Author: Margaret Miller, cross-posted from The World Bank website, August 22 2014 - In the wake of the current Ebola crisis, the 2011 movie Contagion (See the trailer here) directed by Steven Soderbergh has repeatedly been cited as one of the best examples of a movie taking on the subject of pandemic disease and managing to educate while providing gripping entertainment. This is no coincidence. Contagion was produced with both A-list stars (Gwyneth Paltrow, Matt Damon, Laurence Fishburne, Kate Winslet, and others) and support from leading public health experts such as Dr. Ian Lipkin who is the inspiration for one of the scientists portrayed in the film, and award-winning writer Laurie Garrett, author of several books including The Coming Plague. Participant Media, founded by Jeff Skoll to inspire social change through entertainment, was a producer, with the Skoll Global Threats Fund, World Health Organization (WHO), and U.S. Centers for Disease Control and Prevention (CDC) providing input as well.

The tagline from the film is “No One is Immune…to Fear.” While one of the early scenes is of a woman dying of a flu-like illness (played by Paltrow) the movie elicits fear not from gruesome symptoms but instead from plot lines and messages that focus on how human responses to these types of public health crises make matters worse. It also showcases the valuable work done by epidemiologists and other public health workers who are the heroes of this film. Contagion communicates these and other lessons effectively using the power of story, a subject recently discussed on this blog.

It’s one thing to have a government official or medical professional describing (usually dryly) how a pandemic can spread and what precautions to take. It’s another altogether to become transported through a story in a movie (or television or radio program) to a virtual reality where it’s possible to vicariously experience a pandemic threat and its consequences. For example, when one of the main characters, Dr. Erin Mears played by Winslet, discusses the ease with which the virus in the movie Contagion is spread, “The average person touches their face three to five times every waking minute. In between that we're touching door knobs, water fountains, and each other….” viewers instinctively cringe and become aware if they are biting their nails or rubbing their eyes.

Contagion is an example of entertainment education (EE) - the use of entertainment media to inform, educate and support behavior change. Entertainment education is effective because narratives or stories are emotionally powerful – they help us to organize information and to create the “mental models” that we use to make sense of the world and can help to explain why we behave in particular ways. Mental models are one of the central themes of the forthcoming 2015 World Development Report which focuses on how and why people take decisions, including some that appear contrary to their own self-interest. The report also highlights research on entertainment education. In some cases, the stories or mental models that people adopt are based on misinformation and misunderstanding. For example, in the current Ebola crisis doctors coming to care for the sick have been viewed by understandably wary villagers as the cause of the illness and threatened with violence if they did not leave. This has hampered efforts to treat patients and safely dispose of the bodies of those who have died, adding to the risk of further infection. Other potentially risky practices, such as eating bush meat, especially fruit bats and monkeys which may be carriers for the virus, have also proved resistant to change. Of course it is not just ignorance about risks that drives bush meat consumption. In too many areas, meat from livestock is not available or is too expensive, often because veterinary services are absent or so weak that huge losses to disease are the norm.

There is an urgent need for effective communication on how to stop Ebola from spreading in Guinea, Liberia, Sierra Leone and other countries in the region (and perhaps beyond) where it may appear before this outbreak is under control. Research suggests that entertainment programs which capture the imagination (sometimes referred to as “transportation” as viewers experience a virtual reality) are especially effective as people who are engrossed in a drama are more open to both receiving information and to considering a change in attitudes and behaviors. Sometimes viewers even feel that they have a personal relationship with the fictional characters in programs. This phenomenon is known as “parasocial interaction” and can make media messages even more powerful. Entertainment education has been used extensively in the past for other health related challenges such as HIV/AIDS prevention and stigma reduction. The South African drama Soul City and MTV program Shuga are examples of popular television programs seen in the region which combine entertainment with well-developed health messages.

Communications strategies to address the Ebola outbreak are already using text messaging via mobile phones, community radio and TV programs, mobilization of community leaders and influencers, and door-to-door outreach. For instance, UNICEF and partners worked with Hip Hop star Takun in Liberia on messages and songs that target rumors and promote preventive behaviors. Youth volunteers are giving message-driven theater performances in communities and bus terminals.  Barbers and hairdressers in Sierra Leone are being engaged in efforts to dispel rumors.

The scale of the challenge, however, requires both more extensive reach and even more impactful means. Local and regional media could leverage existing serials, soap operas, and the radio dramas which are popular where access to television remains limited. In some instances new, specialized content may be required to address specific cultural or language needs. Video clubs and mobile cinemas could share new film or video content beyond homes that receive broadcast or satellite TV. Combining entertainment education in radio, TV or film with a transmedia strategy that covers various communication platforms (Facebook, text messages, billboards, etc.) with consistent messages – sometimes using characters from a show to increase appeal and interest - is another approach that should be scaled up, as repetition reinforces key messages and increases impact. Furthermore, these should be combined and synergized with on-the-ground efforts such as social mobilization and training of community based health workers and local religious leaders, as well journalists, to compound reach and impact of the EE initiatives.

On August 1, 2014, the WHO warned that the Ebola “outbreak is moving faster than efforts to control it.” Increased use of communications tools to raise risk awareness among populations is not, of course, a substitute for public health interventions such as monitoring and reporting of cases of illness and death, isolating the infected, quarantine, safe burials, and infection control in hospitals. However, without adequate communications strategies, suspicion and fear will lead people to disregard advice on safe behaviors around the ill and the dead. (This blog from Vox provides a good discussion of the public health challenges surrounding Ebola and the need for a strong public education campaign. )

Contagion may seem an unlikely way to reduce the impact from Ebola in this and future outbreaks, but harnessing technologies, like mass entertainment media and cell phone networks, and using innovative approaches like entertainment education that incorporate insights from psychology offer the potential reach and impact that is urgently needed. Helping local media develop EE interventions could make a big difference in effectively transmitting public health messages to populations and securing their cooperation with urgently needed public health measures. Beyond the current crisis, public health capacities in all three countries and elsewhere in Africa (and beyond) will need substantial strengthening. Every country needs to be able to detect and control the next outbreak of Ebola or another disease; the costs to health, communities and economies of not having such capacity are much too high. Entertainment education could make a contribution then as well, by building awareness of health risks and resilience in communities; awareness which in turn could help make government leaders and their external partners accountable for the quality of public health capacities.

This blog post was done in collaboration with the UNICEF Communication for Development Team (C4D).
Links to More Information on How to Prevent and Treat Ebola:

Click here to access the original blog on The World Bank website.
Image credit: European Commission DG ECHO