"We are survivors and not a virus:" Content analysis of media reporting on Ebola survivors in Liberia

Background: The Ebola virus disease epidemic between 2013 and 2016 in West Africa was unprecedented. It resulted in approximately 28.000 cases and 10.000 Ebola survivors. Many survivors face social, economic and health-related predicaments and media reporting is crucially important in infectious disease outbreaks. However, there is little research on reporting of the social situation of Ebola survivors in Liberia. Methods: The study used a mixed methods approach and analysed media reports from the Liberian Daily Observer (DOL), a daily newspaper available online in English. We were interested to know how the situation of Ebola survivors was portrayed; in what way issues such as stigma and discrimination were addressed; and which stigma reduction interventions were covered and how. We included all articles on the situation of Ebola survivors in the quantitative and in-depth qualitative analysis published between April 2014 and March 2016. Results: The DOL published 148 articles that portrayed the social situation of Ebola survivors between the 24 months observation period. In these articles, Ebola survivors were often defined beyond biological terms, reflecting on a broader social definition of survivorship. Survivorship was associated with challenges such as suffering from after-effects, social and economic consequences and psychological distress. Almost 50% of the articles explicitly mentioned stigmatisation in their reporting on Ebola survivors. This was contextualised in untrustworthiness towards international responses and the local health care system and inconclusive knowledge on cures and transmission routes. In the majority of DOL articles stigma reduction and engaging survivors in the response was reported as crucially important. Discussion: Reporting in the DOL was educational-didactical and well-balanced in terms of disseminating available medical knowledge and reflecting the social situation of Ebola survivors. While the articles contextualised factors contributing to stigmatisation throughout the reporting, journalistic scrutiny regarding effectiveness of interventions by government and NGOs was missing. Author summary: The largest Ebola epidemic occurred in West Africa between 2013 and 2016. Liberia was one of the most affected countries with more than 1500 survivors registered. In the height of the Ebola outbreak survivors were increasingly included in the treatment and care of patients and in health sensitizing and social mobilisation efforts. However, the reintegration of survivors back into their communities proved to be challenging across West Africa. Media reporting plays a crucial role in health emergency situations. It gives visibility to what is considered as relevant, frames risk perception and can induce positive health behaviour practices and attitudes. In this study we analysed how one of Liberia’s largest newspapers portrayed and informed the public on the social situation of survivors, in what way it addressed the issues of stigma and discrimination and which stigma reduction interventions were covered and how. We found that reporting was overall comprehensive and well-balanced in terms of disseminating available medical knowledge, scrutinizing stigma. Reports also reflected on contributing factors such as untrustworthiness towards response as well as inconclusive understanding of cures and transmission routes. In a larger context this specific reporting was acting as corrective to what the larger public believed.