What’s needed, experts say, is stronger leadership from public health and top government officials, including the president. “The public has told public health officials what they really need to remain sane and calm,” said Dr. Robert Murphy, director of the Center for Global Health at Northwestern University’s Feinberg School of Medicine. “They need somebody in charge, they need action, they need a continuous stream of facts that are true and believable.”
By contrast, in the current U.S. Ebola situation, “there has really been nobody in charge, and I think that has left the public floundering and coming to their own conclusions, which are not necessarily based on sound public health policy,” he added.
Murphy said the U.S response to the outbreak has been uncoordinated and lacking in forcefulness and authority. That has helped create an information vacuum, allowing misinformation and hysteria to spread. Additionally, mixed information presented in related areas, such as with childhood vaccines and climate change, has contributed to a significant percentage of Americans already distrusting science and government.
Public anxieties over Ebola soared since the first case was diagnosed in the U.S. last month. That was undoubtedly the result of the federal government’s and the U.S. healthcare system’s botched response to the case, which led to the infection of two nurses who treated the first U.S. Ebola patient, and in the subsequent need to monitor hundreds of people who may have had contact with the patient and the two nurses.
A Harvard School of Public Health poll released Oct. 15 showed that much of the anxiety stems from the public’s lack of knowledge about their level of risk. It found that 85% of those surveyed believed it was likely that people carrying the virus could spread it through the air. That’s despite repeated statements by public health officials that Ebola is only spread by contact with an infected person’s bodily fluids.
Another poll conducted by NPR and Truven Health Analytics (PDF) earlier this month found that more than half of the 3,000 people surveyed thought the U.S. response to the Ebola outbreak had been inadequate.
Around 75% said they would prefer the U.S. to implement a travel ban to and from countries affected by the disease. That’s even though President Barack Obama and Dr. Thomas Frieden, head of the Centers for Disease Control and Prevention, have stressed that a travel ban would make it harder to identify and track people traveling from affected African countries. Even more alarming, 60% said they would favor barring U.S citizens from home if they became infected while performing humanitarian work in West Africa.
“Whenever you ban anything, the first thing people figure out is how to get around the ban,” Murphy said. “These borders are fairly porous. If you want to get out, you can get out.”
Another blow to the agency's credibility came when two of the Texas Health nurses treating the first Ebola patient, Thomas Eric Duncan, became infected. It got worse when the public later learned that the CDC had allowed one of the nurses, Amber Vinson, to take a commercial flight to Ohio even though the agency was monitoring her for Ebola. The infection of the nurses prompted the CDC to acknowledge that its safety protocols for healthcare workers treating Ebola patients were inadequate and to make them far more stringent.
Frieden has acknowledged that the CDC should have responded more quickly and effectively as soon as Duncan was diagnosed with the virus at Texas Health Presbyterian Hospital Dallas. “We could have sent a more robust hospital team (to Dallas) and been more hands-on with the hospital from day one about exactly how this should be managed,” Frieden said Oct. 14. “We should have put a larger team on the ground immediately, and we will do that from now on any time there's a confirmed case.”
The contrast between the initial confident, even smug, statements by Frieden and other officials that U.S. hospitals were fully capable of safely treating Ebola cases and preventing the virus’ spread, and subsequent events in Dallas have deeply shaken the public’s confidence. “Those reassurances somehow felt hollow to a lot of people,” said Dr. Ashish Jha, a professor of international health at Harvard University.
Jha said government officials and the public health establishment will have to work hard to regain the public’s trust. “The lesson moving forward is that you have to be very realistic with people, and you have to tell exactly what the risks are, and acknowledge that there might be barriers but that people are on it,” he said. “That is something we can all do better next time.”
Follow Steven Ross Johnson on Twitter: @MHSjohnson
