A survey of Canadian views of the Ebola outbreak in West Africa shows a gap between the risks we face and our fears. Governments need to understand this perception gap, and prepare for the consequences should the virus evolve and elevate the risk to Canada.
There are many terrifying aspects to the Ebola virus outbreak that has killed more than 2,300 people and infected thousands more across Western Africa. Beyond the unprecedented numbers of victims who have rapidly succumbed to the disease are the staggering and rising economic costs, intensifying political instability and horrifying projections of case counts, which could rise to more than a quarter million confirmed infections by the end of 2014.
But we also see a worrying disconnect between the recommendations of public health authorities and the response of people in the affected areas. Experts advise that avoiding contact with diseased bodies is the key to outbreak control, yet many families are hiding their sick and dying relatives from authorities. Because Ebola’s victims are most contagious immediately after death, people are being warned to avoid touching the dead. But cultural traditions of washing and staying close to the deceased persist. Even the foreign medical professionals, who are arriving at last from around the globe, are being met with suspicion, anger and even violence.
Dramatic differences in risk perception between the medical authorities and those they are trying to help are compounding the grave nature of the crisis. This riskperception gap is not unique to that part of the world or to the Ebola epidemic. Such perception gaps can be found in Canadian perspectives on the Ebola outbreak. In early September, Carleton University’s Communication, Risk and Public Health Research Group asked a random sample of 598 Ontarians for their views on different aspects of the Ebola outbreak, options for response and the perceived risk to Canadians (administered by the Carleton University Survey Centre, the survey’s margin of error is +/4 percentage points at the 95 percent confidence level).
The study found that 45 percent of respondents were either ”œvery concerned” or ”œsomewhat concerned” that ”œthere will be a large outbreak of Ebola within Canada in the next 12 months.” While representing only a small piece of the puzzle toward a truly comprehensive understanding of Ebola risk perception, it is remarkable that, against most expert analysis, more than 4 in 10 Ontarians worry that a public health emergency on the other side of the planet could soon pose a threat here.
This is not a matter of limited public awareness. Sixty-seven percent of those surveyed say they are following the news closely (only 4 percent have not heard of the Ebola outbreak at all). Yet there seems to be a measurably low level of understanding about how the disease behaves and the likelihood of it spreading through the population should a case arrive in Canada. Most experts agree that the risk of an Ebola outbreak is very low in developed countries. Unlike Liberia, Sierra Leone, Guinea and other hard hit West African nations, more developed nations have the resources, medical expertise, infection-control measures and regulatory systems needed to tamp out the risk of mass infection before it spirals out of control.
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Still, when asked how easily Ebola can spread from person to person, a high number of our survey respondents (40 percent) believe that the disease spreads ”œvery easily,” and a substantial number (36 percent) believe Ebola spreads ”œsomewhat easily.”
That more than three-quarters of Ontarians believe Ebola transmits easily from person to person may help to account for the startlingly high number – 82 percent – who would support a travel ban to and from any affected regions. As the Globe and Mail‘s Geoffrey York has reported, airlines and governments from around the world have been ignoring the advice of medical experts by imposing unnecessary restrictions on African travellers.
In August, Korean Air Lines suspended all flights to Kenya, a country located thousands of kilometres away from the danger zone and without a single domestic case of Ebola, and both British Airways and Emirates suspended flights to certain West African cities. Chinese officials placed Nigerian athletes in quarantine at a Summer Youth Olympic Games in China, and several African nations, including Ivory Coast, have been blocking the transport of cargo.
Pressure to impose a travel ban is evident in the United States too, where Congressman Alan Grayson (D-Florida), a member of the House of Representatives Committee on Foreign Affairs, called for an immediate travel ban on citizens of Guinea, Liberia and Sierra Leone because ”œthe Ebola virus presents and enhanced danger to the American public.”
If a substantial percentage of Ontarians fear the possibility of a large domestic Ebola outbreak and believe the disease to be easily transmitted, it may be less of a surprise that they show a strong willingness to support sanctions, which the World Health Organization argues would make the situation far worse in Ebola-affected countries and undermine response capacity. Coupled with the fear of contagion, this presents the prospect of a combustible communication problem for governments in Canada if, for example, a case were to be exported here and a community or a health facility be exposed.
Opinion and perception polling on ”œwhat if” scenarios are fraught with difficulty. People can imagine how they might feel, but they can’t really know how they will actually feel in a bestor worst-case situation. Nevertheless, the potential gap in risk perception between health authorities and the public is a significant factor in combatting high-risk events. In the event that the Ebola virus evolves in a way that heightens the risk to Canadians – broader geographic spread, a limited domestic outbreak, or a dangerous genetic mutation – our data offers an indication of the significant nonmedical challenges we may face.
The 67 percent of Ontarians who say they are following news of the outbreak ”œsomewhat” or ”œvery” closely was slightly more than the 62 percent of Americans who report similar levels of attention in a Harvard School of Public Health survey conducted in August. The Harvard study found that almost 40 percent of Americans fear a ”œlarge outbreak” of Ebola virus in the United States, and more than a quarter are afraid that they or a loved one will be infected within the year.
A key explanation given in the US context was the strong influence media has over how people make sense of potentially scary, distant events. The Ebola outbreak, like the SARS scare a decade ago, leads us to draw from the powerful catalogue of disaster and pandemic imagery generated by Hollywood films, television shows, graphic novels, and increasingly by video games and mobile apps, to adjust to real world events that are novel, frightening and exotic. News coverage of the outbreak has consistently been filled with gruesome, terrifying images from the frontlines of affected communities. Carleton University professors Neil Gerlach and Sheryl Hamilton argue that we are now immersed in a ”œpandemic culture” in which the proliferation of institutional, expert discourses of risk mixes almost seamlessly with popular media narratives of contagion.
Reflecting on the Harvard study, we were curious to know whether similar patterns would hold in Canada. Canadians are exposed to the same heavily mediated ”œpandemic culture” as Americans are, and our TV news diet draws on US cable news and the big broadcasters as much as our own public and private media system does. If, as commentary on the Harvard study concluded, newsand entertainment-media depictions of disease threats contribute significantly to the heightened fear and anxiety we have about Ebola, we should expect to see similar findings in Canada.
We did. Although a majority of the respondents in our survey – 55 percent – are either not very concerned or not concerned at all, the more than 4 in 10 who are worried represent a percentage similar to that of the Harvard study.
Success in risk communication hinges crucially on trust: does the public trust their government to share information, in a timely manner, that will protect them from harm? In Canada, as in the United States, health authorities have unequivocally stated that the risk of the Ebola virus spreading to the West and causing an outbreak here is very low. Although a significant number of our survey respondents are concerned about a large outbreak in Canada, a very strong number (82 percent) of them are confident in the risk assessment of the country’s public health authorities, and 81 percent believe that different levels of government would share information and work together if Canada were to face a major public health emergency.
How then to square the apparent contradiction between fear of domestic contagion and high confidence in the government’s low risk assessment? Is it possible to trust the assessment of experts that we have little to fear yet still worry that they may be wrong? An explanation for this conundrum is offered by risk-perception research, which shows that people process risk information in different ways, at different times and for varied reasons. Much of this research tells us that people tend to perceive and act on risk using analytical abilities as well as instinctive and intuitive reactions to danger. Paul Slovic describes the interaction between these dual modes of thinking about risk as ”œthe dance of affect and reason.”
As long as the Ebola virus remains far away, Canadians may be thinking about the potential of domestic contagion in consequentialist terms because the disease does not pose an immediate threat. If, or when, a case arrives in Canada, the pandemic narratives that shape our perceptions of the virus could become more influential in shaping how that risk is understood and processed in experiential terms. In other words, Ontarians are judging the risk of Ebola both by what they think about it and by how it makes them feel.
If so many of the individuals worried about an outbreak at home are also following Ebola news closely, it likely tells us that expert opinion is either not getting through or not being heard. Or, if it is being heard, it is competing with a powerful assemblage of other narratives. The dominant media images of the unfolding crisis in West Africa – bodies left in the street, health workers in full hazmat gear, people left to die suffering in their homes – suggest a highly virulent disease that spreads quickly and easily and spares few victims.
These results also tell us that in the event of an elevated risk in Canada, the public’s misconceptions about the disease’s transmissibility could be difficult to dislodge – the power of the images associated with the disease can’t be ignored. Government agencies and public health authorities should accept this possibility and design their risk communication strategies accordingly, including finding alternative ways to communicate the expert risk assessment.
The high levels of public support for a travel ban may also suggest there is another dynamic at play that would require a sensitive official response should that dynamic develop. Although deeper qualitative investigation is required, it seems likely that strong support for a travel ban would be based on the sense among citizens that the Ebola virus is a foreign, alien risk. In the event that the risk presents itself in a new way on Canadian soil, the same sentiment could result in stigmatization of, for example, West African Canadian communities. As our experience with SARS indicates, smearing certain groups is unfortunately common in high-risk-perception events, and it must be confronted and minimized as best possible. It is not too soon for governments and health authorities to prepare for such a development in public sentiment and devise ways to defuse it.
At the time of writing, the Ebola outbreak is still a regional public health emergency of international concern. There are no indications that Canadians should worry about the disease landing on domestic soil and wreaking havoc here as it has done (and continues to do) in West Africa. But our research, however partial a picture it paints, tells us that the understanding Canadians have of this disease may present a risk-perception gap, and therefore a clear risk-communication dilemma. Canadian authorities ignore this gap at their peril.
A top line report of the study can be found here: Final Topline Report.