842. Social Resistance Fuels Ebola Transmission in the Eastern Democratic Republic of Congo

BACKGROUND: The second largest Ebola epidemic in history is currently raging in Eastern Democratic Republic of Congo (DRC). Stubbornly persistent Ebola transmission has been associated with social resistance, ranging from passive noncompliance to overt acts of aggression toward Ebola response teams. METHODS: We explored community resistance using focus group discussions and assessed the prevalence of resistant views using standardized questionnaires. RESULTS: Despite being generally cooperative and appreciative of the foreign-led Ebola response, focus group participants provided eyewitness accounts of aggressive resistance to control efforts, consistent with recent media reports. Mistrust of Ebola response teams was fueled by perceived inadequacies of the response effort (“herd medicine”), suspicion of mercenary motives, and violation of cultural burial mores (“makeshift plastic morgue”). Survey questionnaires found that the majority of respondents had compliant attitudes with respect to Ebola control. Nonetheless, 78/630 (12%) respondents believed that Ebola was fabricated and did not exist in the area, 482/630 (72%) were dissatisfied with or mistrustful of the Ebola response, 60/630 (9%) sympathized with perpetrators of overt hostility, and 102/630 (15%) expressed noncompliant intentions in the case of Ebola illness or death in a family member, including hiding from the health authorities, touching the body, or refusing an official burial team. Denial of the biomedical discourse and dissatisfaction/mistrust of the Ebola response were statistically significantly associated with indicators of social resistance. CONCLUSION: We concluded that social resistance to Ebola control efforts was prevalent among focus group and survey participants. Mistrust, with deep political and historical roots in this area besieged by chronic violence and neglected by the outside world, may fuel social resistance. Resistant attitudes may be refractory to short-lived community engagement efforts targeting the epidemic but not the broader humanitarian crisis in Eastern DRC. DISCLOSURES: All Authors: No reported Disclosures.