Sierra Leone: Focusing on One; Getting to Zero

Background:  The period from August to December 2014 was critical to the Ebola response in Sierra Leone. By mid-October, the number of Ebola cases increased drastically. An Ebola awareness campaign launched in August had been far-reaching and a Knowledge, Attitudes and Practices (KAP) study conducted in September demonstrated disease awareness among the population but only limited safe behavior changes. General public mistrust resulted in delayed identification and isolation of patients and increased disease transmission, and national surveillance data indicated that <70% of new Ebola cases were occurring through traditional burial practices. A detailed and complex set of “Act Against Ebola” messages (~7 pages) had been prepared but was difficult to deliver effectively. While local journalists regularly reported about the epidemic, key messages regarding safe behaviors were not routinely conveyed.  Large-scale door-to-door social mobilization efforts were just beginning and the overall communication response was not fully organized among partners. CDC implemented a national communication response to prioritize Ebola control and prevention messages and partnered with local journalists to facilitate behavior change.

Program background:  CDC developed and implemented the “Ebola Big Idea of the Week” (EBIW) national campaign. All EBIW communication activities focused on the weekly delivery of a central infection prevention and control message or theme.  Conceived as a 4-week pilot, EBIW concentrated on critical behaviors to break the chain of transmission (e.g., safe burials, isolation, etc.), based on epidemiologic data. On November 8, 2014, CDC launched EBIW with a full-day training for >80 print, radio, and television journalists from across Sierra Leone. Journalists were asked to follow the weekly theme, voluntarily create content, and use local leaders to bolster messages. EBIW messaging was shared with religious leaders and social mobilizers for their cultural and language feedback.

Evaluation Methods and Results:  All Ebola infection prevention and control messaging was coordinated at the national level and delivered nationwide. Local leaders approved all messaging, which was then translated to local languages as needed. CDC conducted daily assessments of program implementation and adjusted as needed. Concordant newspaper coverage was documented, and television and radio stories were observed to align with EBIW themes. CDC Ebola experts were regularly invited to appear on national radio and television shows to discuss the weekly theme, indicating campaign adoption by journalists. Increasing, high audience participation via text messages to radio shows denoted public awareness of the campaign. 

Conclusions:  The “pilot” is now in its 20^th week, confirming its acceptance by partners and the public and its operational value on response efforts. Coordinated official communication activities for the Ebola response should include unofficial voices such as journalists and local influencers to inspire public trust through consistent messaging from varied sources. Aligning messages to national culture is an essential component of an effective communication response, particularly in traditional societies.

Implications for research and/or practice:  Coordinated, culturally-sensitive and scientifically sound messages are critical during epidemics. Complex key messages should be prioritized and then disseminated one at a time. Studies are needed to evaluate the direct impact of EBIW on behavioral change.