Co Producing Epidemic Response: How Institutional Preparedness and Community Health Knowledge Interacted During Sierra Leone’s Ebola Outbreak

Abstract

In 2018, the World Health Organization warned of a potential reemergence of Ebola Virus Disease in regions previously affected. By May 2026, outbreaks resurfaced in the DRC and Uganda, demonstrating the risk of resurgence in other regions such as the Mano River Union basin. Looking toward future epidemics or novel pathogens, this article contends that effective epidemic response depends on a co-produced system in which institutional readiness and community health knowledge are mutually dependent and jointly influence outcomes. The article examines Sierra Leone’s management of the 2014–2015 Ebola crisis, utilizing peer-reviewed research, policy documents, epidemiological data, and reports from affected districts. It tracks: (1) the interaction of institutional weaknesses with community mistrust, rumor-driven perceptions, and culturally rooted burial customs that contributed to faster transmission; and (2) how the response improved as collaboration between institutions and communities grew stronger. Using thematic synthesis and process tracing, the article demonstrates how institutional readiness and community knowledge impacted various stages of the outbreak. The results reveal that epidemic control depends not only on technical readiness but also on institutions’ ability to build trust, incorporate local insights, and adapt strategies to community contexts. The conclusion emphasizes that strengthening epidemic preparedness for potential Ebola resurgence or novel pathogens requires institutionalizing co-produced approaches. This article advances conceptual understanding by framing epidemic response not merely as a unilateral deployment of expertise but as a relational process. This perspective challenges deficit-based narratives that portray communities as obstacles and provides empirical evidence for planning in areas at risk of resurgence.