Guinea, Sierra Leone, Liberia, Nigeria, and now Senegal. The outbreak of Ebola in West Africa continues to spread. Marked by high mortality rates and images of gruesome death by hemorrhage, Ebola is perhaps the quintessential modern plague. The current epidemic has been a fixture of the international news for months now, particularly in regard to public health efforts and the significant risks to medical staff (including two Americans) working with inadequate resources to help afflicted communities.
But why are we so transfixed, particularly since the numbers pale in comparison to global rates for far less “exotic” illnesses? And how do international understandings and fears surrounding Ebola connect with underlying (mis)conceptions regarding Africa? Consider, for instance, that up to an estimated half-million people die each year from influenza around the world. Why does that simple fact lack the visceral panic associated with discussions of Ebola? Ebola is terrifying, to be sure, but it also raises important questions about understandings of risk, contagion, regionalism, and the values attached to some lives, to some forms of death.
Like many around the world, I have been both captivated and horrified by the current Ebola outbreak in West Africa. From the stories of riots in West Point to speculation about “patient zero,” the efficacy of ZMapp, I have followed the developments closely. I first learned of Ebola while in Ghana as undergraduate studying abroad. There was an outbreak in Uganda at that time and the news where I was covered the story with the surprising bluntness of media outside of the U.S. – photos of bodies and dire illness, a shock since I was used to more sanitized stories packed with big words but very few actual images of death. An acquaintance was studying in Uganda at that time and had to abandon her research in a rural area for fear of health risks. I remember thinking how lucky I was to be in a region that was free from such public health horrors. This map shows the scope of Ebola outbreaks since the disease’s discovery in 1976:
As an anthropologist, one of the most fascinating aspects of the media coverage this time around is the focus on local folk beliefs about Ebola. These are often framed as public ignorance or conspiracy theories, typically with a distinctively Western undertone of “Oh, those Africans – not knowing science from superstition!” Such portrayals connect closely to the persistent and false tendency to equate “Africa” with primitive. They rest on the mutually supporting logics of racism and colonialism, “Othering” the victims while also casting them as simultaneously exotic and terribly distant. Tellingly, such thinking masks the persistent reality of medical folklore in the contemporary U.S. It takes only a quick look below the surface to realize that we are still much more superstitious than we think.
Dartmouth professor Brendan Nyhan’s recent NYT article, “Fighting Ebola, and the Conspiracy Theories,” is the first piece I have seen that slices through the ethnocentric bias of most Ebola coverage. As Nyhan reminds readers, medical conspiracy theories are still alive and well in the U.S., with the anti-vaccine movement as the most prominent example. Much as some people in the impacted Ebola countries refuse to believe that the disease is real and is actually killing people, a surprisingly large number of Americans maintain that vaccines are linked to autism and other ills, despite overwhelming scientific consensus that this is not the case. Are these two cases really so different?
First, let’s look at the numbers. According to the most recent reports, the current Ebola epidemic has infected approximately 3,000 people and killed around 1,500. Experts say that the actual numbers are higher, and the head of the CDC recently stated that the current epidemic has yet to reach its peak. The figures are chilling, there’s no doubt about it. But let’s pull back for a moment and consider the numbers for other infectious diseases that are less exotic and, more importantly, for which we have vaccines. Here’s a quick snapshot from Forbes of historical change in infectious disease deaths in the U.S., based on data that are several years old at this point:
Measles offers a telling example. According to the WHO, a whopping 122,000 people worldwide died of measles in 2012, mostly children under the age of five. That breaks down to 14 measles deaths every hour of every day, or 330 total per day. Between January and August of this year, the U.S. experienced the highest number of measles cases since the disease was eradicated in the country over a decade ago. CDC data shows nearly 600 confirmed cases reported in 21 states – that’s nearly half of the country! Measles is typically introduced by people who are unvaccinated and have been or are from other parts of the world. Check out this graphic from the CDC for a snapshot:
Whooping cough (or pertussis) is an even more striking case. In my adopted state of Texas, the number of parents opting not to vaccinate their children tripled in the last seven years. The U.S. reported nearly 40,000 cases in 2012, the highest figure since 1955, and infections have risen steadily since the 1980s. Following a 2010 outbreak in California, the state reported the highest number of infant deaths from pertussis in over six decades. Stories of babies who fall ill and even die, like this one, should spark public demands to reign in this largely preventable illness, particularly if the spike in cases connects to either unvaccinated populations or waning effectiveness among vaccinated adults. Instead, new parents are given vague instructions not to take newborns to crowded areas or places thought to be teeming with germs, and we cross our fingers. I cannot help but wonder why we as a society remain so complacent.
On the global level, there are approximately 16 million cases of pertussis annually, resulting in just under 200,000 deaths. These are staggering figures, given that we have vaccines. For up-to-date information on global incidence of infectious disease outbreaks, including pertussis, the Council on Foreign Relations offers this fascinating interactive map. Focusing on pertussis closer to home, the image below maps 2014 pertussis cases in the state of Texas:
Here’s a fantastic chart from the Texas Department of State Health Services showing historical pertussis trends:
Now, let’s bring our lens back to West Africa. According to the WHO’s fantastic interactive vaccination map, only about half of the children in Guinea, ground zero for the current Ebola epidemic, have received a measles vaccination. The figure is 80% for both Liberia and Sierra Leone, and only 42% for Nigeria. Given its low vaccination rates and high population, it comes as no surprise that Nigeria has reported some of the largest outbreaks of measles worldwide in recent years. And yet the American media has been curiously uninterested in this public health reality, despite repeated stories about the injustice of a lack of Ebola vaccine or approved treatment options. Although well-intentioned, I cannot help but wonder if these critics are as vehement on the subject or conducting routine vaccinations in this region. Perhaps MMR and TDAP access simply isn’t as sexy as Ebola. These illnesses neither conjure Michael Crichton-style fears of a modern plague nor ensure high numbers for the nightly news.
Of course, mortality rates for measles and pertussis are far lower than Ebola’s, at approximately 1-2 in 1,000 for every child with measles. However, with cases on the rise in the U.S. and the E.U., the lack of public awareness – or even interest – is shocking, as is the fact that vaccinations continue to wane among a small subset of the population. Considering that over four percent of school-age children remain unvaccinated in at least five states, including Illinois and Washington, why is there not more fear of the infectious diseases that were once considered so menacing? Going a step farther, why aren’t these parents vilified and ridiculed by the media, treated as ignorant pre-moderns rather than individuals with philosophical objections to a public health good? Is that not how the U.S. media frames current Ebola conspiracy theories and distrustful residents of afflicted areas, articulated most violently by the riots and clinic closure in one section of Monrovia? How curious that what is written off as a questionable fringe movement in the U.S. is coded as primitive superstition as soon as the setting shifts to Africa.
Perhaps our own superstitions and conspiracy theories are clouding our notions of the actual versus fantastical public health risks in the U.S. today. As anthropologist and geneticist Jennifer Raff argues in her viral blog piece, “Dear Parents, You are Being Lied To,” the scientific support for vaccines is so strong that there should be no room left for doubt. We know that the standard vaccines are highly effective and almost always safe. Nonetheless, the local conspiracy theories persist and, as journalist Seth Mnookin illustrates in his fantastic book, The Panic Virus: A True Story of Medicine, Science, and Fear, they have remained a fixture of the American scene ever since vaccines were introduced.
An anthropologist once told me that, in order to gain insights into the mundane and overlooked beliefs in a given society, we have to look at the fringes. There, in those shadowy extremes, will we uncover the logics and assumptions that order our daily lives. There are perhaps few illnesses as exceptional as Ebola, whether in terms of public perception or actual mortality rate if infected, yet the current epidemic reveals much more about mainstream experiences in the U.S. than meets the eye. In comparison with such domestically encountered illnesses as influenza and, increasingly, pertussis and measles – as deadly as they can be – Ebola is quintessentially Othered. It condenses fears of contagion and plague with the persistently unchecked post-colonial racism that so often frames discussions of Africa. But the devil you know is not always better than the devil you don’t, and this time – as infectious diseases continue to rise in the U.S. – I suggest we step back from the spectacle of Ebola’s conspiracy theories and take a closer look at our own.