Staving Off Ebola Panic

The Ebola outbreak in West Africa, which began in December 2013, has touched off widespread anxiety in the United States after a Liberian man who traveled here died of the disease in a Dallas hospital on Oct. 8. Two of the nurses who cared for him were infected, and a physician who treated dying Ebola patients in Liberia is undergoing treatment in a New York hospital.

The hemorrhagic fever has infected nearly 10,000 people in Liberia, Sierra Leone and Guinea, roughly half of whom have died. The most alarming predictions estimate that 5 percent of Liberia’s population could be infected by the end of the year unless the epidemic is brought under control. The rest of the world has been slow to respond, though the United States, France and Britain are sending troops to the region to help establish treatment and medical-response training facilities.

Rosemary C.R. Taylor, an associate professor of sociology and of community health in the School of Arts and Sciences, studies policy responses to cross-border health threats and teaches the course Epidemics: Plagues, Peoples and Politics.

The Ebola epidemic, she says, has to be stopped at its source. “But fear in the United States has escalated, and it may distract us from focusing on where we really need to put resources, which is in West Africa,” she says.

This academic year she is a visiting fellow at the Princeton Institute for International and Regional Studies, where she is working on a book about the global blood supply. She talked with Tufts Now about the Ebola epidemic from her office in Princeton, New Jersey.

Tufts Now: Will we have an Ebola epidemic in the United States?

Rosemary C.R. Taylor: I do not believe we will have an epidemic in the United States or in any industrialized country, because our resources for containing it are so much greater than those in developing nations.

When did we last have a similar situation in which a disease caused so much worldwide concern?

The last time was during the SARS [Severe Acute Respiratory Syndrome] outbreak in 2002 and 2003, in which more than 8,000 people worldwide got sick, and more than 700 died. It’s surprising, in some sense, that the level of anxiety surrounding both diseases was and is so high, because most cases of SARS and Ebola have been linked to transmission that involved very close personal contact with an identified case. From what we know so far, no cases of either disease were reported among people who were exposed to an infected individual before that person began having symptoms. There has been only one death from Ebola in the United States, and there were no SARS-related deaths.

What is behind the panic?

In the case of SARS, people were afraid because it’s passed on by respiratory droplets, which you get when an infected person coughs or sneezes. But Ebola cannot be transmitted in this manner, so why has there been such a panic? There are many reasons: death from Ebola is a gruesome, rapid death; the mortality rate is high; there is no cure or vaccine. One important issue, I believe, is that Ebola is transmitted by bodily fluids.

The last disease where people talked extensively about bodily fluids—blood, semen, etc.—was AIDS, and this connection may signal global pandemic in people’s minds. In addition, Africa, and sub-Saharan Africa in particular, is the part of the world most devastated by AIDS, and now there’s another disease, Ebola, coming out of Africa. The danger is that this imagery will resonate with all sorts of myths and ancient narratives about “the dark continent” and generate unnecessary fear.

Do panics about infectious diseases end up impeding appropriate responses to control them?

Too often they do. One thing that can happen is that instead of fear being focused on the disease, it becomes refocused on the communities affected by the disease. SARS, for example, originated in China. By the time the epidemic was over, Chinatowns in large U.S. cities had lost revenue and Asian Americans had suffered rejection.

The U.S. has a sorry history in this regard. Immigration legislation at the end of the 19th century targeted East European Jews on the grounds that they were bringing in cholera; all Haitians were prohibited from donating blood early in the AIDS epidemic (a decision that was later reversed) because Haitian Americans had been identified as a “high-risk group,” and gay men were similarly rejected as blood donors. 

We run the same risk with Ebola—that it may lead to discrimination against communities based solely on their nationality or race. Already there are reports that members of West African communities in U.S. cities fear they won’t be treated if they go to the hospital with a fever.

Do panics in epidemics spread in certain ways, and die down in certain ways? And do movies like Contagion create fears that then become real when a disease hits home?

It’s hard to generalize about this. It depends on the disease and the identity it acquires: who has it, who is perceived to be carrying it and its cultural and historical associations.

And no, I don’t think Contagion created fear. Just like Outbreak, an earlier movie about a fictional epidemic, it had a happy ending, a vaccine. Modern science triumphed. There is also a limit to fear of this kind. People begin to suffer alert and panic fatigue, which is one of the reasons why it is very difficult to plan effectively for a potential pandemic.

Only one person has died of Ebola in the U.S., but you’d think it was much worse based on media coverage. What are the consequences of that?

Only two people—the nurses who treated the Dallas patient who died—have been infected by person-to-person contact within the United States. Yet CNN is now 24 hours Ebola, all the time. All this hoopla about what is happening in the U.S. really distracts from the central point, which is if you want to stop this epidemic, you need to stop it in West Africa.

What do West African countries need to help them end the Ebola epidemic?

They need everything you can think of. There is little infrastructure in these countries—sewage treatment facilities, electric grids, hospitals, good roads—and they don’t have the resources to combat this on their own. People were understandably nervous about militarizing the epidemic, sending U.S. troops to West Africa. But we are the only country at the moment with the capacity to move the large amount of freight required to shore up this infrastructure, which is essential to constructing treatment facilities and making sure they can keep running.

Another thing West African nations need is international cooperation, which poses problems. Ebola points up once again how fragile the institutions of global health governance are. The European Union has tried to act and has supported Doctors without Borders, which was doing the original frontline work, but the EU is only as strong as the coordination among its 28 member states. Rapid response has been improved in many countries, but the World Health Organization and the World Bank are arguing now about who has the authority to act. The globalization of disease is outstripping our capacity to manage it on a global level.

West Africa also needs a remedy for Ebola, but the only immediate option on the horizon is transfusing the blood of survivors, so-called convalescent serum, into patients. That said, there is no conclusive evidence that this will work. Those few patients who have received such transfusions have also received very good supportive care and some have been given experimental drugs.

This also raises again the question of infrastructure: how plausible is it for West African countries to be able to collect blood and plasma safely at the moment and screen it for infections such as hepatitis and HIV? Despite doubts about such matters expressed by scientific experts, WHO nevertheless announced at the beginning of September that they were prioritizing this strategy. They were under intense political pressure to stem panic by providing a sense that treatment is possible and to give officials from the affected countries at that meeting something, anything, they could bring back to their nations—but it may not be a real solution.

Do you think the United States needs to impose a travel ban?

I look at this prospect with incredible dismay. At the recent congressional hearings on Ebola, one congressman after another was calling for a travel ban, which is a seriously counterproductive measure. In logistical terms, there are no direct flights to the United States from the affected countries. A travel ban would also prevent the CDC and others from tracing the contacts of infected travelers, which is necessary to control the epidemic. 

More important, it would isolate the affected nations and hinder the transport of materials and manpower. It would also discourage medical volunteers. And this is critical: health workers are desperately needed. Few of the nations that are sending troops are also sending doctors and nurses to staff the new treatment centers. Cuba is leading the way in this regard, as it often does.

Has the U.S. ever had a travel ban because of a disease?

Yes. The U.S. imposed a different kind of travel ban, for HIV, in 1987 when Congress put it on a list of “dangerous contagious diseases,” which was grounds to exclude immigrants from entering the United States. Despite two decades of lobbying by epidemiologists and other experts who said there was no scientific or public health basis for the ban and that it served only to discourage HIV-positive immigrants already in the United States from disclosing their status or seeking treatment, it was not effectively lifted until January 2010.

That finally happened in part because the U.S. government was facing the knotty contradiction of promoting initiatives like PEPFAR—the President’s Emergency Plan for AIDS Relief—to contain AIDS around the world, while not letting HIV-positive people into our own country. We have not learned from history, even very recent history. People seem to have forgotten this travel ban, which made the United States a pariah in the global health community.

Tufts is hosting a series of interdisciplinary discussions about the Ebola epidemic: Oct. 30, Ebola: Pathophysiology of the Virus and an Overview of the Outbreak; Oct. 31, Ethical Considerations of the Ebola Outbreak; and Nov. 5, Ebola: Mutations, Markets and the Military. For more information, go to http://provost.tufts.edu/connect/one-health-tufts-highlight-ebola-outbreak/.

Marjorie Howard can be reached at marjorie.howard@tufts.edu.