science Helped End an Epidemic, by Paul Richards
Ebola's Message: Public Health and Medicine in the Twenty-First Century, ed. Nicholas G. Evans, Tara C. Smith, and Maia Majumder
The Ebola epidemic in West Africa was an unprecedented health crisis, causing more than 11,000 deaths and destabilizing three countries. It eventually mobilized a coalition of countries from the United States to China, as well as the African and European unions.
Neither the nations most affected nor the international community were prepared for an epidemic of a highly lethal virus on such a scale. They had to learn on the fly: hands-on experience of Ebola outbreaks and patient care was scant. We now have a much larger body of experts and knowledge, which will be invaluable for preventing and controlling future outbreaks.
Two very different books on the epidemic have now emerged. Anthropologist Paul Richards' Ebola is an original account of how Sierra Leone in general, and 26 villages there in particular, interpreted the epidemic and wider responses to it, and acted on it at its peak.
Ebola's Message has a broad interdisciplinary focus on West Africa's outbreak. Covering aspects from media response to bioethics, it is edited by philosopher Nicholas Evans, molecular epidemiologist Tara Smith and computational epidemiologist Maimuna Majumder.
Ebola's focus on the comparatively poorly documented role of local responses to the epidemic makes it a must-read for all involved in epidemics, epidemiology and public health. It is an important counterweight to analyses by international panels, including one convened by the London School of Hygiene and Tropical Medicine and the Harvard Global Health Initiative, which I chaired. These have focused on institutional aspects and global governance. As the ongoing outbreaks of Zika in the Americas and yellow fever in central Africa show, concerted action — local as well as global — is crucial.
Richards wisely nods to the key role of national and international epidemic control. But his central thesis is that rapid local adaptation and common sense led to the Ebola epidemic's downturn. He terms this community action a “people's science” of Ebola control. The book abounds with real-life examples from his long-term research in Sierra Leone.
Richards bases his analysis of how villagers coped on two concepts. Sociologist Émile Durkheim's social-paradigm theory posits that belief is shaped by social action — in this case, collective emergency response. Durkheim held that it is not enough to “pump knowledge into the heads of affected populations” to prompt behaviour change. (That classic public-health approach has failed repeatedly, from HIV prevention to overcoming immunization refusal and controlling obesity.) The second concept is sociologist Marcel Mauss's “techniques of the body” — the idea that our physical actions, such as hygiene practices, are culturally determined.
Burials during the epidemic revealed how these theories played out. Funerals carry great meaning in West Africa: they are moments for honouring the dead, remembering that life is finite or resolving disputes. They also involve rituals such as washing the deceased — one of Mauss's techniques of the body. Locals unaware of the risks from infected corpses unwittingly helped to spread the disease.
As Richards notes, such circumstances require urgent community dialogue at the start of an outbreak to find a way to control the risk but retain social meaning; training in safe burial techniques is also needed. But he also found that, as in Durkheim's theory, some villagers formed their own evidence-based appraisals of the risks of infection, and demanded to be trained in safe procedures. That approach became a model for rapid action within complex community structures and traditions.