The emerging reaction to America’s newest case of Ebola shows that many Americans are scared by serious contagious diseases.
Recent polling of Americans shows that public concern over Ebola has grown since the first cases arrived in the United States and since the death of the first Ebola patient — with 4 in 10 Americans saying that they are worried about family members contracting Ebola. The symptoms associated with Ebola, such as bleeding and weakness, are frightening, and the death rate in this current outbreak is very high, reaching 70 percent in certain places. Ebola anxiety, while potentially misplaced and harmful, is likely to have an affect on whom Americans trust to handle the disease and what kinds of policies they will support to fight it.
Based on work that we have done on other public health anxieties, such as smallpox and the H1N1 flu, we expect that Ebola anxiety will lead people to seek protection from diseases that may cause harm to them or their family. In seeking protection, we expect that Americans will, at least initially, put their trust in medical experts like the Centers for Disease Control (CDC) to tell them how to stay safe and will support state powers that may lead to quarantine or other civil liberties restrictions for those suspected of exposure.
By looking at another disease – smallpox — we can see how anxiety affects trust in public health officials and support for a variety of policies designed to control smallpox outbreaks and thus keep the population safe. Smallpox is a good analogue to Ebola. It, too, is a lethal infectious disease that few Americans have immunity to. The World Health Organization (WHO) declared smallpox eradicated in 1980, which means that there is no longer routine vaccination. Smallpox can still rouse the public’s fears. It is regularly discussed as a potential bioweapon, and in summer 2014, the National Institutes of Health discovered vials of forgotten live smallpox in a storage closet, raising concerns about its handling and containment.
In 2011, we worked together with YouGov to run an experiment with a representative sample of 600 Americans. Some of the 600 were picked at random to read a news article about a (fictional) smallpox outbreak that occurred 25 years ago in Cleveland (the “past smallpox” condition) and some to read about an ongoing (fictional) smallpox outbreak in Cleveland (the “present smallpox” condition). News about a current smallpox threat significantly increases respondents’ feelings of anxiety compared to reading about a past outbreak.
To combat a smallpox outbreak, both the WHO and the CDC recommend vaccination, isolation of patients diagnosed with the disease either at home or in a hospital, decontamination of clothing, bedding and other personal property through bleach or incineration. All are similar to the procedures for fighting Ebola (with the exception of a potential Ebola vaccine, which is still in development). These policies are designed to offer widespread protection yet also entail a number of limitations, albeit temporary ones, on free movement, participation in public life, and the potential loss of property. In times of health fears, support for these types of restrictive policies increases.
During health crises the American public trusts individuals whom they see as authoritative health experts, such as the director of the CDC, while putting less trust in political appointees. Over several studies, the director of the CDC is rated as the most trustworthy source of information during potential health crises. Anxiety can be a good thing if it leads Americans to trust actors who can provide accurate and useful information on how to keep safe. However, if anxiety leads people to distrust expert sources or trust people who may not have correct medical information, it can plausibly hurt the public interest. In our study, we ask respondents to judge how much they trust both relevant actors like the CDC and irrelevant actors like the Internal Revenue Service (IRS) to provide information about smallpox.
We find that health anxiety motivates citizens to trust actors they deem expert and relevant in ameliorating public health threats. The figure below displays the percent of respondents in each treatment who trust each actor “a great deal,” the highest level of trust on our scale. Respondents ranked the CDC and one’s personal doctor as the most trustworthy and rated the IRS and the Federal Reserve chairmen as the least trustworthy. Respondents were also highly trusting of their friends in the medical field and the AMA. While only five respondents (0.8 percent) said that they trusted the IRS “a great deal” on health issues, 48 percent gave the CDC and 56 percent gave their doctor the highest level of trust. People who had been informed about a present smallpox outbreak are more trusting of actors than people informed about a smallpox outbreak in the past. The most relevant agencies like the CDC and HHS received the biggest increase in trust from anxiety.
After reading the news article, we also asked respondents how much they supported a number of emergency powers that have been proposed by state officials to be used in the event of a smallpox outbreak on a five-point scale from “strongly oppose” to “strongly support.” The policies vary in terms of the burden they place on people and whether they are directed at the general population or just those afflicted with the disease. We found that respondents who had read a story about a present outbreak of smallpox (i.e. the most anxiety-inducing possibility) were the most supportive of emergency powers. In general we find that anxiety makes people more supportive of government playing an expansive role in protecting them during a health crisis.
The graph below shows how anxiety over a smallpox outbreak made respondents significantly more likely to trade privacy, free movement and even property for safety. The figure shows the average level of support for the smallpox policies among both high-anxiety respondents and low-anxiety respondents. Anxiety makes respondents 16 percent more willing to require others to be vaccinated, 20 percent more willing to undergo a medical examination, 12 percent more likely to quarantine suspected smallpox patients, 13 percent more likely to isolate those with smallpox, and 15 percent more likely to destroy property contaminated by smallpox. Anxiety can substantially increase public support for even relatively costly emergency health measures.
Our experimental work doesn’t tell us everything we would like to know about the current politics of Ebola. Our experiment doesn’t look at differences in opinion between when people think that the government looks like it is doing a good job and when government is not properly handling the situation. If people think government isn’t competent, anxiety may make them less likely to trust some actors. The CDC was arguably overconfident about the capacity of U.S. hospitals to deal with this problem, as shown by experience at the Dallas hospital where a patient died and two nurses were infected.
The Obama administration’s decision to appoint Ron Klain as the Ebola czar is an attempt to address the public’s worries. However, the Ebola czar is a political appointee who lacks medical credentials. Should there be future U.S. infections, this could become a liability. In our study, we vary how we describe the surgeon general, either as a political appointee or as a doctor. We find that anxious respondents become more trusting of an SG who is described as a medical expert but not an SG described as a political appointee.
In our smallpox experiment, respondents read newspaper stories that offered dry, factual accounts. In contrast, some in the U.S. media have amped the level of fear associated with the Ebola outbreak through sensationalist coverage of highly improbable events, such as airborne transmission of Ebola and its use as a bioweapon by the Islamic State. Finally, in our smallpox study, no politicians used health issues for electoral gain. Sen. Rand Paul (R-Ky.) recently criticized the Obama administration’s handling of Ebola during an interview with a New Hampshire radio station in which he falsely declared that the virus “appears to be very easy to catch.”
Despite these differences, we think our study and the current Ebola outbreak both emphasize that people will rally around experts and increase their support for policies that fight the contagion, even if they hurt civil liberties. Let us hope that the U.S. health system is ultimately worthy of the confidence the public has in it.
Political scientists Bethany Albertson (University of Texas at Austin) and Shana Gadarian (Syracuse University) are authors of a forthcoming book, “Anxious Politics: Democratic Citizenship in a Threatening World.” Their book includes 14 studies, many of which include experimental manipulations of anxiety and cover emotionally laden topics such as immigration and terrorism.