Ebola and the narrative of mistrust.

### Summary box u003e They who have put out the people’s eyes, reproach them of their blindness. u003e u003e –John Milton, Apology for Smectymnuus (1642)In March 2019, The Lancet Infectious Diseases published data from a population-based survey conducted by Vinck and colleagues in the Democratic Republic of the Congo (DRC). The study suggests that the inhabitants of eastern DRC actively avoided medical care and Ebola vaccination because they did not believe Ebola virus was real.1 International media outlets soon reported the findings and reinforced a narrative that people suffering from Ebola virus disease (EVD) may blame their own false beliefs for the outbreak’s spread. In the following months, we observed how this narrative of mistrust circulated among members of the media, the academy, health ministries and frontline response teams, reinforcing a particular paradigm of causality in the spread of Ebola that obscured the structural determinants of health. There are many reasons that conclusions like those presented in The Lancet Infectious Diseases come to be widely reported and referenced. Analyses that attempt to isolate phenomena like ‘trust’ and ‘belief’ as measurable facts simplify complex social, political and epidemiological dynamics into fungible units that are easy to comprehend. In attributing disease transmission to things like ‘culture’, ‘misinformation’ and ‘conspiracy theories’—as if these are spontaneously arising social forces that lead people in faraway places to act in unexpected ways—these studies offer a form of discussion that is easily engaged and circulated. …