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The Ebola virus swept through the West African country of Sierra Leone in mid-2014, killing more than 3 500 people in the region within 18 months. The virus has a very high mortality rate.
During the outbreak’s peak, fear, rumour and misinformation were rife, spreading as rapidly as the virus through local communities. There was much distrust of national and international institutions beforehand and healthcare practices in general. For example, false rumours led to the belief that these efforts were a population control strategy or that people were being killed inside ambulances.
These rumours threatened to undermine recruitment for the EBOVAC-Salone vaccine study. This large-scale clinical trial in the Kambia district of Sierra Leone is part of the Innovative Medicines Initiative’s (IMI) Ebola+ programme.
To help overcome the rumour mill and recruit volunteers for the study, the EBODAC project developed a novel community engagement strategy to build trust with local communities. The team started with broadcasts of radio and drama shows to spread messages about the study and to encourage people to participate.
Team members also captured iris scans and fingerprints from participants during their first visits. Then, these biometric markers are used to verify personal identities in future clinical visits. EBODAC is also funded through the IMI, a public-private partnership funded by the EU and the pharmaceutical industry.
“Clinical trials were established in communities with no previous exposure to medical research, adding to the complexity of ensuring that communication about the study was clear and could be easily understood,” says project coordinator Heidi Larson of the London School of Hygiene & Tropical Medicine in the UK.
Two teams for a two-stage Ebola vaccine
Team members from EBODAC work in community liaison and social science teams to recruit and retain participants from local communities.
Other follow-up communication efforts to retain participants include mobile phone voice or text messages to participants in their preferred local language to remind them of upcoming appointments.
A community liaison team works hand-in-hand with the study’s team of social science researchers. The community liaison team engages with local stakeholders and community members about the trial and what participation involves; while the social science team provides real-time feedback on any rumours, concerns and misinformation among community members or trial participants.
“There was additional challenge in ensuring that participants returned for their second vaccine, as well as other follow-up visits. And in making sure that the person who received the second vaccine was the same person who received the initial dose,” says Larson.
As of today, 450 adults and 96 adolescents have been enrolled in the study and successfully vaccinated. The team will soon begin recruiting younger children.
On 7 November 2015, the World Health Organization declared the end of the Ebola outbreak in Sierra Leone, but continued monitoring and testing of vaccines are essential to reduce the risk of further outbreaks in the country and elsewhere.