Contextualizing mobility during the Ebola epidemic in Liberia

Based on findings from focus groups and key informant interviews conducted at five sites in Liberia between 2018 and 2019, we explore some of the key factors that influenced people's motivation to travel during the 2014-2016 Ebola Virus Disease (EVD). We discuss how these factors led to certain mobility patterns and the implications these had for EVD response. The reasons for individual mobility during the epidemic were multiple and diverse. Some movements were related to relocation efforts as people attempted to extricate themselves from stigmatizing situations. Others were motivated by fear, convinced that other communities would be safer, particularly if extended family members resided there. Individuals also felt compelled to travel during the epidemic to meet other needs and obligations, such as attending burial rites. Some expressed concerns about obtaining food and earning a livelihood. Notably, these latter concerns served as an impetus to travel surreptitiously to evade quarantine directives aimed specifically at restricting mobility. Improvements in future infectious disease response could be made by incorporating contextually-based mobility factors, for example: the personalization of public health messaging through the recruitment of family members and trusted local leaders, to convey information that would help allay fear and combat stigmatization; activating existing traditional community surveillance systems in which entry into the community must first be approved by the community chief; and increased involvement of local leaders and community members in the provision of food and care to those quarantined so that the need to travel for these reasons is removed. Author summaryHuman mobility is an important element of infectious disease outbreaks, both in terms of its spread and control. Understanding and dealing with the complex issue of human mobility warrants serious consideration in efforts to limit the spread of the disease. For these and other reasons, public health responses to infectious disease outbreaks must first be predicated upon a firm understanding of the contextual issues surrounding human movement and agency, especially those pertaining to the social, cultural and political-economic dimensions involved. Focus groups and key informant interviews conducted at five sites in Liberia in 2018/19 offered insight into the reasons people gave to account for their movements during the 2014/16 EVD outbreaks. Based on the understanding of mobility we gained from this study, we recommend that infectious disease response could be improved through the personalizing of public health messaging through the recruitment of family members and trusted local leaders to convey information that would help allay fear and combat stigmatization; activating existing traditional community surveillance systems in which entry into the community must first be approved by the community chief; and increased involvement of local leaders and community members in the provision of food and care to those quarantined so that the need to travel for these reasons is removed.