Community trust of government and non-governmental organizations during the 2014-16 Ebola epidemic in Liberia

Author summaryBehavior change was critical to the West African Ebola epidemic response in Liberia. Previous studies show trust in the Liberian government was associated with behavior compliance, while hardships related to Ebola were associated with lower levels of trust. Trust of international non-governmental organizations (iNGOs) was consistently higher than trust in the Liberian government. However, studies have not compared exposed communities to non-exposed communities over time. This study measured trust in the government and trust in iNGOs in three communities with different exposure to the Ebola epidemic. Results corroborate that trust of iNGOs was higher than trust in the government across all five time periods. Trust decreased significantly during the peak of the Ebola crisis, especially in the community with the highest incidence. Individuals who believed that Ebola was real and had high levels of knowledge about Ebola had higher trust than those who did not. Being the frequent witness of Ebola-related events was associated with higher trust in iNGOs, but not in the government. These findings indicate that efforts to improve Ebola awareness and knowledge may positively influence trust, while exposure to the epidemic may reinforce prior mistrust of government institutions. The West African Ebola Virus Disease epidemic of 2014-16 cost more than 11,000 lives. Interventions targeting key behaviors to curb transmission, such as safe funeral practices and reporting and isolating the ill, were initially unsuccessful in a climate of fear, mistrust, and denial. Building trust was eventually recognized as essential to epidemic response and prioritized, and trust was seen to improve toward the end of the epidemic as incidence fell. However, little is understood about how and why trust changed during Ebola, what factors were most influential to community trust, and how different institutions might have been perceived under different levels of exposure to the outbreak. In this large-N household survey conducted in Liberia in 2018, we measured self-reported trust over time retrospectively in three different communities with different exposures to Ebola. We found trust was consistently higher for non-governmental organizations than for the government of Liberia across all time periods. Trust reportedly decreased significantly from the start to the peak of the epidemic in the study site of highest Ebola incidence. This finding, in combination with a negative association found between knowing someone infected and trust of both iNGOs and the government, indicates the experience of Ebola may have itself caused a decline of trust in the community. These results suggest that national governments should aim to establish trust when engaging communities to change behavior during epidemics. Further research on the relationship between trust and epidemics may serve to improve epidemic response efficacy and behavior uptake.