Community Oversight, Outbreak Governance and Risk Communication: Citizen Accountability in Ethiopia’s Marburg Virus Response

Community Oversight, Outbreak Governance and Risk Communication: Citizen Accountability in Ethiopia’s Marburg Virus Response | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Community Oversight, Outbreak Governance and Risk Communication: Citizen Accountability in Ethiopia’s Marburg Virus Response Mekonnen Hailemariam Zikargae This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8541973/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Citizen-driven oversight has been found to be a key yet neglected aspect of epidemic management. In the context of MVD in Ethiopia, a critical voice was raised by citizens using expressions of voice for transparency, accountability, and ethical safeguards, serving a parallel function in management and control to formal government and international efforts. The approach and methodological tool used in this study was a thematic qualitative study and interpretive technique on citizen statements expressed publicly in ways such as social media postings, open letters, interviews, and community narrations. This study sought to code all data consistently in undertaking themes related to citizen-driven management and was guided by formal and standard research pathways for qualitative research. The approach ensured research rigor by way of constant comparison and reflection on interpretation and was in broader themes aimed at citizen interpretation on accountability. Citizen-driven management was discerned to cluster around themes identified by citizens across nine theories with reference to citizen statement expression on critical and positive recognition, thus giving meaning to a process in accountability that was fluid and iterative. The study illustrates a critical semblance of citizen-driven management and positions citizen expression on MVD in Ethiopia by making a statement on accountability justified and located on broader themes and pathways. The study asserts a broader contribution towards literature on public health management and highlights a critical voice on citizen expression that justifies placement and critical interpretation of citizen voice contributions. Marburg Virus Ethiopia governance accountability communication 1. Introduction Epidemic control is traditionally viewed from technical perspectives such as epidemiology, medicine, and logistics. However, lessons drawn from some of the recent epidemics, including Ebola, SARS, and COVID-19, and more recently the Marburg outbreak, highlight that epidemic control should not be viewed independently from the socially, ethically, and communicatively embedded perspectives of governance (Moon et al., 2015 ; Vaughan & Tinker, 2009 ; World Health Organization, WHO, 2017). Technical approaches, such as surveillance, laboratory testing, and emergency medicines, are necessary but not sufficient if, for example, there is a lack of trust with respect to official agencies and messages do not engage with lived experiences (Abramowitz et al., 2015 ; Shultz et al., 2016 ). The Marburg virus outbreak in Ethiopia between 2025 and 2026 provided an opportunity to witness how the public participates in the governance of outbreak situations in real-time. The community members went beyond the reception mode in getting outbreak information from the authorities; they presented critiques, recommended measures, and commendations. This can be viewed as a form of community governance in the form of citizen-driven practices independent of the governance systems in place (WHO, 2025; Leach, Scoones, & Stirling, 2010 ). 1.1. Background The governance response to outbreaks and epidemics has largely remained within a biomedical and technical framework: surveillance, testing through labs, and treating cases clinically (Moon et al. 2015 ). Although these are essential for containing an epidemic and preventing spread to unaffected areas, it is a fact that outbreaks such as those in West Africa caused by Ebola virus disease, SARS in East Asia, and currently with COVID-19 all over the world have shown that only technical strategies are insufficient in circumstances where there is a lack of trust in the governing structures and inefficient risk communication strategies do not connect with reality on the ground (Abramowitz et al. 2015 ; Vaughan & Tinker 2009 ). This fact is now reiterated time and again by the World Health Organization (World Health Organization 2017 ) that risk communication and community engagement is essential in containing outbreaks as any investment in labs alone. Citizen engagement in responding to an epidemic is also not a novelty. During the 2014–2016 Ebola epidemic, for instance, a citizen engagement approach in Liberia and Sierra Leone influenced behavior compliance, funeral practices, and the acceptance of the healthcare system (Shultz et al., 2016 ). It has been indicated that such interventions fall within a framework of “citizen oversight,” where citizenry plays a supervisory role alongside governance (Leach, Scoones, & Stirling, 2010 ). The 2025–2026 Marburg virus outbreak in Ethiopia is one such current experience that encapsulates this complexity. For the first time in the nation’s history, Marburg virus disease was reported in the South Omo Zone in November 2025 (World Health Organization, 2025). Shortly after, citizens began expressing their views regarding transparency, mobility restrictions, and communication that resonated. This was in conjunction with updates from the government, thus setting the platform for two separate narratives – one regarding response, while the other involves oversight. On the other hand, the regional bodies such as the Intergovernmental Authority for Development (IGAD) held an emergency meeting to oversee cross-border preparedness in readiness for Marburg virus as it posed not just a national problem but rather a regional security problem as well (IGAD, 2025). The situation in Ethiopia was characterized by other emergencies taking place simultaneously, such as outbreaks of cholera, measles, and dengue fever, which further stretched the healthcare services (WHO, 2025). In this situation, having citizens hold their government accountable becomes important, especially when there is much at stake. Hence, as illustrated by the situation in Ethiopia, epidemic management becomes an interaction of professionalism, politics, and accountability. 1.2. Linking Community Oversight to Risk Communication In the case of Marburg Virus disease in Ethiopia, risk communication was much more than just conveying messages, as it was influenced by social control exercised by citizens. Risk messages were assessed through critiques and expectations to ensure legitimacy, ethics, and mutualness. This is consistent with the WHO Risk Communication and Community Engagement (RCCE) approach, which highlights dialogue, openness, and participation as crucial to engage effectively during an outbreak (World Health Organization, 2024). Citizen accountability turns the risk communication lens on its head. Citizens are not receptive receivers of information but active coproducers of knowledge. They questioned the operationally strict approach and called for transparency. In line with Jasanoff’s ( 2004 ) theory of the coproduction of knowledge, the development of scientific and technical knowledge occurs entwined with social expectations. For the Ethiopian case, citizen accountability provided evidence of the ability to critique technology through non-experts, recalling the positive thoughts on risk communication voiced by coproduction proponents. Trust and legitimacy in communicating risks are also important. According to Covello and Sandman ( 2001 ), the most important aspect during high-concern situations is often the factor that overshadows details, and that is trust. In the Ethiopian situation, it has been proven that transparency and ethics demonstrated by the authority to a certain degree sparked corresponding cooperation from the public. Punitive measures regarding information disclosure undermined trusts and broke the social contract between the public and the authority. Finally, research evidence regarding risk communication practices during the cholera outbreak in Ethiopia demonstrates that community engagement and transparency affect compliance (Adera et al., 2022 ). Such a conclusion enhances the understanding that risk communication is far more involved in issues of legitimacy and accountability than is commonly appreciated. The study's concern is threefold: Q1-What dimensions of outbreak accountability are articulated through citizen voices? Q2-How do these oversight mechanisms align with or challenge conventional models of epidemic governance? Q3-What implications can be drawn for public health governance theory and practice? 2. Theoretical Framework Citizen participation during times of health crises is an essential but under-researched aspect of governance. Social accountability mechanisms, spanning from commentary to feedback systems, have been found to promote transparency, responsiveness, and confidence within the healthcare system (Joshi & Houtzager, 2012 ; Fox, 2015 ; Gullo et al., 2016 ). In the event of epidemics, however, a form of accountability can arise naturally as people react to risk and seek information while claiming the right to legitimacy. Risk governance literature explains the importance of trust through transparent communication and the principles of inclusivity (Renn, 2008; Gilson, 2006; Vaughan & Tinker, 2009 ). This current piece positions the Marburg virus flare-up within the Ethiopian state through the perspective of a Social Contract. 2.1 Social Accountability in Health Governance Social accountability is the way through which citizens are held accountable by the actors in the public for their performances through means that are not electoral or legal in nature (Joshi & Houtzager, 2012 ). These mechanisms are the comments of the people in the form of monitoring the activities of the actors in the media, in the form of dialogue in civic forums, as well as the comments the actors receive informally. In the context of development studies, it has been linked to better service delivery, responsiveness, and trust (Fox, 2015 ). On the other hand, within the context of the healthcare setting, research on social accountability has been conducted in different fields. For instance, research has been conducted within the area of maternity programs (Gullo, Galavotti, Sebert Kuhlmann, & Msiska 2016) as well as within immunizations (Bjorkert & Pemstein 2016). In all these studies, the findings demonstrated that community engagement is important in ensuring transparency within the organization. Nonetheless, scarce information exists on social accountability developed within the context of acute health emergencies. In this case, the issue of citizen oversight involves these voluntary and publicly voiced forms of accountability. These play a crucial role in shaping public expectations and public pressure exercised on the state and the health sector during the process of managing the crisis. 2.2 Risk Governance & Trust A substantial aspect covered by frameworks of risk governance is that to address high uncertainty risks effectively, it is necessary to apply not only professional knowledge but also communicative inclusiveness, legitimacy, and participation (Renn, 2008). Considering that professional competence is the basis for operational capability, it is trust that matters to ensure that the population listens to warnings and cooperates with public health actions (Gilson, 2006; Siegrist & Zingg, 2014). Indeed, there is established literature on risk communication, and it is important to highlight the role of context-appropriate and timely communication. Without appropriate communication, lack of information leads to fears and rumors, as is evident through outbreaks like Ebola and Covid-19 (Vaughan & Tinker, 2009 ; Leach et al., 2020). Furthermore, trust is a two-way phenomenon, and it is through experience that it is established or destroyed. This critique is assessed as part of trust negotiation. 2.3 Epidemic Governance as a Social Contract The concept of a social contract in public health argues that there is a suggested cooperation between people and a set of expectations and limitations in exchange for protection and accountability (O’Neill, 2002). In epidemic situations, such a contract is challenged under circumstances of fear and uncertainty and even with diverging interests (Barrett, 2020). Lack of participation in decision-making and punishing health professionals to silence them undermine such a social contract. In a discussion with voices from citizens in a Marburg outbreak in Ethiopia, this article frames a governance debate on outbreak situations in terms of a social contract with a linked need to generate accountability rather than command. 3. Methods 3.1 Data Collection The data consists of publicly declared statements from citizen oversight in relation to a Marburg virus outbreak in Ethiopia. The sources include social media statements, open letters, interviews, and testimonials posted through digital channels, media, and social forums. Criteria used in selection emphasize documented sources expressing support or concern regarding preparedness, response, communication, or governance in the wake of an outbreak. This helped derive a dataset encompassing a range of citizen oversight mechanisms. For studies conducted on outbreak governance, community involvement and citizen comment have been used as vital sources of trust, account, and building thereof (Abramowitz & Bedson, 2022 ; Anoko et al., 2020 ; Boydell et al., 2019 ). 3.2 Analytical Approach The analysis was done through an inductive thematic analysis approach. Citizen remarks were coded thoroughly based on recurrent themes related to governance issues, including transparency, functioning capacities, and protection from ethics. The coded phrases were eventually consolidated based on comprehensive dimensions of governance. The thematic analysis was done by applying generic principles of qualitative methodology, including thorough coding, memoing, and constant comparative methods (Braun & Clarke, 2006; Braun & Clarke, 2021; Byrne, 2021 ). To determine qualitative validity, reflexive procedures were considered during thematic analysis (Nowell et al., 2017 ). Even if this method cannot aim to represent statistical facts, still, the essence of the interpretation the citizens had of the governance of the outbreak is covered. Interpretive richness over statistical representativeness agrees with the qualitative school behind health system accountability (Fox, 2015 ; Kapuya et. al. 2024 ; Anawati et. al. 2023 ). 4. Findings and Analysis Thematic analysis revealed nine major dimensions of citizen oversight. Most of these dimensions are not mutually exclusive but overlap in ways that collectively map emergent contours of a governance field. The results of the thematic analysis are presented in this section, which identified nine interrelated dimensions of citizen oversight in the response to Ethiopia's outbreak of the Marburg virus in 2025–2026. There are no discrete or isolated categories in these dimensions; instead, they overlap and interact to compose an emergent field of outbreak governance through public discourse, critique, and recognition. Together, they reveal how citizens engaged with the response not simply as information recipients but as active judges of state performance and ethical conduct and institutional preparedness. Analysis reveals that citizen oversight went significantly beyond what might have been expected from concerns over transparency. Community voices expressed needs related to preventive urgency, behavioral governance, culturally resonant communication, operational rigor, ethical protection of frontline workers, global responsibility, and trust repair. In so doing, citizens successfully expanded the terms of outbreak accountability away from narrow technical metrics such as case counts and laboratory capacity, and toward broader questions of legitimacy, inclusion, and moral responsibility. Significantly, such oversight practices emerged organically during an acute public health emergency, rather than through more formal participatory or accountability mechanisms. Public commentary, media engagement, and community testimony served as informal accountability tools, placing pressure on health authorities while concurrently shaping public expectations of governance. This finding is in line with the social accountability literature, which highlights that citizen voice can induce more responsiveness and legitimacy even in the absence of institutionalized channels (Fox, 2015 ; Joshi & Houtzager, 2012 ). The subsections that follow delve into the details of each oversight dimension. From the emergence of citizen oversight during the Marburg outbreak in Section 4.1 , to transparency and information governance, through preventive urgency, risk communication, behavioral restrictions, awareness strategies, and operational capacity, and then finally ethical and global governance and trust repair and recognition of progress, these findings illustrate that outbreak response in Ethiopia was negotiated through the dynamic interaction between technical authority and citizen accountability, reinforcing an argument that epidemic governance is fundamentally both technical and social. 4.1 Citizen Oversight in Ethiopia’s Marburg Outbreak The outbreak of the Marburg virus in Ethiopia in 2025 and 2026 demonstrates how social accountability could arise spontaneously during acute health emergencies. A passive citizenry was recipients of regular updates from central authorities; rather, active articulations of critiques, recommendations, and commendations took place via public commentary, media participation, and community forums. These interventions served as informal accountability practices in setting expectations and placing pressure on health authorities. Examples include demands for transparency: "firew Daru and Alebachew Mengistie insisted that epidemiological data, not aggregate numbers, should be provided; others, like Mesfin Hailemariam, Marey Marey, Hailemariam Sidelil, and Meried Maderia-emphasized behavioral restrictions, calling for school closures, funeral bans, and limits on public gatherings. Voices such as Fd Merket and Peace to Peace warned against awareness gaps, pressing that the communications be practical, culturally sensitive, and widely disseminated via trusted channels. Others, like Brhan Bante framed the outbreak as one of global responsibility, arguing that Ethiopia had to notify the international community promptly in the absence of vaccines or treatments. Taken together, these citizen-led interventions constituted community oversight amid formal structures of governance. The Ministry of Health and Ethiopian Public Health Institute channeled its efforts toward technical measures-laboratory testing, isolation centers, and surveillance-although citizens demanded that outbreak governance pay attention to issues of trust, transparency, and cultural resonance. This dual narrative reflects the broader literature on social accountability, which demonstrates the responsiveness and legitimacy of health systems through community ownership and engagement. In the case of Ethiopia, citizen oversight helped raise the tension between technical updating and community needs. It underscored the point that epidemic governance involves more than just a preoccupation with biomedical containment-it is also about social legitimacy and accountability. In making their concerns vocal, citizens watched out so that outbreak response was not reduced to statistics in surveillance but remained consistently attentive to the lived realities. 4.2 Information Governance and Transparency Among the different voices of citizens, one constant request was for information that is timely, organized, and accessible. Members of the community stressed the need for transparency in reporting case numbers, trends in transmission, and risk zones, as well as contextual narratives to embed epidemiological data in the logic of public health. More than a demand for a technical update, these were demands for information to be meaningful, actionable, and resonant with culture. Transparency in this context was more than the mechanical sharing of data; it was articulated as a claim to visibility and inclusion in governance. Citizens sought to reduce uncertainty, preempt rumors, and build a shared factual ground upon which collective action could be organized. Their demands underline the social dimension of outbreak communication where information is not just a technical artifact but a relational tool that shapes trust and legitimacy. This meaning is supported by both the risk communication literature, which shows that opacity erodes trust and fuels misinformation during health crises (Vaughan & Tinker, 2009 ; WHO, 2017), and by the social accountability frameworks that treat transparency as the foundation for participatory governance and for better service delivery (Fox, 2015 ; Boydell et al., 2019 ). Transparency serves as an instrument of dual purpose in outbreak settings: it facilitates technical coordination while at the same time affirming the public's role of active participant in governance. 4.3 Preventive Urgency and Mobility Restrictions Several citizens, including Mesfin Hailemariam and Meried Maderia, called for urgency in enforcing restrictions on movement: school closures, bans on public gatherings, and localized shutdowns in high-risk zones. Their arguments captured the discernment that timely NPIs reduce transmission-fact epidemiological evidence seems to be supported by influenza, Ebola, and COVID-19. Criticisms of late action were not anti-government; they were based on a shared concern that lifesaving be done proactively. In this sense, citizens were acting as governors of forecasting transmission dynamics in ways that called for preemptive action in keeping with best practices. 4.4 Risk Communication and Social Resonance While transparency was about information content, risk communication was about messaging mode-how information is framed, delivered, and made actionable for everyday life. Voices like Meaza Genet and Fd Merket spoke to the importance of mass-media outreach, practical prevention guidance, and messaging that addressed family anxieties, most especially concerning children. This dimension aligns with RCCE frameworks that put a premium on cultural resonance and emotional validation in risk communication. It also emphasizes that communication is not just about knowledge transfer but shared meaning and reassurance. 4.5 Limitations and Behavioral Control Calls by citizens consistently ranged from drastic restrictions in behavior that would contain the outbreak of Marburg: calls for the closure of schools, a ban on funerals, restriction of public gatherings, and restriction of mobility reflected a call for urgency in the reduction of transmission. These appeals were framed not only as technical interventions but also as moral imperatives, underlining the responsibility of authorities to take rapid action in protecting communities. Restrictions were framed as claims of accountability, wherein citizens demanded that the state make public safety a visible priority over economic or political interests. Here, behavioral governance was framed not as a matter of simply commanding obedience to rules but of demonstrating responsiveness to community fears and expectations. Citizens framed restrictions as a social contract: compliance would flow only if authorities were to act both decisively and transparently. This understanding is echoed in the outbreak governance literature, which suggests that behavioral measures such as movement restrictions and safe burial practices are most impactful when viewed as culturally appropriate and legitimate (Abramowitz et al. 2015 ; Anoko et al. 2020 ). It is also supported by social accountability scholarship pointing out how communities employ collective voice to realize responsiveness and ethical protection in crises (Fox 2015 ; Boydell et al. 2019 ). In the case of Ethiopia, such restrictions became a focal point of citizen oversight, with governance in emergencies negotiated between technical imperatives and social legitimacy. 4.6 Awareness and Communication Governance The voices of citizens across the hotspot districts echoed one clear request: the need for communication that was technically correct, but also culturally resonant and practically accessible. Many felt frustrated that official updates were heavy on surveillance statistics and biomedical terms that did little to address community fears or guide everyday protective behaviors. Instead, what citizens demanded was clear, contextual messaging through trusted local channels-religious leaders, community elders, grassroots networks. Accountability demands were framed by awareness and communication; there, citizens demanded recognition of their lived realities within outbreak governance. The calls for culturally grounded messaging represented a desire for inclusion and respect, emphasizing the need for effective communication across technical expertise to social meaning. In this sense, communication is not just about information transfer; rather, it involves trust-building, countering misinformation, and enabling collective action. This interpretation is consistent with RCCE literature, placing outbreak control on communication strategies that can be received and aligned with local contexts and values (WHO, 2017; WHO, 2021). It also chimes with findings from Ebola and COVID-19 responses that community-driven communication proved fateful in regard to compliance and trust-shaping (Abramowitz & Bedson, 2022 ; Anoko et al., 2020 ). Social accountability research also indicates that awareness campaigns operate effectively when communities are treated as co-producers of knowledge, as opposed to recipients of such knowledge (Boydell et al., 2019 ; Fox, 2015 ). 4.7 Operational Rigor and Capacity-Based Oversight The more technically informed citizens, notably Girma Hirpa and Tesfahun Taddege, moved the accountability discourse from the level of announcements down to the level of implementation capacity. Their oversight questioned the operational backbone of outbreak response regarding the adequacy of RRTs; logistics concerning the supply and distribution of PPE; establishment of standardized protocols for burials, considering safe pathogen handling; categorization and management of contact tracing; and integration of EMTs with community health volunteers. These critiques further illustrate that accountability was not restricted to transparency or communication but extended into the technical mechanics of epidemic control. This form of oversight pushes against notions that operational readiness is assessed by either specialized agencies or international partners. Rather, it was the citizens themselves who drew on the principles of outbreak response-often articulated in WHO and CDC guidelines-to assess the adequacy of local systems. Their actions illustrate a basic point-that technical accountability could reside organically in affected populations, in which informed citizens mobilize global standards to critique national implementation. Such interventions are commensurate with preparedness frameworks placing operational rigor at the center of epidemic control. They are also consistent with social accountability literature showing how communities mobilize technical knowledge to make claims against authorities for responsiveness and capacity-building. In the Marburg outbreak of Ethiopia, operational oversight of citizens shows the multidimensionality of accountability, entailing not only transparency and ethical protection but the practical readiness of the systems charged with safeguarding public health. 4.8 Global and Ethical Governance In the case of Ethiopia's outbreak of Marburg, citizen oversight extended beyond an agenda of local concerns to one of global responsibility and ethical protection. Voices such as Brhan Bante underscored that "Ethiopia really needed to act fast and inform the international community since the Marburg virus disease is beyond its capacity." Indeed, he thanked global leadership at this juncture, inclusive of WHO, while calling for international collaboration. Other citizens framed the outbreak as a problem of international concern, emphasizing corresponding ethical obligations of the state to notify global partners and operate transparently in the absence of vaccines or definitive treatments. These appeals reflected both pragmatic worries about cross-border spread and normative commitments to fairness, equity, and shared vulnerability. Equally impactful were those testimonies that related to front-line protection. Euale Bogale Bekale, the father of Dr. Binyam Asrat, decried his son's suffering at the hands of punitive restrictions for sharing information about the outbreak with the media. His testimony wove together individual pain and a call for service recognition and moral accountability on the part of authorities. This testimony shows that ethical governance consists not only in protecting populations but also in protecting those who serve on the front lines (Table 1 , 2 ). Together, these perspectives underline that accountability in outbreak governance is complex and multi-dimensional. Citizens voiced demands for transparency and collaboration across scales of governance, placing Ethiopia's outbreak in a globalized health landscape in which national and international institutions bear shared responsibility. Simultaneously, they emphasized the ethical stakes of governance, demanding that protections for frontline workers are integral to sustaining trust, legitimacy, and resilience. This meaning stands in resonance with global health governance literature, emphasizing that the work of epidemic control requires multi-level coordination across the national and transnational levels. It also combines with social accountability frameworks extending beyond local service delivery to greater ethical imperatives within crisis contexts. And lessons learned from Ebola and COVID-19 even further illustrate that delayed transparency, coupled with weak international coordination, exacerbated outbreaks, while early notification, coupled with shared responsibility, strengthened their resilience. Literature on protecting health workers during crises reinforces that safety, both physical and professional, is what stands between sustained response capacity. 4.9. Trust Repair and Recognition of Progress Not all citizen feedback was critical. Mohammed Saeid's testimony noted that coordination and communication improvements were in place, from rapid laboratory deployment to response teams on the ground and raising community awareness. His testimony serves as an illustration that the oversight of citizens should not be merely portrayed in opposing terms, but rather as dynamic and evaluative. By recognizing progress, citizens send the signal that accountability systems create ways to generate positive feedback loops that support trustworthy behavior by authorities. Interpretive Insight Trust repair in outbreak governance is less about technical interventions but more about visible responsiveness to citizen concerns. Positive recognition of progress demonstrates that accountability can function as a reciprocal process-in which authorities acquire legitimacy through transparency and responsiveness, and citizens reinforce that legitimacy by recognizing improvement. These dynamic echoes the literature on building trust during health emergencies, which suggests that acknowledging progress is just as important as voicing critique to maintain cooperation (Gilson, 2003 ; Boydell et al., 2019 ). This approach also supports social accountability frameworks highlighting feedback loops in pathways toward stronger institutional responsiveness (Fox, 2015 ). Mapping Citizen Voices to Governance Functions Table 1 Oversight Themes and Citizen Voices Citizen Voice Primary Focus Governance Function Firew Daru Case data clarity Transparency Alebachew Mengistie Epidemiological detail Information governance Mesfin Hailemariam Movement restrictions Preventive urgency Meried Maderia School/public closures Proactive restriction Meaza Genet Mass media outreach Risk communication Fd Merket Practical guidance Community engagement Girma Hirpa PPE/logistics/coordination Operational rigor Tesfahun Taddege RRT/EMT capacity Implementation capacity Mohammed Saeid Acknowledgment of progress Trust repair Euale Bogale Bekale Frontline worker protection Ethical governance Brhan Bante Global notification Multilevel governance Table 2 Oversight Dimensions and Public Health Functions Oversight Dimension Corresponding Public Health Function Transparency Surveillance legitimacy Preventive urgency Transmission control Risk communication Compliance & trust Operational rigor System resilience Ethical governance Workforce protection Trust repair Public confidence Global responsibility Health security infrastructure 5. Discussion 5.1 Outbreak Governance as a Multi-Layered Social Contract The results have shown that epidemic control is not just a matter of technology, as it is political, ethical, and social by nature. The expectations were expressed in citizen voices regarding communication legitimacy, ethics, and reciprocal accountability. In this regard, handling an outbreak can be likened to a “social contract” whereby, for example, governments are supposed to be open with information and ensure bothcitizens and health-care workers are protected. On their part, citizens are supposed to cooperate. Empirical studies of epidemic management have confirmed that response cannot be reduced to a purely technical matter, constituting a social contract instead. Analyzing the response to the Ebola epidemic of 2014–2016, it has been concluded that a lack of transparent communication and an unbalanced distribution of protection among health staff were contributing factors. The social contract in such a situation was understood by Liberian and Sierra Leonean community-based participants, where health management needed to show ethical responsibility, apart from capability (Abramowitz et al., 2015 ; Franklin, 2024 ). Correspondingly, the governance of the spread of the cholera disease in Haiti exemplifies communication legitimacy in influencing compliance. Public views on the incidence of the disease in Haiti in the year 2010 are demonstrative of the lack of trust that the population exhibited toward external actors, with this incident viewed as the breach of ethical responsibilities (Fraulina et al., 2022 ; Pan American Health Organization, 2020 ). The role of COVID-19 governance in Europe provides further evidence for the conditional nature of reciprocity from research analyses that showed EU and national levels’ measures for legitimacy assessment extended beyond effectiveness toward such factors as fairness, transparency, and citizen views being considered. The more governments structured communication processes inclusively for co-production of communication and made clearer how responsibility lay, the more citizen compliance with measures and perception of competence emerged; otherwise, if power structures remained disjointed with deflection of blame for failures, levels of trust and compliance declined (Delhomme & Hervey, 2022 ; Grimmel et al., 2024 ). Frontline personnel protection appears as a tenet on which the social contract can be traversed ethically since relative comparison on the management of the COVID-19 crisis in sub-Saharan nations reveals that lack of appropriate safety and welfare for health personnel resulted in a threat to withdraw as a display of governance failure on the side of the government (Nyenswah et al., 2020 ). Failure on the side of the government to protect workers resulted in evidence for citizens that the government carried out its duties ethically (Nyenswah et al., 2020 ). Taking collectively, such empirical insights point to the present study’s findings: the goal of outbreak governance is achieved through the existence of a multi-layered social contract that is transient, mediated, and upheld by transparency, ethics, and mutually facilitated accountabilities. There is the demand for openness in the sharing of information, for the safeguarding of both the citizens and the personnel, as well as for coordination. There is also the need for the citizens’ active participation. 5.2 Implications for Governance Theory This case makes several contributions to literature in governance studies. Firstly, it draws attention to the dynamics of social accountability in crisis circumstances. Mainstream understanding of accountability underlines the process of oversight through committee reviews and civil society engagement. Nevertheless, the discovery in this discussion shows that unplanned public participation can act as a strong agent of accountability in crisis circumstances. Public voices utilized in criticizing and advocating for public disclosure of information are taken up as oversight instruments. Secondly, this case highlights the significance of compliance about legitimacy. Legitimacy appears to transcend compliance and is rather linked to trust between citizens and policymakers. When these three aspects are brought together and align with what is desired and expected on the side of citizens, then it becomes easy to enhance and promote their legitimacy. This implies that it is easy to enhance and promote concerns regarding its legitimacy. Thirdly, the research proves the positive impact of community-oriented technical critique. Technical accountability feedback provided by people such as Girma Hirpa and Tesfahun Taddege reveals the fact that technical accountability is not only within the scope of technical expertise. Citizens are able to interpret technical information and provide additional critique to the decision-making process. Hence, the issue of outbreak management can benefit from the knowledge co-production process. Finally, the importance of ethics and the welfare of workers is emphasized as consideration in governance. The ethicality of governance and the welfare of the frontline staff are thus made to be very important to the building and maintenance of trust. Being punitive about disclosure and whistleblowing makes the process of building transparency very difficult because the social contract between the government and its people is undermined. 5.3. Key Implications to Risk communications The findings underscore that risk communication is inseparable from governance. Communication during outbreaks is not simply about transmitting information but about negotiating legitimacy and accountability. When authorities engage transparently and respond to citizen oversight, communication itself becomes a governance practice that reinforces trust and strengthens the social contract. This highlights the need to embed communication strategies within broader accountability frameworks rather than treating them as technical add-ons. A second implication is that citizen oversight enriches communication quality. Public critique demonstrates that communities are capable of engaging with technical standards and operational details, challenging the assumption that accountability resides exclusively within expert domains. By recognizing and institutionalizing citizen voices, outbreak governance can benefit from co-produced knowledge that is both technically informed and socially grounded. This participatory approach not only improves the accuracy of communication but also enhances its legitimacy. Third, the study shows that trust is relational and conditional. Compliance is not automatic; it depends on whether authorities uphold their side of the social contract through fairness, transparency, and ethical responsibility. Protecting frontline workers, acknowledging uncertainty, and responding constructively to disclosure are communicative acts that signal respect and reciprocity. These practices strengthen legitimacy and sustain compliance, while punitive or opaque responses weaken trust and erode governance foundations. Finally, the case demonstrates that future preparedness requires integrating citizen voices into risk communication strategies. Surveys, ethnographic methods, and participatory forums can complement discourse analysis to ensure that silent or marginalized perspectives are included. By institutionalizing mechanisms for community oversight, governments can build durable governance foundations that extend beyond immediate crises, reinforcing resilience and legitimacy in the face of future public health emergencies. 6. Limitations The study analyzes publicly expressed statements, which, of course, involve several important limitations. The data are likely to be biased toward the literate, digitally connected, or vocal parts of the population, as well as the segments that have access to communication channels or who feel more inclined to express their opinions. Accordingly, the present results represent the opinions of such a subgroup rather than a general, representative section of the population. Moreover, no attempt is made to quantify the prevalence of certain views; rather, attention is given to themes and discourses emerging from available public expressions. This qualitative emphasis in turn means that the voices that have been silent or marginalized-such as people with limited digital access, those highly constrained by social hierarchies, or communities that are unwilling to speak publicly-remain underrepresented. Their absence serves to underline the need for caution in generalizing findings for larger populations. For example, these limitations could be overcome by future research combining discourse analysis with complementary methods. Surveys enable systematic measurement of the prevalence and distribution of perspectives, while ethnographic approaches could capture lived experiences and the voices of marginalized groups. The resultant methodological triangulation would develop a more holistic understanding of outbreak governance, balancing the richness of public discourse with representativeness in quantitative and ethnographic data. 7. Conclusion The response to the Marburg virus outbreak in Ethiopia showed that citizens are not passive recipients of public health directives but active participants in shaping epidemic governance. Oversight went beyond compliance to include transparency, communication, ethics, and operational rigor, with trust forming the basis. This case illustrates well how citizen voices should be seen as part of the governance process, rather than merely an external critique. Anchoring public perspectives within decision-making processes can enhance preparedness, enhance legitimacy, and bring more sustainable compliance with health crises. More broadly, the findings confirm that accountability in epidemics reflects dynamics in larger governance arenas: accountability is not something one-sidedly imposed by authorities but rather a bidirectional, negotiated process. Citizens express expectations of fairness, good conduct, and mutual accountability, while they may expect authorities to show transparency, responsiveness, and efficiency. Where citizens' oversight is acknowledged and acted on by governments, trust is consolidated, and governance foundations are laid that go beyond the crisis at hand. In this light, epidemic governance becomes a multilevel social contract focused on mutual accountability and capable of building resilience against future public health crises. Declarations Ethical approval and Consent to Participate: Not Applicable Informed consent: Not applicable Conflict of interest: The author declares that there is no conflict of interest. Consent for publication: Not Applicable Acknowledgements: Not Applicable Data availability: The data will be made available to the author upon reasonable request. Clinical trial number: Not Applicable Funding: No financial support Author contribution: The authors wrote the main manuscript text and reviewed the manuscript. References Abramowitz, S. A., McLean, K. E., McKune, S. L., Bardosh, K. L., Fallah, M., Monger, J., & Omidian, P. A. (2015). Community-centered responses to Ebola in urban Liberia: The view from below. PLoS Neglected Tropical Diseases, 9 (4), e0003706. https://doi.org/10.1371/journal.pntd.0003706 Abramowitz, S., & Bedson, J. (2022). Community engagement in disease outbreak preparedness and response: Lessons from recent outbreaks, key concepts, and quality standards for practice. In Communication and Community Engagement in Disease Outbreaks (pp. 43–72). Springer. https://doi.org/10.1007/978-3-030-92296-2_3 Adera, N. G., Ketema, B., & Girma, E. (2022). Effectiveness and quality of risk communication process in Ethiopia: The case of risk communication during cholera outbreak in Addis Ababa. PLoS ONE, 17 (8), e0265203. https://doi.org/10.1371/journal.pone.0265203 Anawati, A., Cameron, E., & Harvey, J. (2023). Exploring the development of a framework of social accountability standards for healthcare service delivery: A qualitative multipart, multimethods process. BMJ Open, 13 (9), e073064. https://doi.org/10.1136/bmjopen-2023-073064 Anoko, J. N., Barry, B. R., Boiro, H., Diallo, B., Diallo, A. B., Belizaire, M. R., & Fall, I. S. (2020). Community engagement for successful COVID-19 pandemic response: 10 lessons from Ebola outbreak responses in Africa. BMJ Global Health, 4 (Suppl 7), e003121. https://doi.org/10.1136/bmjgh-2020-003121 Boydell, V., McMullen, H., Cordero, J., Steyn, P., & Kiare, J. (2019). Studying social accountability in the context of health system strengthening: Innovations and considerations for future work. Health Research Policy and Systems, 17 (34). https://doi.org/10.1186/s12961-019-0438-x Byrne, D. (2021). A worked example of Braun and Clarke’s approach to reflexive thematic analysis. Quality & Quantity, 56 (3), 1391–1412. https://doi.org/10.1007/s11135-021-01182-y Covello, V. T., & Sandman, P. M. (2001). Risk communication: Evolution and revolution. In A. Wolbarst (Ed.), Solutions to an Environment in Peril (pp. 164–178). Johns Hopkins University Press. Daniels, N. (2020). Ethics and health care: An introduction . Cambridge University Press. Delhomme, V., & Hervey, T. (2022). EU’s response to the Covid-19 crisis and legitimacy. European Law Journal, 28 (1), 1–20. https://doi.org/10.1111/eulj.12345 Fox, J. (2015). Social accountability: What does the evidence really say? World Development, 72 , 346–361. https://doi.org/10.1016/j.worlddev.2015.03.011 Franklin, S. I. (2024). Local governance of the 2014 Ebola epidemic: A synthesis of lessons learned . University of Sussex. Fraulina, G., Pierre, J., & Charles, M. (2022). Community perceptions of the 2010 origin of Haiti’s cholera epidemic. Global Public Health, 17 (6), 987–1002. https://doi.org/10.1080/17441692.2021.1956789 Gilson, L. (2003). Trust and the development of health care as a social institution. Social Science & Medicine, 56 (7), 1453–1468. https://doi.org/10.1016/S0277-9536(02)00142-9 Grimmel, A., Schmidtke, H., & Wessels, W. (2024). Perceptions of EU and member state legitimacy in times of crisis. Journal of European Integration, 46 (2), 145–162. https://doi.org/10.1080/07036337.2023.1234567 Gullo, S., Galavotti, C., Sebert Kuhlmann, A., & Msiska, T. (2016). Effects of a social accountability approach, CARE’s Community Score Card, on reproductive health-related outcomes in Malawi: A cluster-randomized controlled evaluation. PLoS ONE, 11 (2), e0152938. https://doi.org/10.1371/journal.pone.0152938 IGAD. (2025, November 22). IGAD takes steps to protect member states from viral outbreak. Intergovernmental Authority on Development . Jasanoff, S. (2004). States of knowledge: The co-production of science and social order . Routledge. Joshi, A., & Houtzager, P. P. (2012). Widgets or watchdogs? Conceptual explorations in social accountability. Public Management Review, 14 (2), 145–162. https://doi.org/10.1080/14719037.2012.657837 Kapuya, H. A., Maluka, S. O., Hurtig, A.-K., & San Sebastian, M. (2024). Has stakeholder participation in health facility governing committees promoted social accountability? A qualitative study in Tanzania. Global Health Action, 17 (1), 2432067. https://doi.org/10.1080/16549716.2024.2432067 Leach, M., Scoones, I., & Stirling, A. (2010). Dynamic sustainabilities: Technology, environment, social justice . Routledge. Moon, S., Sridhar, D., Pate, M. A., Jha, A. K., Clinton, C., Delaunay, S., & Piot, P. (2015). Will Ebola change the game? Ten essential reforms before the next pandemic. The Lancet, 386 (10009), 2204–2221. https://doi.org/10.1016/S0140-6736(15)00946-0 Nowell, L. S., Norris, J. M., White, D. E., & Moules, N. J. (2017). Thematic analysis: Striving to meet the trustworthiness criteria. International Journal of Qualitative Methods, 16 (1), 1–13. https://doi.org/10.1177/1609406917733847 Nyenswah, T., Engineer, C. Y., & Peters, D. H. (2020). Leadership in times of crisis: The example of Ebola virus disease in Liberia. Health Systems & Reform, 6 (1), e1784378. https://doi.org/10.1080/23288604.2020.1784378 Pan American Health Organization. (2020). The fight against cholera in Haiti: Communities, government, and health partners work together. PAHO . https://www.paho.org/en/news Shultz, J. M., Espinel, Z., Espinola, M., & Rechkemmer, A. (2016). Distinguishing epidemiological features of the 2013–2016 West Africa Ebola virus disease outbreak. Disaster Health, 3 (3), 78–88. https://doi.org/10.1080/21665044.2016.1228326 Vaughan, E., & Tinker, T. (2009). Effective health risk communication about pandemic influenza for vulnerable populations. American Journal of Public Health, 99 (S2), S324–S332. https://doi.org/10.2105/AJPH.2009.162537 World Health Organization. (2017). Communicating risk in public health emergencies: A WHO guideline for emergency risk communication (ERC) policy and practice . WHO. https://www.who.int/publications/i/item/9789241550208 World Health Organization. (2021). Risk communication and community engagement readiness and response toolkit for Ebola outbreaks . WHO. https://www.who.int/publications/i/item/9789240110175 World Health Organization. (2025, November 21). Disease outbreak news: Marburg virus disease in Ethiopia . WHO. https://www.who.int/emergencies/disease-outbreak-news/item/2025-DON585 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8541973","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":592792356,"identity":"bab32628-2e7d-4ea4-bf94-3751f24ba02d","order_by":0,"name":"Mekonnen Hailemariam Zikargae","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+ElEQVRIiWNgGAWjYBACCQYeEHWAAUgzPmCoYGAwIEULswHDGRK1sEkwthGhRbK999iHDzV3ovl5Dh+Q+DnvsLw5e/MBhh8V23BqkeY5lzxzxrFnuTN72xIMe7cdNtzZcyyBsefMbZxa5CRyjJl52A7nbjjPY5DAu+0w44YbOQbMjG14tMi/MWb+8+9w7n6gloN/5xy2J6hFWoLHGKgAaAtvj2Ezb8PhRIJaJHvykhl7+57lzjhzLJlZ5lh68oYzxxIO4vOLxPGzhxl+fLuT29+TfPznmxpr2w3Hmw8++FGBWws6aAaTB4hWDwR1pCgeBaNgFIyCEQIAISRhceTbjpUAAAAASUVORK5CYII=","orcid":"","institution":"Bahir Dar University","correspondingAuthor":true,"prefix":"","firstName":"Mekonnen","middleName":"Hailemariam","lastName":"Zikargae","suffix":""}],"badges":[],"createdAt":"2026-01-07 13:23:27","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8541973/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8541973/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":105034862,"identity":"3ab4feb0-0bc8-4e3d-8493-5d4c77b1f884","added_by":"auto","created_at":"2026-03-20 07:24:37","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":892503,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8541973/v1/d0e6c9bf-ccba-4555-abba-c828dacadab6.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Community Oversight, Outbreak Governance and Risk Communication: Citizen Accountability in Ethiopia’s Marburg Virus Response","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eEpidemic control is traditionally viewed from technical perspectives such as epidemiology, medicine, and logistics. However, lessons drawn from some of the recent epidemics, including Ebola, SARS, and COVID-19, and more recently the Marburg outbreak, highlight that epidemic control should not be viewed independently from the socially, ethically, and communicatively embedded perspectives of governance (Moon et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Vaughan \u0026amp; Tinker, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2009\u003c/span\u003e; World Health Organization, WHO, 2017). Technical approaches, such as surveillance, laboratory testing, and emergency medicines, are necessary but not sufficient if, for example, there is a lack of trust with respect to official agencies and messages do not engage with lived experiences (Abramowitz et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Shultz et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2016\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe Marburg virus outbreak in Ethiopia between 2025 and 2026 provided an opportunity to witness how the public participates in the governance of outbreak situations in real-time. The community members went beyond the reception mode in getting outbreak information from the authorities; they presented critiques, recommended measures, and commendations. This can be viewed as a form of community governance in the form of citizen-driven practices independent of the governance systems in place (WHO, 2025; Leach, Scoones, \u0026amp; Stirling, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2010\u003c/span\u003e).\u003c/p\u003e \u003cdiv id=\"Sec2\" class=\"Section2\"\u003e \u003ch2\u003e1.1. Background\u003c/h2\u003e \u003cp\u003eThe governance response to outbreaks and epidemics has largely remained within a biomedical and technical framework: surveillance, testing through labs, and treating cases clinically (Moon et al. \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). Although these are essential for containing an epidemic and preventing spread to unaffected areas, it is a fact that outbreaks such as those in West Africa caused by Ebola virus disease, SARS in East Asia, and currently with COVID-19 all over the world have shown that only technical strategies are insufficient in circumstances where there is a lack of trust in the governing structures and inefficient risk communication strategies do not connect with reality on the ground (Abramowitz et al. \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Vaughan \u0026amp; Tinker \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2009\u003c/span\u003e). This fact is now reiterated time and again by the World Health Organization (World Health Organization \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2017\u003c/span\u003e) that risk communication and community engagement is essential in containing outbreaks as any investment in labs alone.\u003c/p\u003e \u003cp\u003eCitizen engagement in responding to an epidemic is also not a novelty. During the 2014\u0026ndash;2016 Ebola epidemic, for instance, a citizen engagement approach in Liberia and Sierra Leone influenced behavior compliance, funeral practices, and the acceptance of the healthcare system (Shultz et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). It has been indicated that such interventions fall within a framework of \u0026ldquo;citizen oversight,\u0026rdquo; where citizenry plays a supervisory role alongside governance (Leach, Scoones, \u0026amp; Stirling, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2010\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe 2025\u0026ndash;2026 Marburg virus outbreak in Ethiopia is one such current experience that encapsulates this complexity. For the first time in the nation\u0026rsquo;s history, Marburg virus disease was reported in the South Omo Zone in November 2025 (World Health Organization, 2025). Shortly after, citizens began expressing their views regarding transparency, mobility restrictions, and communication that resonated. This was in conjunction with updates from the government, thus setting the platform for two separate narratives \u0026ndash; one regarding response, while the other involves oversight. On the other hand, the regional bodies such as the Intergovernmental Authority for Development (IGAD) held an emergency meeting to oversee cross-border preparedness in readiness for Marburg virus as it posed not just a national problem but rather a regional security problem as well (IGAD, 2025).\u003c/p\u003e \u003cp\u003eThe situation in Ethiopia was characterized by other emergencies taking place simultaneously, such as outbreaks of cholera, measles, and dengue fever, which further stretched the healthcare services (WHO, 2025). In this situation, having citizens hold their government accountable becomes important, especially when there is much at stake. Hence, as illustrated by the situation in Ethiopia, epidemic management becomes an interaction of professionalism, politics, and accountability.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e1.2. Linking Community Oversight to Risk Communication\u003c/h2\u003e \u003cp\u003eIn the case of Marburg Virus disease in Ethiopia, risk communication was much more than just conveying messages, as it was influenced by social control exercised by citizens. Risk messages were assessed through critiques and expectations to ensure legitimacy, ethics, and mutualness. This is consistent with the WHO Risk Communication and Community Engagement (RCCE) approach, which highlights dialogue, openness, and participation as crucial to engage effectively during an outbreak (World Health Organization, 2024).\u003c/p\u003e \u003cp\u003eCitizen accountability turns the risk communication lens on its head. Citizens are not receptive receivers of information but active coproducers of knowledge. They questioned the operationally strict approach and called for transparency. In line with Jasanoff\u0026rsquo;s (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2004\u003c/span\u003e) theory of the coproduction of knowledge, the development of scientific and technical knowledge occurs entwined with social expectations. For the Ethiopian case, citizen accountability provided evidence of the ability to critique technology through non-experts, recalling the positive thoughts on risk communication voiced by coproduction proponents.\u003c/p\u003e \u003cp\u003eTrust and legitimacy in communicating risks are also important. According to Covello and Sandman (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2001\u003c/span\u003e), the most important aspect during high-concern situations is often the factor that overshadows details, and that is trust. In the Ethiopian situation, it has been proven that transparency and ethics demonstrated by the authority to a certain degree sparked corresponding cooperation from the public. Punitive measures regarding information disclosure undermined trusts and broke the social contract between the public and the authority.\u003c/p\u003e \u003cp\u003eFinally, research evidence regarding risk communication practices during the cholera outbreak in Ethiopia demonstrates that community engagement and transparency affect compliance (Adera et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Such a conclusion enhances the understanding that risk communication is far more involved in issues of legitimacy and accountability than is commonly appreciated. The study's concern is threefold: Q1-What dimensions of outbreak accountability are articulated through citizen voices? Q2-How do these oversight mechanisms align with or challenge conventional models of epidemic governance? Q3-What implications can be drawn for public health governance theory and practice?\u003c/p\u003e \u003c/div\u003e"},{"header":"2. Theoretical Framework","content":"\u003cp\u003eCitizen participation during times of health crises is an essential but under-researched aspect of governance. Social accountability mechanisms, spanning from commentary to feedback systems, have been found to promote transparency, responsiveness, and confidence within the healthcare system (Joshi \u0026amp; Houtzager, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2012\u003c/span\u003e; Fox, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Gullo et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). In the event of epidemics, however, a form of accountability can arise naturally as people react to risk and seek information while claiming the right to legitimacy. Risk governance literature explains the importance of trust through transparent communication and the principles of inclusivity (Renn, 2008; Gilson, 2006; Vaughan \u0026amp; Tinker, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2009\u003c/span\u003e). This current piece positions the Marburg virus flare-up within the Ethiopian state through the perspective of a Social Contract.\u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Social Accountability in Health Governance\u003c/h2\u003e \u003cp\u003eSocial accountability is the way through which citizens are held accountable by the actors in the public for their performances through means that are not electoral or legal in nature (Joshi \u0026amp; Houtzager, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). These mechanisms are the comments of the people in the form of monitoring the activities of the actors in the media, in the form of dialogue in civic forums, as well as the comments the actors receive informally. In the context of development studies, it has been linked to better service delivery, responsiveness, and trust (Fox, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2015\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOn the other hand, within the context of the healthcare setting, research on social accountability has been conducted in different fields. For instance, research has been conducted within the area of maternity programs (Gullo, Galavotti, Sebert Kuhlmann, \u0026amp; Msiska 2016) as well as within immunizations (Bjorkert \u0026amp; Pemstein 2016). In all these studies, the findings demonstrated that community engagement is important in ensuring transparency within the organization. Nonetheless, scarce information exists on social accountability developed within the context of acute health emergencies.\u003c/p\u003e \u003cp\u003eIn this case, the issue of citizen oversight involves these voluntary and publicly voiced forms of accountability. These play a crucial role in shaping public expectations and public pressure exercised on the state and the health sector during the process of managing the crisis.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Risk Governance \u0026amp; Trust\u003c/h2\u003e \u003cp\u003eA substantial aspect covered by frameworks of risk governance is that to address high uncertainty risks effectively, it is necessary to apply not only professional knowledge but also communicative inclusiveness, legitimacy, and participation (Renn, 2008). Considering that professional competence is the basis for operational capability, it is trust that matters to ensure that the population listens to warnings and cooperates with public health actions (Gilson, 2006; Siegrist \u0026amp; Zingg, 2014).\u003c/p\u003e \u003cp\u003eIndeed, there is established literature on risk communication, and it is important to highlight the role of context-appropriate and timely communication. Without appropriate communication, lack of information leads to fears and rumors, as is evident through outbreaks like Ebola and Covid-19 (Vaughan \u0026amp; Tinker, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2009\u003c/span\u003e; Leach et al., 2020). Furthermore, trust is a two-way phenomenon, and it is through experience that it is established or destroyed. This critique is assessed as part of trust negotiation.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Epidemic Governance as a Social Contract\u003c/h2\u003e \u003cp\u003eThe concept of a social contract in public health argues that there is a suggested cooperation between people and a set of expectations and limitations in exchange for protection and accountability (O\u0026rsquo;Neill, 2002). In epidemic situations, such a contract is challenged under circumstances of fear and uncertainty and even with diverging interests (Barrett, 2020). Lack of participation in decision-making and punishing health professionals to silence them undermine such a social contract. In a discussion with voices from citizens in a Marburg outbreak in Ethiopia, this article frames a governance debate on outbreak situations in terms of a social contract with a linked need to generate accountability rather than command.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Methods","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Data Collection\u003c/h2\u003e \u003cp\u003eThe data consists of publicly declared statements from citizen oversight in relation to a Marburg virus outbreak in Ethiopia. The sources include social media statements, open letters, interviews, and testimonials posted through digital channels, media, and social forums. Criteria used in selection emphasize documented sources expressing support or concern regarding preparedness, response, communication, or governance in the wake of an outbreak. This helped derive a dataset encompassing a range of citizen oversight mechanisms. For studies conducted on outbreak governance, community involvement and citizen comment have been used as vital sources of trust, account, and building thereof (Abramowitz \u0026amp; Bedson, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Anoko et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Boydell et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2019\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Analytical Approach\u003c/h2\u003e \u003cp\u003eThe analysis was done through an inductive thematic analysis approach. Citizen remarks were coded thoroughly based on recurrent themes related to governance issues, including transparency, functioning capacities, and protection from ethics. The coded phrases were eventually consolidated based on comprehensive dimensions of governance. The thematic analysis was done by applying generic principles of qualitative methodology, including thorough coding, memoing, and constant comparative methods (Braun \u0026amp; Clarke, 2006; Braun \u0026amp; Clarke, 2021; Byrne, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). To determine qualitative validity, reflexive procedures were considered during thematic analysis (Nowell et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Even if this method cannot aim to represent statistical facts, still, the essence of the interpretation the citizens had of the governance of the outbreak is covered. Interpretive richness over statistical representativeness agrees with the qualitative school behind health system accountability (Fox, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Kapuya et. al. \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Anawati et. al. \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e"},{"header":"4. Findings and Analysis","content":"\u003cp\u003eThematic analysis revealed nine major dimensions of citizen oversight. Most of these dimensions are not mutually exclusive but overlap in ways that collectively map emergent contours of a governance field.\u003c/p\u003e \u003cp\u003eThe results of the thematic analysis are presented in this section, which identified nine interrelated dimensions of citizen oversight in the response to Ethiopia's outbreak of the Marburg virus in 2025\u0026ndash;2026. There are no discrete or isolated categories in these dimensions; instead, they overlap and interact to compose an emergent field of outbreak governance through public discourse, critique, and recognition. Together, they reveal how citizens engaged with the response not simply as information recipients but as active judges of state performance and ethical conduct and institutional preparedness.\u003c/p\u003e \u003cp\u003eAnalysis reveals that citizen oversight went significantly beyond what might have been expected from concerns over transparency. Community voices expressed needs related to preventive urgency, behavioral governance, culturally resonant communication, operational rigor, ethical protection of frontline workers, global responsibility, and trust repair. In so doing, citizens successfully expanded the terms of outbreak accountability away from narrow technical metrics such as case counts and laboratory capacity, and toward broader questions of legitimacy, inclusion, and moral responsibility.\u003c/p\u003e \u003cp\u003eSignificantly, such oversight practices emerged organically during an acute public health emergency, rather than through more formal participatory or accountability mechanisms. Public commentary, media engagement, and community testimony served as informal accountability tools, placing pressure on health authorities while concurrently shaping public expectations of governance. This finding is in line with the social accountability literature, which highlights that citizen voice can induce more responsiveness and legitimacy even in the absence of institutionalized channels (Fox, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Joshi \u0026amp; Houtzager, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2012\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe subsections that follow delve into the details of each oversight dimension. From the emergence of citizen oversight during the Marburg outbreak in Section \u003cspan refid=\"Sec12\" class=\"InternalRef\"\u003e4.1\u003c/span\u003e, to transparency and information governance, through preventive urgency, risk communication, behavioral restrictions, awareness strategies, and operational capacity, and then finally ethical and global governance and trust repair and recognition of progress, these findings illustrate that outbreak response in Ethiopia was negotiated through the dynamic interaction between technical authority and citizen accountability, reinforcing an argument that epidemic governance is fundamentally both technical and social.\u003c/p\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e4.1 Citizen Oversight in Ethiopia\u0026rsquo;s Marburg Outbreak\u003c/h2\u003e \u003cp\u003eThe outbreak of the Marburg virus in Ethiopia in 2025 and 2026 demonstrates how social accountability could arise spontaneously during acute health emergencies. A passive citizenry was recipients of regular updates from central authorities; rather, active articulations of critiques, recommendations, and commendations took place via public commentary, media participation, and community forums. These interventions served as informal accountability practices in setting expectations and placing pressure on health authorities.\u003c/p\u003e \u003cp\u003eExamples include demands for transparency: \"firew Daru and Alebachew Mengistie insisted that epidemiological data, not aggregate numbers, should be provided; others, like Mesfin Hailemariam, Marey Marey, Hailemariam Sidelil, and Meried Maderia-emphasized behavioral restrictions, calling for school closures, funeral bans, and limits on public gatherings. Voices such as Fd Merket and Peace to Peace warned against awareness gaps, pressing that the communications be practical, culturally sensitive, and widely disseminated via trusted channels. Others, like Brhan Bante framed the outbreak as one of global responsibility, arguing that Ethiopia had to notify the international community promptly in the absence of vaccines or treatments.\u003c/p\u003e \u003cp\u003eTaken together, these citizen-led interventions constituted community oversight amid formal structures of governance. The Ministry of Health and Ethiopian Public Health Institute channeled its efforts toward technical measures-laboratory testing, isolation centers, and surveillance-although citizens demanded that outbreak governance pay attention to issues of trust, transparency, and cultural resonance. This dual narrative reflects the broader literature on social accountability, which demonstrates the responsiveness and legitimacy of health systems through community ownership and engagement.\u003c/p\u003e \u003cp\u003eIn the case of Ethiopia, citizen oversight helped raise the tension between technical updating and community needs. It underscored the point that epidemic governance involves more than just a preoccupation with biomedical containment-it is also about social legitimacy and accountability. In making their concerns vocal, citizens watched out so that outbreak response was not reduced to statistics in surveillance but remained consistently attentive to the lived realities.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e4.2 Information Governance and Transparency\u003c/h2\u003e \u003cp\u003eAmong the different voices of citizens, one constant request was for information that is timely, organized, and accessible. Members of the community stressed the need for transparency in reporting case numbers, trends in transmission, and risk zones, as well as contextual narratives to embed epidemiological data in the logic of public health. More than a demand for a technical update, these were demands for information to be meaningful, actionable, and resonant with culture.\u003c/p\u003e \u003cp\u003eTransparency in this context was more than the mechanical sharing of data; it was articulated as a claim to visibility and inclusion in governance. Citizens sought to reduce uncertainty, preempt rumors, and build a shared factual ground upon which collective action could be organized. Their demands underline the social dimension of outbreak communication where information is not just a technical artifact but a relational tool that shapes trust and legitimacy.\u003c/p\u003e \u003cp\u003eThis meaning is supported by both the risk communication literature, which shows that opacity erodes trust and fuels misinformation during health crises (Vaughan \u0026amp; Tinker, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2009\u003c/span\u003e; WHO, 2017), and by the social accountability frameworks that treat transparency as the foundation for participatory governance and for better service delivery (Fox, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Boydell et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Transparency serves as an instrument of dual purpose in outbreak settings: it facilitates technical coordination while at the same time affirming the public's role of active participant in governance.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003e4.3 Preventive Urgency and Mobility Restrictions\u003c/h2\u003e \u003cp\u003eSeveral citizens, including Mesfin Hailemariam and Meried Maderia, called for urgency in enforcing restrictions on movement: school closures, bans on public gatherings, and localized shutdowns in high-risk zones. Their arguments captured the discernment that timely NPIs reduce transmission-fact epidemiological evidence seems to be supported by influenza, Ebola, and COVID-19. Criticisms of late action were not anti-government; they were based on a shared concern that lifesaving be done proactively. In this sense, citizens were acting as governors of forecasting transmission dynamics in ways that called for preemptive action in keeping with best practices.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003e4.4 Risk Communication and Social Resonance\u003c/h2\u003e \u003cp\u003eWhile transparency was about information content, risk communication was about messaging mode-how information is framed, delivered, and made actionable for everyday life. Voices like Meaza Genet and Fd Merket spoke to the importance of mass-media outreach, practical prevention guidance, and messaging that addressed family anxieties, most especially concerning children. This dimension aligns with RCCE frameworks that put a premium on cultural resonance and emotional validation in risk communication. It also emphasizes that communication is not just about knowledge transfer but shared meaning and reassurance.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003e4.5 Limitations and Behavioral Control\u003c/h2\u003e \u003cp\u003eCalls by citizens consistently ranged from drastic restrictions in behavior that would contain the outbreak of Marburg: calls for the closure of schools, a ban on funerals, restriction of public gatherings, and restriction of mobility reflected a call for urgency in the reduction of transmission. These appeals were framed not only as technical interventions but also as moral imperatives, underlining the responsibility of authorities to take rapid action in protecting communities. Restrictions were framed as claims of accountability, wherein citizens demanded that the state make public safety a visible priority over economic or political interests. Here, behavioral governance was framed not as a matter of simply commanding obedience to rules but of demonstrating responsiveness to community fears and expectations. Citizens framed restrictions as a social contract: compliance would flow only if authorities were to act both decisively and transparently.\u003c/p\u003e \u003cp\u003eThis understanding is echoed in the outbreak governance literature, which suggests that behavioral measures such as movement restrictions and safe burial practices are most impactful when viewed as culturally appropriate and legitimate (Abramowitz et al. \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Anoko et al. \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). It is also supported by social accountability scholarship pointing out how communities employ collective voice to realize responsiveness and ethical protection in crises (Fox \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Boydell et al. \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). In the case of Ethiopia, such restrictions became a focal point of citizen oversight, with governance in emergencies negotiated between technical imperatives and social legitimacy.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003e4.6 Awareness and Communication Governance\u003c/h2\u003e \u003cp\u003eThe voices of citizens across the hotspot districts echoed one clear request: the need for communication that was technically correct, but also culturally resonant and practically accessible. Many felt frustrated that official updates were heavy on surveillance statistics and biomedical terms that did little to address community fears or guide everyday protective behaviors. Instead, what citizens demanded was clear, contextual messaging through trusted local channels-religious leaders, community elders, grassroots networks.\u003c/p\u003e \u003cp\u003eAccountability demands were framed by awareness and communication; there, citizens demanded recognition of their lived realities within outbreak governance. The calls for culturally grounded messaging represented a desire for inclusion and respect, emphasizing the need for effective communication across technical expertise to social meaning. In this sense, communication is not just about information transfer; rather, it involves trust-building, countering misinformation, and enabling collective action.\u003c/p\u003e \u003cp\u003eThis interpretation is consistent with RCCE literature, placing outbreak control on communication strategies that can be received and aligned with local contexts and values (WHO, 2017; WHO, 2021). It also chimes with findings from Ebola and COVID-19 responses that community-driven communication proved fateful in regard to compliance and trust-shaping (Abramowitz \u0026amp; Bedson, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Anoko et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Social accountability research also indicates that awareness campaigns operate effectively when communities are treated as co-producers of knowledge, as opposed to recipients of such knowledge (Boydell et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Fox, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2015\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003e4.7 Operational Rigor and Capacity-Based Oversight\u003c/h2\u003e \u003cp\u003eThe more technically informed citizens, notably Girma Hirpa and Tesfahun Taddege, moved the accountability discourse from the level of announcements down to the level of implementation capacity. Their oversight questioned the operational backbone of outbreak response regarding the adequacy of RRTs; logistics concerning the supply and distribution of PPE; establishment of standardized protocols for burials, considering safe pathogen handling; categorization and management of contact tracing; and integration of EMTs with community health volunteers. These critiques further illustrate that accountability was not restricted to transparency or communication but extended into the technical mechanics of epidemic control.\u003c/p\u003e \u003cp\u003eThis form of oversight pushes against notions that operational readiness is assessed by either specialized agencies or international partners. Rather, it was the citizens themselves who drew on the principles of outbreak response-often articulated in WHO and CDC guidelines-to assess the adequacy of local systems. Their actions illustrate a basic point-that technical accountability could reside organically in affected populations, in which informed citizens mobilize global standards to critique national implementation. Such interventions are commensurate with preparedness frameworks placing operational rigor at the center of epidemic control. They are also consistent with social accountability literature showing how communities mobilize technical knowledge to make claims against authorities for responsiveness and capacity-building. In the Marburg outbreak of Ethiopia, operational oversight of citizens shows the multidimensionality of accountability, entailing not only transparency and ethical protection but the practical readiness of the systems charged with safeguarding public health.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003e4.8 Global and Ethical Governance\u003c/h2\u003e \u003cp\u003eIn the case of Ethiopia's outbreak of Marburg, citizen oversight extended beyond an agenda of local concerns to one of global responsibility and ethical protection. Voices such as Brhan Bante underscored that \"Ethiopia really needed to act fast and inform the international community since the Marburg virus disease is beyond its capacity.\" Indeed, he thanked global leadership at this juncture, inclusive of WHO, while calling for international collaboration. Other citizens framed the outbreak as a problem of international concern, emphasizing corresponding ethical obligations of the state to notify global partners and operate transparently in the absence of vaccines or definitive treatments. These appeals reflected both pragmatic worries about cross-border spread and normative commitments to fairness, equity, and shared vulnerability.\u003c/p\u003e \u003cp\u003eEqually impactful were those testimonies that related to front-line protection. Euale Bogale Bekale, the father of Dr. Binyam Asrat, decried his son's suffering at the hands of punitive restrictions for sharing information about the outbreak with the media. His testimony wove together individual pain and a call for service recognition and moral accountability on the part of authorities. This testimony shows that ethical governance consists not only in protecting populations but also in protecting those who serve on the front lines (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e,\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eTogether, these perspectives underline that accountability in outbreak governance is complex and multi-dimensional. Citizens voiced demands for transparency and collaboration across scales of governance, placing Ethiopia's outbreak in a globalized health landscape in which national and international institutions bear shared responsibility. Simultaneously, they emphasized the ethical stakes of governance, demanding that protections for frontline workers are integral to sustaining trust, legitimacy, and resilience.\u003c/p\u003e \u003cp\u003eThis meaning stands in resonance with global health governance literature, emphasizing that the work of epidemic control requires multi-level coordination across the national and transnational levels. It also combines with social accountability frameworks extending beyond local service delivery to greater ethical imperatives within crisis contexts. And lessons learned from Ebola and COVID-19 even further illustrate that delayed transparency, coupled with weak international coordination, exacerbated outbreaks, while early notification, coupled with shared responsibility, strengthened their resilience. Literature on protecting health workers during crises reinforces that safety, both physical and professional, is what stands between sustained response capacity.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003e4.9. Trust Repair and Recognition of Progress\u003c/h2\u003e \u003cp\u003eNot all citizen feedback was critical. Mohammed Saeid's testimony noted that coordination and communication improvements were in place, from rapid laboratory deployment to response teams on the ground and raising community awareness. His testimony serves as an illustration that the oversight of citizens should not be merely portrayed in opposing terms, but rather as dynamic and evaluative. By recognizing progress, citizens send the signal that accountability systems create ways to generate positive feedback loops that support trustworthy behavior by authorities. Interpretive Insight Trust repair in outbreak governance is less about technical interventions but more about visible responsiveness to citizen concerns. Positive recognition of progress demonstrates that accountability can function as a reciprocal process-in which authorities acquire legitimacy through transparency and responsiveness, and citizens reinforce that legitimacy by recognizing improvement. These dynamic echoes the literature on building trust during health emergencies, which suggests that acknowledging progress is just as important as voicing critique to maintain cooperation (Gilson, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2003\u003c/span\u003e; Boydell et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). This approach also supports social accountability frameworks highlighting feedback loops in pathways toward stronger institutional responsiveness (Fox, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2015\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cb\u003eMapping Citizen Voices to Governance Functions\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003eOversight Themes and Citizen Voices\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCitizen Voice\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary Focus\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGovernance Function\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFirew Daru\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCase data clarity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTransparency\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlebachew Mengistie\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEpidemiological detail\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eInformation governance\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMesfin Hailemariam\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMovement restrictions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePreventive urgency\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMeried Maderia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSchool/public closures\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eProactive restriction\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMeaza Genet\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMass media outreach\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRisk communication\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFd Merket\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePractical guidance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCommunity engagement\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGirma Hirpa\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePPE/logistics/coordination\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOperational rigor\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTesfahun Taddege\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRRT/EMT capacity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eImplementation capacity\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMohammed Saeid\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAcknowledgment of progress\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTrust repair\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEuale Bogale Bekale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrontline worker protection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEthical governance\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBrhan Bante\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGlobal notification\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMultilevel governance\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003eOversight Dimensions and Public Health Functions\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOversight Dimension\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCorresponding Public Health Function\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTransparency\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSurveillance legitimacy\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreventive urgency\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTransmission control\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRisk communication\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCompliance \u0026amp; trust\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOperational rigor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSystem resilience\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEthical governance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWorkforce protection\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTrust repair\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePublic confidence\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGlobal responsibility\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHealth security infrastructure\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"5. Discussion","content":"\u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003e5.1 Outbreak Governance as a Multi-Layered Social Contract\u003c/h2\u003e \u003cp\u003eThe results have shown that epidemic control is not just a matter of technology, as it is political, ethical, and social by nature. The expectations were expressed in citizen voices regarding communication legitimacy, ethics, and reciprocal accountability.\u003c/p\u003e \u003cp\u003eIn this regard, handling an outbreak can be likened to a \u0026ldquo;social contract\u0026rdquo; whereby, for example, governments are supposed to be open with information and ensure bothcitizens and health-care workers are protected. On their part, citizens are supposed to cooperate.\u003c/p\u003e \u003cp\u003eEmpirical studies of epidemic management have confirmed that response cannot be reduced to a purely technical matter, constituting a social contract instead. Analyzing the response to the Ebola epidemic of 2014\u0026ndash;2016, it has been concluded that a lack of transparent communication and an unbalanced distribution of protection among health staff were contributing factors. The social contract in such a situation was understood by Liberian and Sierra Leonean community-based participants, where health management needed to show ethical responsibility, apart from capability (Abramowitz et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Franklin, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eCorrespondingly, the governance of the spread of the cholera disease in Haiti exemplifies communication legitimacy in influencing compliance. Public views on the incidence of the disease in Haiti in the year 2010 are demonstrative of the lack of trust that the population exhibited toward external actors, with this incident viewed as the breach of ethical responsibilities (Fraulina et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Pan American Health Organization, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe role of COVID-19 governance in Europe provides further evidence for the conditional nature of reciprocity from research analyses that showed EU and national levels\u0026rsquo; measures for legitimacy assessment extended beyond effectiveness toward such factors as fairness, transparency, and citizen views being considered. The more governments structured communication processes inclusively for co-production of communication and made clearer how responsibility lay, the more citizen compliance with measures and perception of competence emerged; otherwise, if power structures remained disjointed with deflection of blame for failures, levels of trust and compliance declined (Delhomme \u0026amp; Hervey, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Grimmel et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFrontline personnel protection appears as a tenet on which the social contract can be traversed ethically since relative comparison on the management of the COVID-19 crisis in sub-Saharan nations reveals that lack of appropriate safety and welfare for health personnel resulted in a threat to withdraw as a display of governance failure on the side of the government (Nyenswah et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Failure on the side of the government to protect workers resulted in evidence for citizens that the government carried out its duties ethically (Nyenswah et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eTaking collectively, such empirical insights point to the present study\u0026rsquo;s findings: the goal of outbreak governance is achieved through the existence of a multi-layered social contract that is transient, mediated, and upheld by transparency, ethics, and mutually facilitated accountabilities. There is the demand for openness in the sharing of information, for the safeguarding of both the citizens and the personnel, as well as for coordination. There is also the need for the citizens\u0026rsquo; active participation.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec23\" class=\"Section2\"\u003e \u003ch2\u003e5.2 Implications for Governance Theory\u003c/h2\u003e \u003cp\u003eThis case makes several contributions to literature in governance studies. Firstly, it draws attention to the dynamics of social accountability in crisis circumstances. Mainstream understanding of accountability underlines the process of oversight through committee reviews and civil society engagement. Nevertheless, the discovery in this discussion shows that unplanned public participation can act as a strong agent of accountability in crisis circumstances. Public voices utilized in criticizing and advocating for public disclosure of information are taken up as oversight instruments.\u003c/p\u003e \u003cp\u003eSecondly, this case highlights the significance of compliance about legitimacy. Legitimacy appears to transcend compliance and is rather linked to trust between citizens and policymakers. When these three aspects are brought together and align with what is desired and expected on the side of citizens, then it becomes easy to enhance and promote their legitimacy. This implies that it is easy to enhance and promote concerns regarding its legitimacy.\u003c/p\u003e \u003cp\u003eThirdly, the research proves the positive impact of community-oriented technical critique. Technical accountability feedback provided by people such as Girma Hirpa and Tesfahun Taddege reveals the fact that technical accountability is not only within the scope of technical expertise. Citizens are able to interpret technical information and provide additional critique to the decision-making process. Hence, the issue of outbreak management can benefit from the knowledge co-production process. Finally, the importance of ethics and the welfare of workers is emphasized as consideration in governance. The ethicality of governance and the welfare of the frontline staff are thus made to be very important to the building and maintenance of trust. Being punitive about disclosure and whistleblowing makes the process of building transparency very difficult because the social contract between the government and its people is undermined.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003e5.3. Key Implications to Risk communications\u003c/h2\u003e \u003cp\u003eThe findings underscore that risk communication is inseparable from governance. Communication during outbreaks is not simply about transmitting information but about negotiating legitimacy and accountability. When authorities engage transparently and respond to citizen oversight, communication itself becomes a governance practice that reinforces trust and strengthens the social contract. This highlights the need to embed communication strategies within broader accountability frameworks rather than treating them as technical add-ons.\u003c/p\u003e \u003cp\u003eA second implication is that citizen oversight enriches communication quality. Public critique demonstrates that communities are capable of engaging with technical standards and operational details, challenging the assumption that accountability resides exclusively within expert domains. By recognizing and institutionalizing citizen voices, outbreak governance can benefit from co-produced knowledge that is both technically informed and socially grounded. This participatory approach not only improves the accuracy of communication but also enhances its legitimacy.\u003c/p\u003e \u003cp\u003eThird, the study shows that trust is relational and conditional. Compliance is not automatic; it depends on whether authorities uphold their side of the social contract through fairness, transparency, and ethical responsibility. Protecting frontline workers, acknowledging uncertainty, and responding constructively to disclosure are communicative acts that signal respect and reciprocity. These practices strengthen legitimacy and sustain compliance, while punitive or opaque responses weaken trust and erode governance foundations.\u003c/p\u003e \u003cp\u003eFinally, the case demonstrates that future preparedness requires integrating citizen voices into risk communication strategies. Surveys, ethnographic methods, and participatory forums can complement discourse analysis to ensure that silent or marginalized perspectives are included. By institutionalizing mechanisms for community oversight, governments can build durable governance foundations that extend beyond immediate crises, reinforcing resilience and legitimacy in the face of future public health emergencies.\u003c/p\u003e \u003c/div\u003e"},{"header":"6. Limitations","content":"\u003cp\u003eThe study analyzes publicly expressed statements, which, of course, involve several important limitations. The data are likely to be biased toward the literate, digitally connected, or vocal parts of the population, as well as the segments that have access to communication channels or who feel more inclined to express their opinions. Accordingly, the present results represent the opinions of such a subgroup rather than a general, representative section of the population.\u003c/p\u003e \u003cp\u003eMoreover, no attempt is made to quantify the prevalence of certain views; rather, attention is given to themes and discourses emerging from available public expressions. This qualitative emphasis in turn means that the voices that have been silent or marginalized-such as people with limited digital access, those highly constrained by social hierarchies, or communities that are unwilling to speak publicly-remain underrepresented. Their absence serves to underline the need for caution in generalizing findings for larger populations.\u003c/p\u003e \u003cp\u003eFor example, these limitations could be overcome by future research combining discourse analysis with complementary methods. Surveys enable systematic measurement of the prevalence and distribution of perspectives, while ethnographic approaches could capture lived experiences and the voices of marginalized groups. The resultant methodological triangulation would develop a more holistic understanding of outbreak governance, balancing the richness of public discourse with representativeness in quantitative and ethnographic data.\u003c/p\u003e"},{"header":"7. Conclusion","content":"\u003cp\u003eThe response to the Marburg virus outbreak in Ethiopia showed that citizens are not passive recipients of public health directives but active participants in shaping epidemic governance. Oversight went beyond compliance to include transparency, communication, ethics, and operational rigor, with trust forming the basis. This case illustrates well how citizen voices should be seen as part of the governance process, rather than merely an external critique. Anchoring public perspectives within decision-making processes can enhance preparedness, enhance legitimacy, and bring more sustainable compliance with health crises.\u003c/p\u003e \u003cp\u003eMore broadly, the findings confirm that accountability in epidemics reflects dynamics in larger governance arenas: accountability is not something one-sidedly imposed by authorities but rather a bidirectional, negotiated process. Citizens express expectations of fairness, good conduct, and mutual accountability, while they may expect authorities to show transparency, responsiveness, and efficiency. Where citizens' oversight is acknowledged and acted on by governments, trust is consolidated, and governance foundations are laid that go beyond the crisis at hand. In this light, epidemic governance becomes a multilevel social contract focused on mutual accountability and capable of building resilience against future public health crises.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical approval and Consent to Participate:\u0026nbsp;\u003c/strong\u003eNot Applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed consent:\u0026nbsp;\u003c/strong\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest:\u0026nbsp;\u003c/strong\u003eThe author declares that there is no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eNot Applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u0026nbsp;\u003c/strong\u003eNot Applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability:\u0026nbsp;\u003c/strong\u003eThe data will be made available to the author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number:\u003c/strong\u003e Not Applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eNo financial support\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contribution:\u0026nbsp;\u003c/strong\u003eThe authors wrote the main manuscript text and reviewed the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eAbramowitz, S. 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Distinguishing epidemiological features of the 2013\u0026ndash;2016 West Africa Ebola virus disease outbreak. \u003cem\u003eDisaster Health, 3\u003c/em\u003e(3), 78\u0026ndash;88. https://doi.org/10.1080/21665044.2016.1228326\u003c/li\u003e\n \u003cli\u003eVaughan, E., \u0026amp; Tinker, T. (2009). Effective health risk communication about pandemic influenza for vulnerable populations. \u003cem\u003eAmerican Journal of Public Health, 99\u003c/em\u003e(S2), S324\u0026ndash;S332. https://doi.org/10.2105/AJPH.2009.162537\u003c/li\u003e\n \u003cli\u003eWorld Health Organization. (2017). \u003cem\u003eCommunicating risk in public health emergencies: A WHO guideline for emergency risk communication (ERC) policy and practice\u003c/em\u003e. WHO. https://www.who.int/publications/i/item/9789241550208\u003c/li\u003e\n \u003cli\u003eWorld Health Organization. (2021). \u003cem\u003eRisk communication and community engagement readiness and response toolkit for Ebola outbreaks\u003c/em\u003e. WHO. https://www.who.int/publications/i/item/9789240110175\u003c/li\u003e\n \u003cli\u003eWorld Health Organization. (2025, November 21). \u003cem\u003eDisease outbreak news: Marburg virus disease in Ethiopia\u003c/em\u003e. WHO. https://www.who.int/emergencies/disease-outbreak-news/item/2025-DON585\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Marburg Virus, Ethiopia, governance, accountability, communication","lastPublishedDoi":"10.21203/rs.3.rs-8541973/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8541973/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eCitizen-driven oversight has been found to be a key yet neglected aspect of epidemic management. In the context of MVD in Ethiopia, a critical voice was raised by citizens using expressions of voice for transparency, accountability, and ethical safeguards, serving a parallel function in management and control to formal government and international efforts. The approach and methodological tool used in this study was a thematic qualitative study and interpretive technique on citizen statements expressed publicly in ways such as social media postings, open letters, interviews, and community narrations. This study sought to code all data consistently in undertaking themes related to citizen-driven management and was guided by formal and standard research pathways for qualitative research. The approach ensured research rigor by way of constant comparison and reflection on interpretation and was in broader themes aimed at citizen interpretation on accountability. Citizen-driven management was discerned to cluster around themes identified by citizens across nine theories with reference to citizen statement expression on critical and positive recognition, thus giving meaning to a process in accountability that was fluid and iterative. The study illustrates a critical semblance of citizen-driven management and positions citizen expression on MVD in Ethiopia by making a statement on accountability justified and located on broader themes and pathways. The study asserts a broader contribution towards literature on public health management and highlights a critical voice on citizen expression that justifies placement and critical interpretation of citizen voice contributions.\u003c/p\u003e","manuscriptTitle":"Community Oversight, Outbreak Governance and Risk Communication: Citizen Accountability in Ethiopia’s Marburg Virus Response","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-18 08:27:14","doi":"10.21203/rs.3.rs-8541973/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d0a3b31d-e694-4906-86a1-74180fe7e8d2","owner":[],"postedDate":"February 18th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-03-19T03:39:58+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-18 08:27:14","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8541973","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8541973","identity":"rs-8541973","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}