Public health messages about Ebola could, and should, have been better

http://www.theguardian.com/commentisfree/2014/oct/17/public-health-ebola-virus-uk

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Ebola panic is rife. Makeup artists at the BBC are said to be worried about touching the faces of interviewees from Guinea, a school cancelled the visit of a mother and child from Sierra Leone , and rumours and conspiracy theories float through the air in a way that the Ebola virus cannot (it is categorically not airborne).

Ask most people and they will probably think Ebola is about to arrive in the UK and is a threat. The first may be true – but it will be a handful of cases, at most – and the second is not. Ebola is not easy to catch. It is transmitted by an exchange of bodily fluids with somebody who is so sick they are vomiting, bleeding or excreting heavily. That puts health workers potentially at risk but very few of the rest of us, and the planned emergency response to any Ebola diagnosis – tracking down and monitoring every contact, just in case – will ensure the risks of spread are minimal.

Ebola panic is a global development. It is hard to reassure people when unfounded scare stories are broadcast across the worldwide web. But in several ways this could have been better handled.

1. Public Health England, full of expertise on infectious diseases and keeping the public safe, does not have a high enough profile. It talks absolute sense and advises government and journalists, but its voice is not much heard by the general public – and nor do they know what it does. In fact, the expertise on infectious diseases resides in Colindale in north London, in what used to be called the Health Protection Agency, which maybe has a more resonant name when it comes to Ebola. Public Health England is responsible for obesity and smoking cessation and other health issues. It may be a problem that PHE has existed only for the last couple of years. It is not the go-to place for Ebola information for most of the general public.

In the US, public health messages are dispensed by the surgeon general, and have been for a long time. Warnings in his name are plastered over cigarette packets. The top item on the surgeon general’s website is Facts about Ebola, with the one line underneath: “The risk of an Ebola outbreak in the US is very low.” It is a simple message, put out by a known authority, with more detail available for those who want to click onwards.

2. Politicians have been part of the problem. Public Health England was not in favour of screening people returning from west Africa at ports and airports, and advised ministers so. You cannot detect Ebola virus until somebody has symptoms, which is usually about five days after infection but can be up to 21 days. So taking temperatures at Heathrow is a needle-in-a-haystack exercise. You will be lucky to find anybody who was well enough to board the flight but has become symptomatic on arrival in the UK.

Keith Vaz, chair of the Commons home affairs select committee, was one of those who did not listen. Last Thursday, he called for screening to increase public confidence, on the back of the US decision to screen. The defence secretary, Michael Fallon, had said there were no plans to screen and the chancellor, George Osborne, said they would screen only if they had medical advice that this was useful – but on Monday the health secretary, Jeremy Hunt, announced screening would go ahead. At best, the public gets a very confused message. More probably, this fuels the panic.

Hunt has not weighed his words carefully on Ebola. The disease, he said this week, could reach the scale of the Aids epidemic. For Sierra Leone, Liberia and Guinea, and potentially other countries nearby, that is sadly true, although Nigeria and Senegal have tracked down all cases and stopped Ebola in its tracks within their own borders. But many readers of Hunt’s words will be thinking of the UK, the US and Europe. Scary.

3. The media have not helped. Hunt’s words were, of course, blasted across the front page of the Times, and were prominent in the Telegraph, the Mail and elsewhere. But the sheer quantity of unsubstantiated and sometimes unchecked stories on Ebola are just as much of a problem. Because people are worried, Ebola stories on newspaper websites get huge numbers of hits. People are certainly looking for information. It is a disservice, however, to ramp up and run every minor scare.

Maybe we need a trusted voice on Ebola and public health generally. Members of the Royal College of Physicians, anxious about escalating obesity in the UK, urged that there should be an obesity champion and even suggested it could be a member of the royal family. Maybe not, but we need somebody on the public health side with a much higher profile, who must not then be gainsaid by politicians or railroaded by the press into measures that are not justified by any evidence.