When you choose to publish with PLOS, your research makes an impact. Make your work accessible to all, without restrictions, and accelerate scientific discovery with options like preprints and published peer review that make your work more Open.

PLOS BLOGS Speaking of Medicine

Ebola has Taught us a Crucial Lesson about our Views of “Irrational” Health Behaviors

Sara Gorman compares “irrational” reactions to the Ebola outbreak by Americans and West Africans.

As Ebola rears its ugly head in the U.S., there has been a lot of discussion about how afraid we really should be. While health officials have remained relatively calm, insisting in a tense congressional hearing that there is no need to panic, some members of the American public have gone in the opposite direction, proclaiming a state of emergency on social media channels such as Twitter and Facebook. Donald Trump has been an especially noisy voice on the topic on Twitter, demanding that Obama stop all flights to and from West Africa and proclaiming that Ebola is actually much more contagious than the CDC says it is. At the end of September, with the announcement of the first suspected case of Ebola in the U.S., Trump expressed panic on Twitter, writing:

trump 1

trump 2

Trump’s comments suggest not only a distrust of health authorities but also a kind of hysteria, with the use of the word “plague,” that is reminiscent of the infectious disease panic seen in many other outbreaks in American history, including SARS in 2003 and bubonic plague in 1924, the latter an outbreak that famously led to the frantic firing of thousands of Latino workers and destruction of homes in low-income Latino neighborhoods because they were seen as the “source” of the disease.

At the same time, a good deal of the coverage of the Ebola crisis in West Africa has focused on the “irrationality” and “ignorance” of West Africans, choosing to visit traditional healers instead of doctors and ignoring warnings from health officials that traditional burial rituals can hasten the spread of the disease. Indeed, this “lack of faith in Western medicine” is now being addressed by local and foreign health officials who are running educational programs in places like Liberia and Sierra Leone in order to ensure that the people exposed to the illness have the correct scientific information.

But while certain cultural practices and lack of education have certainly played a role in the rapid spread of Ebola in West Africa, the amount of attention we have paid to the “ignorance” and “irrationality” of people living in these developing countries has not been balanced with an equal amount of attention to our own developed nations’ manifestations of similar irrational health beliefs. Are we really that much more knowledgeable and rational than our West African counterparts, or do our irrationalities and psychological missteps simply take different cultural forms? And do our ignorance levels and irrationalities have the potential to be just as dangerous to our health as seeking out a local healer instead of a trained healthcare professional in response to a life-threatening viral illness?

Some recent news articles have focused on the need for anthropologists in the response to the Ebola outbreak in West Africa. These anthropologists have noted that the response to any disease outbreak or epidemic is fundamentally social and cultural. In this same vein, our response here in the U.S. to Ebola (and likely in other developed nations) is similarly prone to social and cultural inflections, psychological influences, and misinformation.

For one thing, responses to “exotic,” novel infectious diseases seem to incur a kind of panic in the U.S. that is often out of proportion to the actual threat of the illness. This leads to a situation in which people worry about these illnesses to the exclusion of other, more serious threats, like the seasonal flu, a highly infectious airborne virus with no reliable cure that is known to cause many deaths every year. Misunderstanding the relative risks of Ebola and the flu is not only irrational but also misinformed. Because we are accustomed to the flu but not to Ebola there may be a temptation to think the former is less of a threat than the latter when in fact the opposite is the case.  What is the most effective treatment for Americans to protect themselves from early death by an infectious pathogen? A flu shot.

In the U.S., our responses to infectious disease outbreaks can also sometimes tap into embedded racial tensions. For example, the widow of the first American citizen to die of Ebola has noticed that many members of the sizeable Liberian community in the Twin Cities are being ostracized because of fears of the disease. One Liberian friend of the widow—an individual who had not had any contact with an infected person–even had a doctor refuse to examine her.  This kind of behavior among healthcare providers is not only irrational but also potentially dangerous, since it tends to foster distrust of the medical community.

Finally, distrust of government and a tendency toward conspiracy theories also seems to become a particularly popular trend in response to infectious disease in the U.S. In early October, a doctor strolled through the Atlanta airport wearing a hazmat suit reading “CDC is lying”. Needless to say the idea has gained traction and is now circulating around the internet, often alongside a series of other “lies” fed to us by the government. This is particularly dangerous, since it leads to a general erosion of the public’s trust in our nation’s public health authorities and it tends to spread false information. A recent survey by the Kaiser Family Foundation showed that 25% of Americans believe that Ebola can be transmitted through the air and 37% believe that Ebola can be transmitted by shaking hands with someone who has it but is still asymptomatic.

So are some of the views of West African citizens on Ebola irrational and misinformed? Yes, and this is a dangerous problem that needs to be rectified. Yet, and I would argue in many ways equally as dangerous, some of the views of people in developed countries such as the U.S. on Ebola are also irrational and misinformed. This is also a serious problem that needs to be rectified. Perhaps anthropologists are also key in the developed world’s fight against the Ebola virus.

Discussion
  1. Great piece. I’d also mention that thanks to the Internet and social media, people worldwide (including the affected nations in W. Africa) read and relay conspiracy theories propagated in the US — making it difficult and dangerous for local and international public health organizations on the ground.

  2. Sara, I feel part of what is happening is that Americans are not sure of what is true and what is correct. So many times recently we have beentold things by the government and agencies that end up not being true. Americans are cynical and distrustful, and don’t know who to trust.

  3. Having worked EMS in New Orleans at the outbreak of HIV, I would agree with Sara’s position, that panic, stemed by those who do not know or understand infectious diseases, and further fueled by the media with their drive for a story and ratings turns the Ebola issue into a crisis.

  4. Great post, thanks.

    People in the US, like those in Africa (and everywhere else) always need time to adjust to new threats. And no one has ever yet been calmed down when someone else says “calm down!” That usually just makes them angry.

    So I sure wish the CDC, as they talked to the public about Ebola, had not come across like every cliche version of CDC you find in bad fiction: “Nothing to worry about, we have it under control, calm down.” They should have been more humble.

  5. So this indicates in theory it can transmit “through the air” (I’m guessing you mean a >3 foot transmission by very small particle, not having a very sick ebola patient vomit at your feet).

    But the fact is, that hasn’t been observed, despite 40 years of experience with the disease. If that was at all likely–even a little bit–we’d have seen it by now. We haven’t. Remember the people who lived with Mr. Duncan in his small apartment for days, while he got sicker and sicker. They never were infected.

    This underscores my comment below: when talking to the public about a new risk, don’t exaggerate, and don’t tell people their worry is absurd. CDC would have been better off saying “it’s conceivable that Ebola could be transmitted a long way through the air, but we’ve never seen it happen. We are keeping our eyes out for that.” And NOT a flat “it can’t happen.”

Leave a Reply

Your email address will not be published. Required fields are marked *


Add your ORCID here. (e.g. 0000-0002-7299-680X)

Back to top