Characterizing Community Hesitancy in Ebola Response: Responder Reflections from the Sudan Ebolavirus Disease (SVD) 2022 Outbreak in Uganda

Abstract Background: Thearticle explores community emergency response intervention hesitancy using reflections from the Sudan Ebolavirus Disease (SVD) 2022 outbreak response in Uganda. Methods: Data from participant observation are complemented with data from four other sources particularly, documentary reviews, ethnographic group discussions (12), informant interviews (60) and transect drives for social risk mapping. Results: The main results indicate that, community emergency response intervention hesitancy in the SVD 2022 outbreak response in Uganda occurred both in direct and non-direct forms. The direct ones included some suspected cases refusing to go to and/or running away from isolation units (IUs) and Ebola treatment units (ETUs), some bereaved families refusing to handover bodies for safe and dignified burials (SDBs) and accosting responders, some bereaved families exhuming and reburying SVD bodies and survivors having sex without protection. The indirect ones included dual naming and false identity declarations, visiting traditional healers and spiritual leaders, hiding identities of high-risk contacts, secretly burying the dead at night and lastly, changing location of or taking patients to other districts Conclusions: The conclusion the study generates is that to avert community emergency response intervention hesitancy, response teams should strike a balance between the health protocol prioritization on one hand and the environmental and socio-economic context of the outbreak on the other hand that includes, lived and observed transgenerational experiences. This must be augmented with a sustained integrated community engagement action that the study found critical to recovery of community trust and control of outbreaks in the community.