A CNN discussion about Ebola

A CNN discussion about Ebola

Screenshot via CNN

How to talk to the public about Ebola: Five tips from risk communication experts

Shortly before 8 a.m. on Wednesday morning, a Liberian man died from Ebola in a hospital in Dallas, Texas—the first fatal case in the United States. It was the end of a personal tragedy that, according to an article in The New York Times, started when the man helped carry a woman who was 7 months pregnant and dying of Ebola to a taxi in the Liberian capital of Monrovia.

But the media frenzy that started when the Centers for Disease Control and Prevention (CDC) announced the case on 30 September shows no signs of abating. CDC has been holding daily press conferences. Politicians have called for U.S. borders to be closed and attacked President Barack Obama for not doing enough. And news channels have been vying for superlatives to describe the deadly disease; experts on CNN recently opined on the question of whether Ebola is “the ISIS of biological agents.”

In an exchange on Fox News, for instance, Megyn Kelly talked to a former official from the Department of Justice about closing borders:

“These are people like the person in Dallas, who vomited everywhere, who Lord knows what he did on the airplane and in the Dulles airport.”

“He was asymptomatic on the airplane, they said.”

“Yeah, well you don’t have to be symptomatic to spread this disease.”

“They say you do.”

“Well, we’ll see.”

Peter Sandman, a longtime expert and consultant on risk communication based in Brooklyn, New York, wasn’t especially shocked when he first heard about the patient's case. "My first reaction was: Well, it had to be somewhere. Better Dallas than Mumbai,” he says. But Sandman says the past week has been a missed opportunity. The Dallas case could have been used to explain to Americans what makes Ebola a global threat, he says. “ ‘This was a spark to a place that knows how to extinguish sparks. What is terrifying us is that there are going to be sparks to places that don’t know how to extinguish them.’ That should have been the main message,” Sandman says.

 As public health officials and scientists tried to reassure the public that there was no danger and to address the Texas hospital’s mishaps in dealing with the case, they missed that chance, Sandman says. “So far it’s more a distraction and distortion.”

In a long e-mail to ScienceInsider, Sandman and his wife and colleague Jody Lanard discuss what years of work in risk communication have taught them, and where they think government officials as well as journalists are failing. Two big mistakes in how the Dallas case was handled—sending the patient home when he first sought medical care and keeping the family under quarantine in the potentially contaminated apartment for days—have raised questions about how well prepared the United States really is for Ebola. That question has become the focal point of media coverage of Ebola.

"As long as U.S. media are justifiably fixated on ‘exposing’ what went wrong and what keeps going wrong and what might go wrong in Dallas, the conversation here won’t turn to West Africa, where it belongs,” Sandman and Lanard write in their e-mail. "The screw-ups in Dallas need to be acknowledged and apologized for—repeatedly,” they argue. "The more officials continue to sound like cheerleaders, ignoring or minimizing what goes wrong, the more the media will focus on knocking them off their high horse.“

The conversation will turn back to West Africa, the couple predicts, but the focus will be on how to reduce spread of the virus from the three currently affected countries there. "There will be nativist, naïve proposals on the table, proposals to close our border or, better yet, close theirs," Sandman and Lanard write. "The question is whether there will be more realistic, more empathic proposals on the table as well. Or will the issue be left to the far right?”

Sandman and Lanard end their e-mail with some concrete advice, five points they think governments, experts, and media should stress when talking about Ebola. Here are their recommendations:

1. Teach the world how exponential growth works. Explain that the CDC’s worst-case estimate of 1.4 million Ebola cases by mid-January is essentially the same estimate as 700,000 in late December and 2.8 million in early February. Reducing the doubling time of Ebola requires reducing the number of contacts sick people have a chance to infect. Isolation is—tragically—a much higher priority than treatment. This isn’t a humanitarian crisis. It is a global health crisis. And it is a global security crisis. Armies may be a more important part of the solution than healthcare workers.

2. Teach the world what’s in store for us all if Ebola isn’t stopped. It’s about more than numbers. Paint vivid pictures of what life would be like if Ebola were to establish itself throughout the developing world the way it has established itself in three West African countries so far. Talk about the likely impact on supply chains, on the world economy, on political stability. Point out that developed countries can probably extinguish the sparks that come their way, at least if there aren’t too many—though with greater difficulty and greater pain than we’re imagining. And point out that developing countries probably can’t. Lagos and Port Harcourt somehow managed to extinguish the spark that ignited after Patrick Sawyer brought Ebola from Liberia to Nigeria, as few thought they could. Almost nobody thinks the developing world can extinguish spark after spark after spark.

3. Teach the world why finding, testing, mass-producing, and actually distributing an Ebola vaccine is the only realistic way to end this global disaster-in-the-making. Investigate the vaccine development story in detail. Find the choke points that need to be smoothed. Figure out what else could be done to improve the probability of success and the speed with which it happens. Report in detail on what’s hopeful and what’s not so hopeful in the Ebola vaccine story so far. Assess—and keep assessing—whether a vaccine is a pie-in-the-sky deus-ex-machina or a reasonable hope.

4. Teach the world why “spark suppression”—reducing the number of Ebola sparks emanating from West Africa—is essential to buy time for the desperate attempt to find a vaccine. Don’t settle for the false dichotomy: Border closings never work (that is, they never work perfectly) so there’s no point in inhibiting travel. Foster a thoughtful debate about various proposals for reducing the number of sparks, and thus reducing not just the burden of extinguishing those sparks but also the chances of Ebola establishing itself in additional countries. Help assess which proposals will probably backfire, which will do little good at great humanitarian cost, and which will do comparatively more good at comparatively lower cost.

5. Teach the world to endure uncertainty. The Ebola virus might mutate in ways that would make it even more dangerous than it is now—to enable airborne transmission, for example, or to enable an infected person to function longer in the world and thus spread the disease to more people. At the other extreme, Ebola might somehow burn itself out. Or it might become endemic in Africa without spreading widely elsewhere in the world. More important than any individual scenario is the reality that we know so little about which scenarios are likely and which are vanishingly unlikely or even impossible. Until now, our knowledge of Ebola comes almost entirely from small outbreaks in African villages; now we are learning from a big epidemic in West Africa. We still know next to nothing about how an Ebola outbreak might play out in a developed country in the northern hemisphere.

*The Ebola Files: Given the current Ebola outbreak, unprecedented in terms of number of people killed and rapid geographic spread, Science and Science Translational Medicine have made a collection of research and news articles on the viral disease freely available to researchers and the general public.