Communicating Challenging Concepts in a Challenging Environment: Sierra Leone Trial to Introduce a Vaccine Against Ebola (STRIVE) Communications

Background:  West Africa is experiencing the largest Ebola outbreak in history.  Recently developed Ebola vaccines have shown promise in early testing.  The CDC-sponsored Sierra Leone Trial to Introduce a Vaccine against Ebola (STRIVE) is being conducted to assess the safety and efficacy of an Ebola vaccine among health and other frontline workers.  Effective communication with multiple target audiences is critical for the trial’s success.

Program background:  The communication objectives for STRIVE include

• Ensuring clear, consistent communication among partners and key stakeholders, including CDC and vaccine study staff, Sierra Leone’s College of Medicine and Allied Health Sciences, Ministry of Health and Sanitation, and partner organizations
• Educating potential study participants and their families about the risks, benefits, and details of the vaccine trial so they can make an informed decision about participation
• Increasing awareness and building confidence among the general public and key influencers about the vaccine trial
• Anticipating and managing issues and challenges related to the study using established risk communication principles

Evaluation Methods and Results:  When developing a communication strategy for the trial, several complex issues needed to be addressed.  Given the context of an ongoing outbreak, work began with exploring the socio-cultural understanding and perceptions of Ebola.  Interviews and focus groups highlighted a limited understanding of clinical trials among potential study participants and the public. Communication around the trial also took into consideration the levels of influence on eligible study participants. Engagement of community leaders, such as district chiefs, religious leaders, and Parliament committees, was critical to building a strong foundation for public support of the trial.  Meetings were held with health facility leadership as well as key stakeholders to inform and gain study support.  Culturally-appropriate materials and activities were designed using the local language and illustrations, and further revised using feedback from local partners.  Communication addressed barriers and concerns regarding participation in the clinical trial, including questions about the study vaccine. Working in Sierra Leone posed additional challenges, such as technical obstacles and language and literacy barriers as well as the ever-changing nature of the outbreak. 

Conclusions:  Thoughtful and strategic communication efforts to educate and inform vaccine trial target populations, the general public, and other key stakeholders are critical to increasing acceptance of and involvement in clinical trials.  As such, the development and delivery of appropriate communications and messaging strategies for the trial require a comprehensive understanding of current knowledge, attitudes, and beliefs regarding vaccines, vaccine studies, and Ebola, in general, as well as numerous other cultural, social, and political factors.

Implications for research and/or practice:  The West Africa Ebola epidemic and response, including this vaccine trial, posed unique communication challenges.  However, lessons were learned that can be applied to future global and emergency communication efforts, particularly those in low resource settings.  The experience underscored the importance of creating culturally appropriate communication materials as well as engaging key stakeholders at multiple levels when communicating to a diverse population.  Communicating about a clinical trial required exploring a variety of ways to present complex information using socio-culturally appropriate and effective methods and channels.