Ebola Fear and Stigma – Part 1
November 15, 2014
J. Stephen Morrison, director of the Global Health Policy Center here at CSIS, got my attention when he described the Ebola outbreak as a two-front war: a public health battle in plague-like conditions in West Africa, one, and a communications battle against fear and overreaction in the United States, two. Government officials, wrote Dr. Morrison, “failed to appreciate just how swiftly a small number of Ebola cases in Dallas could ignite fear across the nation, raise the risk of panic, and begin to erode public trust.”
Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, made a similar point at the Washington Ideas Forum at the end of October: “I think what we’re seeing,” he said, “is a catastrophic health crisis in West Africa and an epidemic of fear here.”
By now many of us have our favorite, most outrageous episodes of Ebola paranoia: the teacher placed on leave in Maine after traveling to Dallas; the girl kept out of third grade in Connecticut after a family wedding in Nigeria; the Congressional candidate who suggested a city-wide “no handshakes, no hugs” policy for Dallas; the scams and snake oil cures; and so on.
But the examples quickly veer from the amusing and aggravating to the darker and more disturbing. Even as West Africans in the United States grapple with the toll of a wildfire epidemic in Guinea, Liberia, and Sierra Leone, some are finding themselves subject to stigma, slurs, and harassment here. In one case, two young brothers originally from Senegal were “called ‘Ebola’ by other students, taunted about possibly being contagious and … pummeled by classmates on the playground of Intermediate School 318 in the Bronx.” The Wall Street Journal, reporting on stigma in the workplace and in New York neighborhoods, observes that Liberians in the United States are thus at the nexus of both fronts against Ebola; one 6-year-old Staten Island boy coming home from school is quoted saying, “I don’t want to be Liberian anymore.”
American misunderstanding extends to the geography of the epidemic as well. Google any number of countries on the opposite side of the continent from the epidemic, and you’ll find stories of American misunderstanding and fear: Ethiopia, Kenya (here and here), Rwanda (here and here), Tanzania, Zambia, South Africa (here and here).
Fear doesn’t just produce stigma and xenophobia. It’s also bad for public health. Promoting health, preventing disease, tracking infections, responding to outbreaks—in all its aspects public health is a scientific and technocratic field. At its best, decisions are driven by data, based on evidence of effectiveness; unlike diplomacy or intractable social problems, most decisions in controlling an epidemic need not rely on intuition, ideology, or guesswork. Data-driven policy and fear-driven policy, however, rarely line up. When panic takes hold, people demand action against what scares them, and politicians—who report to the people and have electoral reasons to direct fear and blame against their opponents—are inclined to support drastic but ill-conceived measures. A travel ban, say public health experts including Dr. Fauci, would bring people with Ebola into the United States through alternate routes that make them harder to track, and would interrupt U.S. assistance to West Africa. But that hasn’t stopped 77% of the public and at least 86 members of Congress from supporting one.
At the state level, in fact, travel bans and 21-day quarantines of health workers returning from West Africa are already having an effect. In an unsigned piece published November 10, the editors of The Lancet Infectious Diseases point to quarantines in New York, New Jersey, Illinois, and other states; these knee-jerk measures, they write, “have the potential to discourage volunteering, reduce humanitarian assignments to west Africa, and stigmatise those travelling from affected countries.” The Louisiana Department of Health and Hospitals ruled in October that travelers from Guinea, Liberia, and Sierra Leone will be quarantined in their hotel rooms, a decision that kept thirty researchers and practitioners from attending last week’s annual meeting of the American Society of Tropical Medicine and Hygiene in New Orleans. This weekend, when the American Public Health Association comes to the Crescent City for its own annual meeting, it will face the same challenge. The travel ban, by its nature, removes from these conferences the public health experts with the most recent, firsthand experience of the epidemic.
The CDC and other public health experts deem these rash measures unnecessary. The probability of a wide-scale Ebola outbreak in the United States—let alone that any particular person in the United States will contract Ebola—is virtually zero. Yet fear, stigma, and popular demand for these policies persist. In a second post, I’ll turn to the underlying psychology of irrational fear and how public officials can best keep the calm in this and similar episodes.
