About one in four people in the Ebola-affected regions of the Democratic Republic of Congo (DRC) think that the disease outbreak is not real, according to a new report.

The report, published in the Lancet Infectious Diseases journal, surveyed 961 respondents from 977 households in Beni and Butembo, two cities at the forefront of the current Ebola outbreak. Out of the 961, less than 40% trusted local authorities to serve their best interests — and 230 people believed the Ebola outbreak in the DRC to be fake altogether.

The findings emphasize the fact that mistrust and misinformation can be detrimental to containing an epidemic. In short, the report found that if people mistrusted the information they were being given or the authority figures giving it to them, they were less likely to comply with suggested behavioral changes, get vaccinated, or seek appropriate health care.

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“The mistrust is not completely surprising, we knew that it [was] there and [that] it [had] been there for a long time,” Patrick Vinck, assistant professor in the department of global health at Harvard University who led the study, told Global Citizen.

“[The surprising part] was how quickly it became violent and the prevalence of misinformation, and the fact that people were ready to believe … rumours that were clearly unfounded,” he said.

Examples of prevalent, but unfounded, information included the idea that the Ebola virus had been fabricated for financial gains or to destabilize the region.

Challenge of mistrust and Ebola is not new - mistrust and misinformation plague other public health interventions, including vaccine campaigns for measles and other diseases. Need commitment to advance social response, not just medical breakthrough https://t.co/o7Y4Z8AuwR

— Patrick Vinck (@developmentdata) March 30, 2019

The most notable difference between the 2014-2016 West African outbreak and the current one in the DRC is the strong conflict surrounding the affected areas.

This conflict has made reaching people with the experimental vaccine much harder, but, more than that, it has increased the levels of mistrust within the communities.

Presidential elections in the area were postponed in December, citing concerns of Ebola spreading, but critics argued they were pushed back in an effort to keep the current leaders in power. This likely added to the mistrust, and therefore the increasing misinformation about the outbreak.

“It’s a combination of all those factors, but it’s clear that 20 years of conflict has really undermined the social cohesion,” Vinck said. “What you see is that anything that is from outside — and it doesn’t just mean foreign aid, it’s also outside the community, from another territory, another province — [is] seen with mistrust.”

This, in turn, can make containing the deadly disease much more difficult, even as health workers work around-the-clock to vaccinate as many people as possible.

The West Africa outbreak of 2014-2016 resulted in 28,616 cases and 11,310 deaths in Guinea, Liberia, and Sierra Leone. With the experimental vaccine and treatments being used in the DRC, the hope is to keep the virus contained and to put an end to the outbreak as soon as possible.

Vinck called the vaccine a game changer, but stressed how vital trust building is in this situation.

In the short term, he suggests that health workers be as responsive and as transparent about the epidemic as possible — he said that while people seemed to be well informed about symptoms and protection, they knew little about the overall response to outbreak.

He also stressed the need for health workers to adapt within local contexts.

“What works in one community might not work in another one,” he said.

Working with trusted individuals in the community could help prevent the spreading of the disease and improve efforts to vaccinate all those who have come into contact with the disease, he said.

“If people are not coming forward when they see somebody sick or when they’re sick themselves, then why would they come forward if they are known to have had contact with someone who died from Ebola,” Vinck said.

“This example shows how important it is and the implication that it has when we don’t do it, when we fail to rebuild those relations.”