Editor's Note: As the Democratic Republic of Congo works to curb an Ebola outbreak, Nigerians expressed strong reactions to the proposal of a friendly match on the 25th of May, 2018 between the Super Eagles of Nigeria and Congo-Kinshasa of Democratic Republic of Congo. In this week's Thought Leadership Piece, Dr Ibrahim Mamadu, an Epidemiologist with the World Health Organization reflects on the heated discourse and how communications (or the lack of it) plays an important role in public health events.
As I listened to the raging arguments on the radio about whether the Nigerian National Football team, the Super Eagles should or shouldn't play a friendly match with the Democratic Republic of Congo's (DRC) National Team ahead of the upcoming World Cup, the heated comments from callers in opposition to Nigeria hosting a team from a country with reported cases of an Ebola outbreak may have sounded over dramatic. This made me reflect on the power of a populations' deepest fears and perceptions during disease outbreaks.
The callers were concerned that in spite of repeated reassurances from the Federal Ministry of Health, that the risk of Ebola spreading to the country was not high, and preparedness plans being in full swing, the World Health Organisation (WHO) had not yet declared the outbreak a public health emergency of international concern, and under the International Health Regulations (IHR) of 2005, it would not be ideal for the country to arbitrarily impose travel or trade restrictions without neutral expert guidance in assessing the public health risks of the disease spreading.
This public hysteria took me down memory lane to another incident some years back and how I accidentally stumbled on, in my practice in epidemiology, the great importance of risk communications.
The year was 2014, I was back in Nigeria after studying and working in the United Kingdom. There was a rapidly spreading epidemic of Ebola in three West African countries for the first time. Believe it or not, at the time, even for us in West Africa and Nigeria in particular, Ebola seemed like a distant killer disease we only heard about on the news and saw in movies. Suddenly we were hearing that it was ravaging countries in our neighborhood and at an alarming rate! Scary, but it still wasn't an immediate danger in our minds. That all changed when a single male passenger flew into Lagos, a city of over 20 million people from Sierra Leone and checked himself into a high brow private hospital when he fell ill. In an act of true heroism, a group of very committed medical professionals were able to detect that he had Ebola and tried to contain the virus, at the eventual cost of some of their own lives. Although the outbreak had spread to a few other cities, it was controlled before it spread more widely across the country.
However, a danger no one considered was social media; early one morning at about 4 a.m. a message went viral via text, WhatsApp, BBM and all the popular social media platforms, telling people to protect themselves from the deadly Ebola by taking their baths with a salt and water solution, as well as drinking a mixture of salt and water. Health professionals like myself read it and quickly dismissed it as absolute rubbish that no one would believe and went back to sleep. By the time I woke up, I discovered to my dismay that the message had spread like wildfire and several thousand citizens had incredibly, gone through with the salt water bath! In a country with an extremely high prevalence of undiagnosed and untreated hypertension, this was a disaster. Several people did drink this high salt concoction with the attendant adverse events of spikes in blood pressure and other negative effects.
At the time, I was part of a volunteer group of health professionals that met and were discussing how to act in the face of the outbreak, on Facebook, called EbolaAlert (now EpidAlert). We immediately got to work trying to find avenues to counter the wrong information, using social media, alongside several communication experts from government and NGOs. The outbreak of mass hysteria was finally controlled, though with some difficulty. This however opened my eyes to how dangerous misinformation can be in the context of public health events, because by the time the outbreak was contained, rumours and misinformation had probably caused more deaths than the actual virus!
The WHO defined this phenomenon as an "infodemic" , defined as "the rapid spread of information of all kinds, including rumours, gossip and unreliable information". Like epidemics, infodemics can be managed through similar measures, like monitoring and identifying patterns and content of chatter around the epidemic, as well as putting in place communication measures to combat the misinformation.
Four years later and back to the public hysteria regarding the football match, despite multiple assurances from the Federal Ministry of Health and Federal Ministry of Youth and Sports Development, the perceived fear in the public shows how much work still needs to be done to get ahead of the misinformation that spreads in the context of an outbreak. The average Nigerian cannot be blamed for being scared and wanting to protect their families. At that point, they are least concerned about International Health Regulations or government statements that things are under control.
Around the world we have seen cases where hysteria and misinformation has led to the population attacking and even killing the same health workers that were trying to help them. Public hysteria regarding epidemics reveals the importance of sustained community level engagement and information dissemination through all possible avenues. However, this is most effective when people trust their government institutions enough to take their word that they are in control of a situation and would truthfully provide facts to the public with no cover-ups.
The Nigeria Centre for Disease Control (NCDC), the government agency tasked with dealing with public health events like outbreaks, has over the past couple of years, consistently and transparently provided up to date factual situation reports, known as sitreps, on outbreaks in the country on their website for public viewing and the organisation has encouraged the same transparency at the state level. They also coordinate with stakeholders and partners in the risk communications space like the National Orientation Agency (NOA), WHO, UNICEF and a host of others to provide accurate, timely, and clear messages to the public to prevent the spread of false information, like we have witnessed in the past.
Changing people's perceptions and behavior during public health emergencies is a long term and painstaking process, but it is a task that must be done. Agencies such as the NCDC, NPHCDA and NOA, and other partners, are increasingly taking important steps in that direction, and this is steadily increasing the public's confidence in and demand for proper, accurate information.
In the meantime, the fans relaxed their fears of Nigeria playing the DRC. The match took place at the Adokiye Amiesimaka Stadium in Port Harcourt, with a 1-1 score at the final whistle.
Good luck to the Super Eagles at the 2018 FIFA World Cup in Russia!