African countries are the latest to confront the coronavirus pandemic, with over 17,000 confirmed cases on the continent. Two West African countries, Burkina Faso and Senegal, have seen particularly sharp increases in the number of covid-19 cases after initial case confirmation, which suggests these countries may follow a coronavirus path similar to Spain and Italy, two particularly hard-hit countries.
But some governments have struggled to convince citizens to follow basic public health guidelines to limit the spread of disease. Protesters in Côte d’Ivoire destroyed a covid-19 health center under construction, recalling the resistance to officials during the 2014 West African Ebola epidemic. Journalists documented individuals refusing treatment for Ebola, and families hiding or lying about the whereabouts of infected relatives. In Guinea, one community attacked medical personnel, accusing them of bringing the Ebola virus to them.
How can African governments convince their citizens to comply with public health guidelines to counter the transmission of covid-19? My research with Professor Leo Arriola in the West African country of Guinea suggests that governments and their international partners may gain higher levels of compliance if they tailor the messenger of those guidelines. Specifically, this research finds that members of politically marginalized groups are more likely to comply if they hear health advisories coming from local — rather than national — political authorities.
Here’s how we did our research
To understand why some people might resist public health measures intended to save their lives, this survey included over 1,200 adults in Guinea, a West African country at the epicenter of the 2014-2016 Ebola outbreak. Local enumerators conducted the survey in person in two prefectures in Guinea in July 2016. They selected participants using a random walk protocol modeled on Afrobarometer methods. Our paper describes the survey in greater detail.
We wanted to know how social identity — individuals’ sense of identity based on their membership in shared groups, such as religious or ethnic groups — might affect compliance with public health advisories. Survey respondents came from the country’s three largest ethnic groups, the Soussou, Peul and Malinke. This survey presented a fictional scenario that urged respondents to seek a free HIV/AIDS test after being informed of new cases in their area.
The survey randomly varied the identity of the authority issuing the fictional advisory for each respondent. Respondents received messages attributed to the country’s president, a local government official, a traditional chief, a religious authority or U.N. representative. We then asked respondents if they would be willing to follow the public health advisory, encourage family members to comply, or go to a health center for a free HIV test.
In getting people to change their behavior, the messenger matters
So who complied with the fictional scenario? We find that individuals comply with messages only when they report trusting the messenger.
Respondents from the Peul ethnicity, a politically marginalized group in Guinea, are less likely to follow a public health advisory, or encourage their family to do so, when it comes from the country’s president rather than a local or religious leader. The Peul make up Guinea’s largest ethnic group, but they have suffered from political exclusion since independence.
In our study, people who identify as Soussou or Malinke were relatively more receptive to public health advisories from Guinea’s president. Unlike the Peul, these two ethnic groups have been represented in or have led national government.
We also found that international organizations or their representatives have no advantage over the national government in inducing compliance. Members of politically marginalized ethnic groups were no more willing to follow a U.N.-issued advisory than one coming from the president, whose messages they already discount.
Respondents who perceive themselves as targets of ethnic discrimination from government also express negative views of the United Nations. The survey results suggest international organizations can’t presume that they will be welcomed as neutral or benevolent figures when responding to public health emergencies — particularly if Guineans see them as working closely with government.
What does this mean for the 2020 coronavirus pandemic?
Coronavirus is spreading in Guinea, where many people are currently wary of their government. Last month, President Alpha Condé won a contested referendum that allows him to amend the constitution to seek a third term in office. In the run-up to this referendum, more than 40 people died during violent protests, where security forces repressed the majority-Peul protesters.
These survey results suggest that international donors funding the response to covid-19 might consider working with nongovernmental authority figures, both national and local, if the goal is effective public health communication to all Guineans.
To contain infectious diseases, government informational campaigns often target ways to alter intimate practices such as sexual behavior (HIV/AIDS), burial customs (Ebola) — and now, for covid-19, emphasizing handwashing and enforcing social distancing. But some communities in Guinea may be suspicious of government campaigns and motives, especially they feel the government does not represent their community.
Disasters and epidemics often hit marginalized communities hardest, and protecting these communities may require public health messaging from authorities citizens are more likely to trust.
Allison Namias Grossman (@allisonnamias) is a PhD candidate in political science at the University of California, Berkeley.