Liberia: Words Were All We Had

Background:  Liberian President Ellen Johnson Sirleaf called her own country “the poster child for everything that could go wrong.” The period of August to December 2014 was critical to the response. In early September, there were bodies in the streets, and Liberia lacked Ebola Treatment Unit beds, ambulances, and doctors to care for the hundreds falling ill each day. In the absence of a cure and in the presence of disbelief, communication was one of the frontline defenses against further spread of the fatal virus. Effective communication was complicated by the number of national and international agencies entering the response.

Program background:  CDC’s Liberia field team expanded from about 12 staff in August to as many as 50 in mid-December; only about 10% of those were communicators, a ratio also seen in other groups. During just four months, the epidemic response went through three rapid phases, each requiring different communication approaches. During September and October 2014 a risk communication frame was introduced and a structure adopted to help organize international NGOs and improve reporting to the Incident Management System. By November 2014, the structure was operational, risk communication messages and methods had been adopted by leaders, and a comprehensive national training program was underway. In December 2014, with beds, ambulances, and rapid response teams in place, the number of confirmed cases began declining, and the communication focus moved to development of an evidence-based campaign to support achieving no new cases.

Evaluation Methods and Results:  Evaluation in the midst of any emergency response is challenging, and more so in a developing nation where people are dying in large numbers. Evaluation was largely observational; results could be substantiated to some extent through review of public statements in news reports and meetings. These informal methods demonstrated, for example, that the structure was fully functional. Risk communication messages were used consistently by key leaders (e.g., IMS command, ministers, NGO leads), and key messages were incorporated across organizations. The “Ebola Must GO: Stopping Ebola is Everybody’s Business” campaign was conceived and launched in only eight days, but messages focused on building self-efficacy for individuals, families, and communities were validated, field tested, and rapidly was incorporated into both public affairs and social mobilization activities.

Conclusions:  Throughout the multifactorial Liberia Ebola response, communication played a crucial role in establishing a common communication operations framework, supporting consistent messaging across government and response organizations, and integrating science into applied information to support self-efficacy. Effective communication in an international crisis requires not only an evidence-based message strategy and organizational structures that can be managed and sustained by national actors, but also acute attention to national norms, values, and culture.

Implications for research and/or practice:  Developing nations may have limited human resources and capacity, thus an influx of international partners and burgeoning national organizations potentially can overwhelm national ministries. Finding a means of organizing the communication response and aligning messages while respecting national culture are essential components of an effective communication response.