Responding to Public Health Crises: Avoiding a Legacy of Social Unrest and Conflict

» Lire en français: French

Research investigating the crisis response to the Ebola epidemic in West Africa in 2014-16 contains some important lessons for policymakers, both for dealing with the ongoing COVID pandemic and for building resilience to prepare for future heath crises.

5 min read

Elena Esposito is an applied economist with research interests in the fields of development economics, economic growth, political economy, and economic history.


The current coronavirus pandemic is accompanied by the considerable social and economic risks associated with managing a major public health crisis. Not least the risk of social unrest, as is evident from the reaction in many countries to COVID measures taken by governments. However, as a research study into the public health response to the 2014-16 Ebola epidemic in Western Africa shows, that while increased civil disobedience, social unrest and conflict, is predictable, with the right approach it is also potentially avoidable.

If policymakers do not pay attention to the factors highlighted by the research, they risk engendering social unrest that persists for many years after the health crisis has abated, and which may threaten the success of any policies aimed at recovery.

Unintended consequences

From their in-depth investigation into the public health response to the Ebola epidemic, co-authors Elena Esposito, Assistant Professor at HEC Lausanne, and Ada Gonzalez-Torres, Assistant Professor of Economics at Ben Gurion University, show that the epidemic leads to an increase in civil violence of 40%. Importantly, they find that the main underlying condition for this rise in social unrest is low levels of trust in institutions, such as trust in political and community leaders.

Furthermore, they demonstrate a strong correlation between two aspects of a state’s health response and this increase in social unrest.  In particular, they observed a link between both coercive measures, (in this case militarily enforced district-quarantines or area blockades), and demand for health treatment, (through the provision of medical health centers), and the increase in civil violence.

Militarily enforced district-quarantines or area blockades – local and regional lockdowns – were drivers of civil violence  in places where there were below average levels of trust in state institutions, but not in high trust areas. Similarly, too slow a response in terms of rolling out emergency treatment and rapid testing centers in low trust areas created civil unrest that only subsided when medical provision was ramped up. In areas of low trust, the shock of the epidemic even appeared to act as a catalyst for coordinating action against institutions.

In addition, there was another alarming and unexpected finding from the research. The mistrust-driven social unrest sparked by the epidemic was not shortlived but outlasted the immediate crisis. It persisted for several years, creating a legacy of conflict that in some cases surpassed the levels of conflict seen at the time of the epidemic.

Lessons for policymakers

These findings can be applied to public health crises more generally, including the current pandemic, say the authors. Indeed the effects are already evident following the imposition of coercive COVID rules such as lockdowns, curfews and mask wearing requirements, for example. These measures have sparked a spike in civil disobedience, across the African continent, as well as in emerging and advanced economies like Brazil, the Netherlands, the UK, US, Germany or Israel, ranging from peaceful protests to riots involving the destruction of property, and violence between state officials and civilians. (Much of this civil disorder can be tracked via the COVID-19 Disorder Tracker).

Frequently these protests are led by groups that oppose the government or exhibit historically low trust in the state. They may also be associated with conspiracy theories and accusations of fake news that undermine the authority of institutions.

Fortunately, governments can take steps to avoid a legacy of unrest resulting from their handling of a major health crisis. In particular, they should consider the underlying levels of trust in institutions when they are designing health interventions in the context of an epidemic. Levels of trust can be evaluated on a regular basis using a range of relevant and publically available indicators. The aim is twofold – to avoid erosion of trust and to build trust, especially in groups and areas where trust levels are low.

Key elements to maintaining levels of trust in institutions include, for example, good communication and accountability. For example, related research by co-author Gonzalez-Torres suggests that communication that is both public, whether it is through radio or TV, and local, emanating from trusted community leaders, is key to affecting social behaviors that are difficult to change, and that are important to halt viral infections, such as certain cultural or religious practices. While a common issue associated with accountability, for example, is ensuring that rules, and sanctions for breaking those rules, are applied to all segments of the population regardless of wealth or position, including officials.

Another sensible practical intervention would be to focus on both granting access to vaccines for communities where levels of trust in institutions are lower, and building trust and good communication with them. Rather than using coercion to accompany this vaccination process.

If policymakers do not take heed of these findings and proactively seek to measure, build and strengthen trust (and prevent the erosion of existing trust) then, as the research shows, the resulting trust deficit may undermine steps taken by authorities to deal with a health crisis. Not only is this likely to prolong any crisis but, in addition, the social and economic effects may last much longer than governments expect, creating a persistent and unwanted legacy of social unrest and violence that hampers recovery efforts.

Related research paper: González-Torres, Ada and Esposito, Elena, Epidemics and Conflict: Evidence from the Ebola Outbreak in Western Africa (2020).

Featured image by