Lessons From the West Africa Ebola Epidemic: A Systematic Review of Epidemiological and Social and Behavioral Science Research Priorities.

This systematic literature review compared the epidemiological (EPI) research and the qualitative social and behavioral science (SBS) research published during the West Africa Ebola virus disease (EVD) epidemic. Beginning with an initial capture of over 2000 articles, we extracted 236 EPI and 171 SBS studies to examine how disciplinary priorities affected research conducted during the EVD response, with implications for epidemic response effectiveness. Building on this research, we set forth a roadmap for the closer integration of EPI and SBS research in all aspects of epidemic preparedness and response that incorporates the lessons of the West Africa EVD outbreak. Key priorities include the following: (1) developing the capacity to systematically quantify qualitative sociocultural variables; (2) establishing interdisciplinary collaborations to improve "risk segmentation" practices; (3) creating and prepositioning qualitative indicators and composite sociocultural indexes for rapid deployment in outbreaks; (4) integrating novel systems with community resources; (5) developing new techniques for modeling social mobilization and community engagement; (6) prioritizing good data and complex analyses early in emergencies; and (7) learning from past experiences. Our findings support a program of action that situates data collection and analysis in real-time, recursive, integrated efforts to move community attitudes, behaviors, and responses into epidemiological research. We offer recommendations to improve coordinated, multidisciplinary approaches to health emergencies.

The poor have become rich, and the rich have become poor: collective trauma in the Guinean Languette.

This paper uses Kai Erikson's (Everything in its path: the disaster at Buffalo Creek. Simon & Schuster, New York, 1978) definition of collective trauma to interrogate the symptom reports and narrative accounts of six Guinean communities attacked by Sierra Leonean and Liberian RUF forces in 2000-2001. These data, collected in 2003, found high rates of fear, physical anxiety, emotional anxiety, depression, physical distress, sadness, and post-traumatic stress disorder-related symptoms across all communities, but found lower rates of distress among communities that had developed collective narratives of resistance to violence, or had concertedly resisted post-conflict social change. Communities with higher rates of distress tended to report community narratives of violence and post-conflict social life, which emphasized abandonment, isolation, disregard of community rituals and social supports, and the dislocation of local moral worlds. This study argues that the physical and emotional symptoms of trauma-related mental illness are articulations of collective trauma and represent the physical and emotional manifestations of the destruction of local moral worlds. It illuminates the processes by which violence inverts social experience, and argues that the social dimensions of trauma have long-term consequences for post-conflict reconstruction.