WASHINGTON – A prominent AIDS researcher recently recalled for me the panic at the start of the pandemic in the 1980s. Her superiors asked her not to publicize her work because they didn’t want their institution to be known as an “AIDS hospital.” Some parents instructed their children at school not to play with the researcher’s children, because she was in contact with the AIDS virus. Fear and stigma were only overcome by the relentless application of science.
The Ebola virus – which can swiftly attack the body’s organs in the manner of a horror movie – is particularly adapted to cause fear. But it is not particularly communicable. Since the 1970s, intermittent outbreaks have traveled from animals to humans. Among humans, the spread requires direct contact with bodily fluids such as vomit, blood or diarrheal feces. Previous outbreaks, as in Uganda, were quickly controlled (in part because of close U.S.-Ugandan medical cooperation on AIDS, which built effective and respected local health structures). The current outbreak in Guinea, Sierra Leone and Liberia is taking place in a vacuum of capable and trusted health care institutions. As fatalities go from the hundreds to the thousands, a broader global response will be required to fill gaping needs. But America and other countries with advanced health systems have very limited vulnerability to the Ebola virus.
Ebola fever, however, continues to infect the American media. Some of this fascination is natural – deeply rooted in the evolutionary fear that nature is cruel, relentless and out to kill us all. (And, of course, nature does always get us in the end.) Lions and sharks may be fearsome. But pathogens and parasites make our tenuous species feel most vulnerable: smallpox, malaria, tuberculosis, cholera, yellow fever, syphilis, polio. Bubonic plague carried off about half of Medieval Europe. The 1918 flu took about 50 million lives. Ashes, ashes, we all fall down.
Some of our Ebola obsession, however, is unnatural; it is manufactured for political reasons. A few conservatives – reaching for whatever stick lies handy in the immigration debate – have raised the prospect of Ebola-infected illegal immigrants crossing our porous southern border. The Centers for Disease Control and Prevention and Prevention finds this prospect remote. It is, in fact, fantastical and malicious. The incubation period for Ebola is from two to 21 days. It strains credulity that a sick West African would purchase a plane ticket for Central America and then travel to the U.S. border over an arduous land route while bleeding from various orifices.
But credibility is not the goal here; it is the opportunistic incitement of fear. There is a long American history of equating immigration with infection. Fear of disease has always been bizarrely central to American immigration policy. The filtering at Ellis Island and at the European ports where people left for America was almost entirely about disease, and largely about rare conditions that weren’t much of an issue. (Only about 1 percent of immigrants at Ellis Island were turned away because of disease.)
The Ebola outbreak has also revealed, in some quarters, a deep distrust of institutions, including those dealing with public health. Infectious disease experts are accused of withholding information or of being engaged in nefarious experiments. Some conservative commenters have accused public health authorities of inviting an American Ebola crisis “so Obama can strut his stuff.” Mistrust of medical professions, of course, can be found on the left as well – the anti-vaccination movement is often a fringe-left phenomenon. But when medical authorities are also governmental authorities, right-wing populism inclines to turn against scientific elites.
This is positively dangerous. It is one thing to criticize the Department of Veterans Affairs. It is another to cultivate distrust in the CDC and the National Institutes of Health. We are already seeing a corrosive, dangerous reduction in vaccination rates in some areas of the U.S. But it would not take much to cause a serious American flu outbreak – a minor genetic mutation, resulting in an easily communicable virus with, say, a 30 percent mortality rate. In this case, trust in public health officials would be the only alternative to mass panic and self-destructive behavior. Significant public resistance to CDC plans during a communicable disease emergency could make all of us dramatically more vulnerable.
We don’t often think of it, but our way of life depends on extremely effective and respected public health systems. That is the useful, universal lesson of the Ebola outbreak of 2014.