Community action in preventing epidemics: comparative lessons of Ebola virus disease, COVID-19 and smallpox in Sierra Leone

Novel viruses and zoonotic disease outbreaks are an increasing global health risk. Early warning systems and rapid development of vaccines are helpful but also distract from neglecting social agency in disease prevention. The first inter-country epidemic of Ebola virus disease (EVD) from 2013-2015 in West Africa was halted before vaccines became available. A major part of that prevention came from timely community action in devising and applying non-pharmaceutical interventions (NPIs). Experience of EVD also boosted social defences against the pandemic of COVID-19. This proved useful in mitigating against a slow roll-out of promised vaccines. Countries have much to gain from evidence-based lessons of what works, and what does not work, when communities seek to protect themselves from infection through social action. This chapter focuses on comparative lessons from community responses to Ebola virus and COVID-19 in Sierra Leone, with some reference to earlier work on smallpox eradication.