Ebola 2013-16: when science learned to listen

Today, Kondema Kargbo is a focused, athletic young man – proud of his country and ambitious for the future. A dedicated member of Sierra Leone’s Lunsar Cycling Team, he dreams of one day riding in the Tour de France.

In 2014, though, such a future might have seemed almost unimaginable. Kondema was 12 years old when Ebola arrived in his family’s hometown. When his aunt fell ill with the disease, he and his relatives quarantined in their home for three weeks.

As days passed, more of Kondema’s relatives began to fall sick. Ambulances would come and take them away. Kondema would never see them again. Of the 22 people isolating in his household, only Kondema and his big brother survived.

To limit transmission, funerals were banned, so the brothers could not grieve properly. Even now, they don’t know where many of their relatives’ graves are. “We only know the burial sites of a few,” Kondema says. “The others… we were just told that they died.”

The 2013-16 West African Ebola outbreak remains the largest that has been seen, with more than 28,000 cases and 11,000 deaths. Its size was largely due to the failure of the initial public health response. Early efforts to prevent transmission, like those Kondema experienced, were heavy handed, culturally insensitive and often met with significant resistance. They struggled to limit new infections.

This failure was devastating. But it also led to the creation of new community-engagement strategies that went on to make containment much more effective. Along with vaccines, trial protocols and other tools developed in the outbreak, these are the basis of Ebola responses today.

The West African outbreak began in late 2013, in a small village in the tri-border region of Guinea, Sierra Leone and Liberia. The disease spread slowly at first, but cases and deaths continued to gather pace until they could not be ignored.

Watching from England, Melissa Leach – a social anthropologist and then director of the Institute of Development Studies at the University of Sussex – saw what was going wrong. The international response had gathered pace and was well-funded, but its ignorance of local feelings and customs meant it was doing more harm than good.

Leach spoke with anthropologists with experience of the region, and took their views to a meeting convened by Wellcome. She successfully put forward the case – to scientists, the UK government and NGOs – that the accelerating outbreak was not just a medical issue, but a social one. She argued that social anthropology – understanding how people live, grieve, care for the sick and relate to authority – could help.

With funding from Wellcome and what was then the UK Department for International Development (now the UK Foreign, Commonwealth & Development Office), Leach helped establish the Epidemic Response Anthropology Platform, or ERAP. This online hub allowed experts from around the world to upload evidence about community practices and beliefs in the region in real time, feeding directly into responders’ actions.

Some of ERAP’s evidence came from academic journals. Other guidance was uploaded by anthropologists with in-country knowledge, with some submitting insights live from the outbreak. The platform published briefings, ran training for responders and directly answered questions submitted by health workers on the ground.

“The aim was to help that response be more socially sensitive, more attuned to local context and understandings, and therefore more effective,” Leach says.

From the beginning, Leach had understood how crucial getting input from anthropologists in the field would be – and there was one name she thought of immediately.
 

In 2014, anthropologist Esther Mokuwa was asked to return to her home country of Sierra Leone and provide in-depth reporting for ERAP in addition to data that was being carefully gathered by 24 Sierra Leonean colleagues. She went into the field and visited those most affected to learn why so many people didn’t trust the responders.

She soon discovered that a Paramount Chief in Kailahun District on the Liberian border – one of the worst-affected regions – had halted the spread of the virus. Straight away she went to find out how.

Chief Kallon had banished Ebola from his chiefdom before anywhere else in Sierra Leone, without waiting for external guidance. Working with community volunteers, youth leaders and traditional authorities, he had created a local task force to conduct contact tracing, local quarantining of the sick, and burials that limited transmission but respected deeply held beliefs about death and community.

“They didn’t lift the funeral ban, they just made an adjustment,” says Mokuwa. A special team equipped with personal protective equipment did the traditional washing and burying, rather than the family. There were clear actions taken to make this socially acceptable, Mokuwa notes: “Allow people to see what they are doing. Employ somebody who is from the community.”

Through patient fieldwork, Mokuwa also surfaced the logic behind how communities cared for the sick and honoured the dead – knowledge that explained behaviours the international response had earlier deemed irrational. This offered a path to working with communities rather than against them.

Mokuwa recorded everything she observed and uploaded it to ERAP for responders across West Africa to see.

Thanks to information gathered through the platform, the strict international ban on traditional funerals was lifted. It was replaced with a protocol for ‘safe and dignified burials’, based on Chief Kallon’s strategy. This was designed with community knowledge at its heart, assembled through ERAP.

ERAP’s knowledge also saw remote Ebola treatment facilities replaced with community care centres embedded in villages and towns, with safety practices that allowed relatives to visit the sick.

The impact was immediate. People who would previously have hidden a sick relative started calling responders. Families could begin to grieve again. Trust, once broken, began slowly to be rebuilt.

“There was a major recognition that the Ebola response anthropology platform, together with Wellcome, had helped to turn the epidemic around,” says Leach. In 2016, Sierra Leone had been declared Ebola free.

Rebuilding trust didn’t just help bring down transmission. It also built support locally for conducting research on Ebola while the epidemic was still live. This allowed Wellcome and others to fund trials of the first Ebola vaccine, ERVEBO®, during the outbreak.

These trials helped show that the vaccine was highly effective. ERVEBO® has since been used to fight the Zaire strain of Ebola – the form of ebolavirus that caused the 2013-16 epidemic – in multiple subsequent outbreaks. It was authorised in 2019.

Funding from Wellcome also supported development of Ebola diagnostics during the outbreak, as well as setting up a permanent genomics lab in Sierra Leone.

Just as involving social anthropologists in the response was unprecedented, so too was running research trials. “Never before was research a core component of an outbreak response,” says Josie Golding, Head of Epidemics and Epidemiology at Wellcome. In the decade since, conducting research and trials during an outbreak has become normal. “It’s just shifted the way outbreak response is done,” Golding says.

However, the research conducted during the 2013-16 outbreak was a mix of successes and failures overall, Golding says. “It was a scattergun approach, it wasn’t coordinated, and there were probably a lot of missed opportunities.” It was also fortunate that an Ebola vaccine candidate already existed that could be taken off the shelf and tested. “That’s not the case for most epidemic-prone diseases.”

In response, the WHO created its R&D Blueprint for Epidemics to guide future epidemic-related research and make it more effective. Meanwhile Wellcome and other partners established CEPI, the Coalition for Epidemic Preparedness Innovations, to accelerate the development of candidate vaccines against epidemic and pandemic threats, to provide options for testing when future threats emerge.

This is the big shift that characterises the period after the West African epidemic, says Golding. “Not just having research be a core component of the emergency framework, but it being much more tightly coordinated."

ERAP’s influence didn’t end with the 2013-16 outbreak. It went on to become the model for the Social Science in Humanitarian Action Platform, or SSHAP.

Set up with Wellcome support, SSHAP is today run by the UK Foreign, Commonwealth & Development Office. It is a permanent platform that replicates how ERAP works to help create contextually informed, community-engaged emergency responses for any infectious disease outbreak. It has been mobilised for Covid-19, mpox and cholera.

Ten years have passed since the end of the West African Ebola epidemic, but the disease has not gone away. In 2026, a new outbreak began in the Democratic Republic of the Congo (DRC) and Uganda, caused by the Bundibugyo strain of the virus.

Evidence suggests that vaccines developed for one Ebola species – such as ERVEBO® for Zaire – may not adequately protect against others, and there are currently no approved vaccines, treatments or rapid tests specifically for the Bundibugyo species. The outbreak has been declared a Public Health Emergency of International Concern by the WHO.

Vaccine candidates that target non-Zaire Ebola strains are in development, and CEPI is looking to fund trials of these – but it will be some time before the vaccines are ready to evaluate in DRC and ultimately be deployable to protect communities.

Without vaccines, the key principles of Ebola control become even more critical: contact tracing, case isolation, early detection, patient care, and safe and dignified burials. The WHO has been explicit that community engagement will be key to the success of these measures and bringing this outbreak under control.

“The WHO’s framework, it’s about the community perspective. It’s your starting point and everything comes from that,” says Golding.

The lesson ERAP taught the world a decade ago – that communities are not obstacles but essential partners, that listening is not optional but foundational – has never felt more urgent. That is what ERAP taught the world, and what SSHAP was built to sustain.

For Kondema, thinking back to the epidemic is painful, and he doesn’t like to dwell on the past. Instead, he likes to think about what he might do with the Lunsar Cycling Team in the future, such as travel outside of Sierra Leone to compete in races. “Cycling helps me forget about my family dying,” he says.

But when he does think about the West African epidemic, he believes that people would be better prepared in the face of another Ebola outbreak in his country. “That many people won’t die,” he says, “because we know what to do to survive after the last experience."

The Ebola Response Anthropology Platform was co-ordinated by anthropologists at: Njala University, The London School of Hygiene and Tropical Medicine LSHTM, The Institute of Development Studies IDS, The University of Sussex, The University of Exeter. It was supported by Wellcome and the UK’s Foreign, Commonwealth and Development Office (FCDO) through the Research for Health in Humanitarian Crisis (R2HC) programme. Wellcome and FCDO also provided core support for the follow-on Social Science in Humanitarian Action Platform (SSHAP).