Ebola, Liberia and the Cognitive Dissonance of Development Research

This week, the world received some encouraging news: Liberia was declared Ebola-free. After a 14-month battle with the virus that claimed nearly 5,000 Liberian lives and brought the country to its knees, the World Health Organization announced on Saturday that the devastating epidemic is over (Guinea and Sierra Leone, however, are still experiencing new cases). Now, as the country breathes a long overdue sigh of relief and transitions from containing the outbreak to recovering from it, it will inevitably ask itself the million dollar question (or $240 million according to World Bank estimates): what could it have done to prevent the epidemic?

The complex and no doubt divergent answers to this question will soon manifest in commentaries and panel discussions at places like the World Health Assembly, which starts next week. But there exists one obvious and inconvenient solution that the global health community can no longer afford to overlook: Make development research more accessible to developing countries' policymakers, institutions, health workers and communities.

A recent New York Times editorial written by leading health experts in Liberia shed light on the inaccessibility of research that could have prevented -- or at least informed recovery efforts for -- the latest Ebola outbreak. Authors Bernice Dahn, Vera Mussah and Cameron Nutt note that European researchers knew about latent Ebola antibodies existing in Liberian blood samples as long as 30 years ago. Shockingly, an article published in Annals of Virology said of this research, "The results seem to indicate that Liberia has to be included in the Ebola virus endemic zone."

Yet when Ebola emerged decades later, this warning was nowhere to be found. Instead, like too many of these studies, it sat atop the proverbial ivory tower, well out of reach of the Liberian doctors and policymakers who could have used its critically important findings to save lives.

This cognitive dissonance -- in other words, the disconnect between development research and the communities it studies -- is all too common a field that should (by its very nature) eschew it. New public health studies are presented at forums like the Healthcare in Africa Summit, held, naturally, in London. New strategies to propel billions of people out of poverty are discussed during meetings like the World Economic Forum, where hundreds of private jets descend on Davos, Switzerland. New articles investigating trends in low- and middle-income countries are written and reviewed by Western academics and published in expensive subscription-based journals like the Lancet.

Mike Powell, director of IKM Emergent -- a think tank that examines knowledge-management practices in the global development sector -- has noticed this trend for years. "The amount of research that is getting in the hands of local people in a useable format to make decisions is a minuscule fraction," he acknowledged in a recent phone conversation. "We pour massive amounts of money into development research with no sense of how it will be practically applied."

Powell cites a number of factors contributing to this cognitively dissonant reality. On one hand, the bulk of development research is proprietary and protected by expensive paywalls. For instance, as the authors of the aforementioned Times editorial mention, downloading one of the articles with vital information about Ebola antibody prevalence "would cost a physician [in Liberia] $45, about half a week's salary." In fact, even after significant gains in open-access publishing, only about 17% of scholarly journal literature is open-access, with roughly 42% of journal articles published by the three leading commercial publishers (Elsevier, Springer and Wiley).

Beyond price, Powell sees another major challenge to access: format. Unless they're affiliated with a developed-world institution, people rarely consume information in the traditional "abstract-methods-results-conclusion" format in which academic studies are published. Whether they're a member of the Ministry of Health, the local healthcare workforce, a service delivery NGO or anyone in between, those living and working "in the field" (as they say) may not be able to intuit how academic research can influence the policies and models they're implementing -- in part because it simply isn't intended for them.

Fortunately, there are possible resolutions to this disconnect. One, of course, is making studies more readily available through open-access publishers like PLOS ONE. Another involves mandating that researchers report their findings to relevant local institutions, empowering them to ascertain a study's implication and application as they craft solutions of their own. Yet another is finding creative, culturally competent ways of allowing research to resonate with the affected population. Powell informed me of a social scientist named Dr. Martha Chinouya who used dramas to communicate research about HIV to families in Zimbabwe. Approaches like these could go a long way in equipping local communities with the tools and knowledge they need to prevent and manage public health challenges.

In their article, Dahn, Mussah and Nutt cite an old public health adage in relation to the Ebola data they so tragically lacked: "The road to inaction is paved with research papers." It's impossible to predict the number of lives that could have been saved had Liberians instead been able to follow a road to action paved with non-paywalled research and practical solutions. In many ways, it's a question not worth exploring. But as Liberia and other developing countries prepare themselves to fight Ebola and the countless other health scourges they face, one question is worth exploring: If research is published and no one is able to understand or apply it, does it make an impact?