Via NEJM: Ebola in the United States — Public Reactions and Implications. Click through for the full article and many links. Excerpt:
Although there had been only two cases of Ebola transmission inside the United States and both patients had survived, a November 2014 opinion poll revealed that the U.S. public ranked Ebola as the third-most-urgent health problem facing the country — just below cost and access and higher than any other disease, including cancer or heart disease, which together account for nearly half of all U.S. deaths each year (see Table S1 in the Supplementary Appendix, available with the full text of this article at NEJM.org).
The U.S. public's high ranking of a disease is important because it can influence policy leaders' views of appropriate actions and spending, running the risk of redirecting attention and funds from health policies that help more people domestically or from critical responses overseas. This kind of jump in public priorities related to emerging infectious diseases has happened before, including during the H1N1 influenza pandemic in 2009 (see the Supplementary Appendix).
To examine the reasons for such a public response, we used Ebola as a case study. In a project supported by the Robert Wood Johnson Foundation, we reviewed 179 public opinion polls about Ebola (2 of which were conducted by researchers at the Harvard T.H. Chan School of Public Health and SSRS) and conclude that there were primarily four interrelated reasons why the public prioritized Ebola. Our findings have implications for effective communications with the public during future outbreaks of emerging infectious diseases (for a list of referenced polls and reports, see the Supplementary Appendix).
A central reason for the high priority placed on Ebola is that people did not understand, or perhaps did not believe, information about how this gruesome disease spreads. The vast majority of those polled (85%) said a person is likely (“very likely” or “somewhat likely”) to get Ebola if he or she is sneezed or coughed on by a symptomatic person, and half (48%) said a person could transmit the virus before he or she shows symptoms (see table The U.S. Public's Attitudes, Beliefs, and Knowledge about Ebola. ).
These descriptions conflict with evidence that the virus is not airborne — meaning that people are extremely unlikely to get sick from someone sneezing or coughing — and that Ebola is not contagious before symptoms appear.
As a result of such misperceptions, people felt personally threatened. At the peak of concern, about half the U.S. public (45%) was worried (“very worried” or “somewhat worried”) that they or their family would become sick with Ebola. These responses were obtained in mid-October 2014, when Ebola was transmitted in a U.S. hospital despite precautions, which reinforced the idea that it spreads easily. Worry then diminished after no other people became infected, even though people with Ebola had been in public places while they had symptoms (see Table S2 in the Supplementary Appendix).
The media most likely played a role in increasing public concern, primarily by running many stories about Ebola.1 Nightly news shows on three major networks — CNN, NBC, and CBS — aired nearly 1000 segments about Ebola between mid-October and early November 2014,2 when the majority of the U.S. public (76 to 81%) said they were following news on Ebola “very closely” or “fairly closely.”
The media's style of coverage may also have shaped public perception, in that it followed specific people, such as one of the nurses who was infected. Naming individual patients was logical because there were so few of them in the United States, but political science research suggests that this practice can drive public concern.3
The level of public concern was also high because communications that might otherwise have reduced it, such as information about the limited mechanisms by which Ebola is spread, were not well trusted. Only 31% of the public said they trusted public health officials in the United States (“a great deal” or “a fair amount”) to share complete and accurate information about the Ebola virus, and 40% of the public said they did not trust information (“not too much” or “not at all”) about the Ebola outbreak from the Centers for Disease Control and Prevention (CDC) (see table).
It's striking, and discouraging, that Americans evidently trust their healthcare system about as much as West Africans trust theirs.