Ebola in the rear-view mirror: how epidemic pasts shaped Sierra Leone’s preparedness and response to Covid-19

Abstract

This paper examines how past experience and legacies of epidemics shaped Sierra Leone's response to COVID-19 and how these influences evolved over time. COVID-19 unfolded in the wake of the West African Ebola epidemic (2013-2016), a crisis which was unprecedented in scale. Despite differing markedly in both transmission patterns and clinical outcomes, the Sierra Leonean government repeatedly invoked Ebola when responding to COVID-19, framing the new outbreak through the lens of the old. Drawing on ethnographic fieldwork and interviews with policymakers, response personnel, health workers, and members of the public, the paper analyses how Ebola's imprint surfaced across four domains of the COVID-19 response: public and governmental framings, the design and implementation of key control measures, disputes over incentives and hazard pay, and practices of data and testing. It shows that when confronting a new outbreak, the past manifests in diverse ways. The analysis reveals how these 'epidemic pasts' - contained in lessons, memories, legacies, and assumptions - actively constitute 'epidemic presents'; and should be understood as politically mobilised and socially contested, shaping responses in both enabling and constraining ways. As such, it is suggested that past experience has been under-explored in preparedness and response, and that formal 'lessons learned' exercises offer a limited view of how the past is relevant.