That was in the fall of 2014, weeks after the peak of the Ebola epidemic that ultimately claimed almost 5,000 lives in the country. Yet by the end of the crisis, Kou’s township, population 17,000, had registered just two cases and a single death. “We prevented Ebola before it even started,” she said.
As the coronavirus that causes the disease known as covid-19 continues to spread rapidly and elicit panic across the globe, there is much the world can learn from Liberia’s experience with Ebola — and very little of it has to do with health care. The most important lessons relate to trust and governance. Back in 2014, Liberia was still struggling to recover from two decades of war, and Liberians had never seen a government that understood their needs or provided effective services. Corruption had gutted administrative systems. So when Ebola began, many Liberians presumed it was a scam by the government to steal money from the international community.
In situations where there is no trust between citizens and the powers-that-be, official messaging around a public health emergency can backfire. In Liberia, that tension eventually led to violence when officials placed a low-income community under quarantine — an incident that undermined the authority of the administration of Nobel Peace Prize-winning President Ellen Johnson Sirleaf. We’ve begun to see something similar happening in Iran, where a hapless government coverup of the severity of the coronavirus outbreak has led to public protests by anxious citizens, and in Hong Kong, where there is no shortage of animosity between people and the Chinese authorities.
Containing Ebola in Liberia required a focus on two core issues. First, it was vital to find leaders whom people could trust. In Liberia, that meant community leaders such as Kou, popular musicians with large followings among young people, and pastors and imams who could mobilize their churches or mosques to push for safe behaviors.
Countries battling the coronavirus now need to think through what this means for them. In the United States, President Trump or Vice President Pence might not be the right messengers, since their recent public statements about the outbreak haven’t exactly inspired public confidence. This challenge will only be exacerbated by coordinated disinformation campaigns that we are now seeing across multiple countries. Americans tend to trust people they know — which means that the most useful information about the coronavirus will not come from politicians but from doctors, teachers and religious leaders. The current confusion around the virus only exacerbates fear. Trusted voices contain it.
Second, fighting Ebola required a realization that an effective response depends on collective action to solve problems and improve decision-making. In Liberia, as the virus spread, many people refused to go to hospitals, because they were more likely to get infected there than at home, meaning many did not get the care they needed, both for Ebola and other illnesses.
The United States faces a similar challenge, albeit for different reasons. In the United States, a dysfunctional health-care system means that millions of people simply cannot afford to see a doctor or go to the hospital. If people are not part of an inclusive welfare system that they know they can access freely and safely, they will opt out — which eventually affects everyone. In China, the urge for self-preservation among politicians, rather than effective health-care management, has also hamstrung the response to the virus, no doubt contributing to the deaths of many.
Liberia finally overcame Ebola with a broad array of measures. The government formed partnerships with the international community to rapidly deploy and manage adequate health facilities. There was also coordinated action with other countries in the region to control population movements (rather than banning travel or imposing quarantines, which are rarely an effective response to virus outbreaks). And communities mobilized from the bottom up to carry out door-to-door monitoring and tracing of the virus.
All of this relied on planning, implementation and compliance — not on some medical or technological miracle. The virus was under control well before a vaccine was developed. As a result, Liberia is now better prepared to tackle the coronavirus than many countries that are just coming to grips with the outbreak.
Washing our hands, stocking up on home supplies and avoiding public gatherings will reduce our chances of spreading the sickness. But to truly overcome health emergencies like this now and in the future, we need to mobilize communities and collectively rebuild the relationship between citizens and people in power. In our hyper-connected, politically polarized world, this is only becoming more difficult, and we should not ignore the lessons that others have already learned.