Why community trust is critical to health emergency response

Brazzaville- When an outbreak of Ebola was declared in the Democratic Republic of the Congo's Kasai Province on 4 September 2025, health authorities faced more than the virus itself. Fear, uncertainty and mistrust threatened to undermine outbreak control efforts in communities experiencing their first Ebola outbreak since 2007.

From the outset, the Ministry of Health Public Health Emergency Operations Center (PHEOC), with support from the World Health Organization (WHO) and partners, recognized that halting transmission would depend not only on disease surveillance, treatment, vaccination and contact tracing, but also on the trust, participation and leadership of communities. Guided by WHO's Health Emergency Preparedness and Response (HEPR) framework, the response adopted a comprehensive Community Protection approach that addressed both epidemiological risks and the social conditions that influence whether public health measures succeed.

Rather than serving as a standalone activity, community protection was integrated across the response and became a critical enabler of outbreak control. The following initiatives illustrate key lessons for future health emergency responses. This approach was subsequently validated by a recent study that identified community protection as one of seven key strategies contributing to the rapid containment of the outbreak.

The early deployment of community engagement and protection teams enabled residents to ask questions, express concerns and access accurate information. Seventy-one national and local Risk Communication and Community Engagement (RCCE) practitioners were mobilized across Bulape Health Zone and two neighbouring health zones. WHO also supported the deployment of eight national and six provincial government RCCE specialists to the field, reinforcing national leadership of this critical pillar.

Trusted local actors identified through community dialogues played a vital role in building confidence, addressing rumours and encouraging early care-seeking. Their presence, alongside response teams, helped stabilize communities during a decisive phase of the outbreak and strengthened public confidence in response efforts.

Community feedback and evidence informed decision-making throughout the response. Inputs gathered through radio call-in programmes, hotlines, youth forums, women's groups and community dialogues were systematically fed into daily coordination meetings and translated into operational actions.

Community concerns influenced efforts to increase access to vaccination and address fears surrounding treatment and safe and dignified burials. Alongside a baseline Knowledge, Attitudes and Practices (KAP) survey conducted at the onset of the outbreak, a rapid community assessment generated socio-anthropological insights to inform response strategies.

The assessment revealed that some public health messaging had unintentionally contributed to fear and delayed care-seeking. To better understand community experiences, COUSP partners, supported by WHO, conducted a rapid Community Protection Assessment involving 270 community members through 38 focus group discussions and 40 key informant interviews. The assessment generated ten recommendations that were subsequently validated through feedback sessions with 165 community members and helped guide recovery planning.

With WHO support, the Ebola RCCE pillar worked closely with the traditional leadership structures of Bulape's historic Kuba Kingdom. Traditional leaders monitored and reported weekly on six key indicators that supported community-based surveillance and strengthened communication between communities and responders.

This informal partnership between traditional chiefs and the Ebola response team helped bridge trust gaps and align local leadership with public health objectives, particularly during a period of heightened fear in September 2025.

A notable example of local ownership occurred in November 2025, when traditional leaders convened the "Ngese wa buadi" ceremony to address acts of vandalism targeting newly installed water systems supported by WHO. Through customary justice mechanisms, community leaders reinforced collective responsibility for protecting public health infrastructure.

Community protection was integrated across all response pillars, ensuring that trust and community participation strengthened operational effectiveness. RCCE teams, led by the PHEOC and supported by WHO and partners, worked alongside surveillance teams to facilitate access to households and improve contact tracing activities.

They also supported vaccination teams by addressing concerns and improving vaccine acceptance, while working with Safe and Dignified Burial teams to promote respectful and culturally appropriate practices. This integrated approach reduced resistance to response activities and strengthened the role of community health workers as trusted links between responders and the populations they serve.

The experience in Kasai Province demonstrates that community partnership enhances the relevance, acceptability and effectiveness of emergency response efforts. By centring community perspectives, strengthening local leadership and ensuring that community feedback informed decision-making, the response was able to build trust while implementing critical public health measures.

Community trust is not a peripheral or "soft" component of emergency response. It is a foundational element that enables response operations to succeed and helps communities protect themselves during times of crisis.