A new semester has just started at Stevens Institute of Technology, and I'm more excited than usual—that is, less depressed that summer vacation is over. My division, the College of Arts & Letters, just hired two scholars to beef up our programs in Science and Technology Studies and Science Communication. One is historian of science Alex Wellerstein, who writes the "Nuclear Secrecy" blog and created the creepy-cool "NUKEMAP." The other is Theresa MacPhail, who has a doctorate in medical anthropology, master's in social science and bachelor's in journalism. Her first book, The Viral Network: A Pathography of the H1N1 Influenza Pandemic, will be published this fall by Cornell University Press. (See her faculty profile and comments below for more on her background.) I recently ran into MacPhail at the departmental copy machine and started chatting with her about the Ebola outbreak (which Scientific American covers in "Ebola: What You Need to Know"). MacPhail graciously agreed to share her extensive knowledge with readers of "Cross-check."
Horgan: Can you briefly describe your experience in infectious-disease epidemiology?
MacPhail: As a medical anthropologist, I study networks of expertise and the production of scientific knowledge. Specifically, I have an interest in infectious disease and the epidemiologists and microbiologists working on infectious disease agents. In 2009, I was lucky enough to be allowed to volunteer and observe inside the U.S. Centers for Disease Control. I worked with a group of global disease analysts there. They are a dedicated team of epidemiologists who pay attention to early disease reports, help make sense of outbreak situations, and play a role in responding to outbreaks in the U.S. and around the globe. Almost everything I know about infectious disease surveillance and response, I learned by watching and talking to them.
Horgan: Has your experience made you more worried about the potential for global epidemics?
MacPhail: Yes and no. As part of the team, I was given access to their outbreak email account, so I got to monitor all the potential threats to our health. In the beginning, when I first started going through those reports, I was terrified. But after a while, as I learned more about what goes on in global health surveillance and response, I felt like we were in incredibly good hands. Outbreaks are going to happen. And there is always a chance that a disease agent like SARS (Severe Acute Respiratory Syndrome) or MERS (Middle East Respiratory Syndrome)--both corona viruses that are airborne and harder to contain than something like HIV or Ebola--will cause a very serious and global epidemic. But I also know that investing in basic public health structures, training local public health workers to respond to deadly outbreaks, and maintaining a high-quality surveillance and response system will make a deadly pandemic less likely. In other words, I trust these people. They are smart, they don’t get a lot of sleep, and they are amazing at what they do.
Horgan: I've been reading some scary stories about the Ebola epidemic lately, such as one by journalist Laurie Garrett headlined, "You Are Not Nearly Scared Enough About Ebola." Should people be scared?
MacPhail: I think what Laurie Garrett is saying about the public health infrastructure is true. That’s what we should be frightened of – the chronic inequality in the global healthcare system. Ebola is a terrible disease. It is more terrible in countries without basic supplies. But I don’t think that fanning the flames of Ebola fears are going to solve those problems. We should be more worried that the basic infrastructure isn’t there. I’m more frightened of MERS, for instance, than I am of Ebola. Ebola cases might trickle into the U.S. or other cities. But those cases are not likely to lead to any additional spread. I think Paul Farmer sums it up best in his response to a reporter’s question below:
“Amy Goodman: "That was very interesting that you just said that Ebola couldn’t be—there couldn’t be an outbreak in the United States."
Dr. Paul Farmer: "Well, there could be, but it would be stopped quickly, because patients would be isolated, not in quarantine facilities without medical care, but in places like Emory or the place where I work in Boston, at the Brigham and Women’s Hospital."
Horgan: Some Americans were very worried when Ebola victims were brought to the US for treatment. Were their fears unfounded?
MacPhail: Absolutely. Ebola is a filovirus and it’s only spread through close contact – from coming into direct contact with an infected person’s blood, mucus, or other excretions. So unless you come into direct contact with one of those things, you’re not going to get this virus. And the people being brought in were under strict isolation, so there was never any danger to the public.
Horgan: Is there a downside to exaggerated reports about infectious diseases?
MacPhail: I think so, yes. I think that when you hype up fears around a single disease agent like Ebola, or MERS or SARS for that matter, you run the risk of masking the true threats to health – which have more to do with how prepared we are to handle ANY outbreak of infectious disease than with any single infectious disease agent. Take bird flu, as just one example. For years, we’ve been preparing for an outbreak of a deadly strain of influenza. All this money has poured into surveillance systems (which is probably good) and planning. But in our myopia about flu, what did we miss? In preparing for a deadly outbreak of a highly infectious disease agent, did we adequately prepare to deal with something like the spread of dengue fever or Chikungunya – both of which are nasty viruses spread by mosquitoes and are making slow but sure advances here in the U.S.? I’m a fan of making people aware of the dangers, but I’m not sure I see how exaggerating the dangers of someone in the U.S. contracting Ebola is going to help us.
Not to be too crass, but there’s always money to be made in fear mongering. I’m sure the click-thru rates go up for a story with a bold title about Ebola.
Horgan: Your bachelor's degree was in journalism. Do you have any advice for journalists and other communicators reporting on outbreaks of diseases like Ebola?
MacPhail: I think it’s easy to get caught up in the drama of outbreaks. Ebola is a dramatic virus – the havoc it creates is real and the effects it can have on the body are truly horrific. It’s hard, as a journalist, not to focus on those aspects of an outbreak. Ebola is like all our worst nightmares coming true. But as journalists, we need to take a step back and analyze the bigger picture.
Something like Ebola takes the old adage “If it bleeds, it leads” to a whole new level. My advice would be to make sure you ask a lot of questions about the science – understand how the bug spreads and how it works. I think Carl Zimmer is a stellar example of this approach. He always makes sure he gets the science right first, and that shows in his reporting. Also get into the bigger picture issues. Why is this a problem? What political and economic aspects of this outbreak are hampering or helping the public health response? What other factors are contributing to its spread? Answering those questions will automatically put things back into perspective.
Horgan: What kind of job are the media doing reporting on Ebola?
MacPhail: Not a great one overall. But I think it depends on the outlet and the individuals assigned to the task. Clearly we didn’t need live-streaming of the ambulance carrying the two U.S. patients to Emory. That was taking “sensationalism” to new heights. The other glaring problem I’ve noticed is how people have been reporting on African “culture” in relationship to this outbreak. Burial practices, wild meat consumption, and local reactions to quarantine and isolation have all been described as “cultural” problems that promote the spread of Ebola. As an anthropologist, I think that journalists should be careful when they use “culture” as a rationale. Culture is not an explanation. It’s something that needs further examination. Culture should not be a cudgel used to blame the victims of Ebola for their own suffering. I’m thinking, in specific, of that horrible and racist Newsweek cover (Aug. 29), blaming the consumption of bushmeat for the spread of Ebola. (The best rebuttal to this was in the Washington Post.) That Newseek story, in my opinion, is just really bad journalism. Where were their facts, statistics, evidence? Sadly, I think that Ebola has created another venue for Western journalists to promote Africa as a “backwards” or “dirty” and diseased place – and not only is that not true, that type of racist rhetoric doesn’t do anyone any good. As journalists, we need to do better than this.
Overall, though, I’d say print journalists have done a better job than their TV and social media counterparts. I’ve noticed that the Washington Post seems to be doing a better job at broader coverage. And the N.Y. Times is always reliable for even-handed science coverage.
Horgan: Are there any epidemics out there that you do find alarming?
MacPhail: I think the continuing cases of MERS in places like Saudi Arabia are cause for concern. So far, there hasn’t been sustained spread in the community, but with a 30% death rate, I feel like we need to know a lot more about this virus.
And on the home front, I wish we were paying more attention to climate change and its effects on disease. Right now, we’ve got Dengue fever in Florida – and it’s endemic, so it will slowly spread, especially if we don’t get the word out. And we’ve got Chikungunya virus making inroads – again in Florida and other southern states with hot, humid climates (like Texas). We aren’t really prepared for these. People still think the worst thing that happens at a summer cookout is a few itchy welts. Now, maybe, we’re going to have to start thinking about really taking precautions against mosquitos. That’s going to change our culture.
Horgan: The journalist David Quammen, author of the new book Spillover, says on his website: "The next big and murderous human pandemic, the one that kills us in millions, will be caused by a new disease--new to humans, anyway. The bug that's responsible will be strange, unfamiliar, but it won't come from outer space. Odds are that the killer pathogen--most likely a virus--will spill over into humans from a nonhuman animal." Care to comment on Quammen's remarks?
MacPhail: Zoonotic diseases – and MERS is one of them – are going to continue to be a serious threat to our collective health. And viruses are definitely a top contender to cause a huge pandemic. But, really, I think that we shouldn’t discount the “old standbys” like TB – or multidrug resistant TB. Or Methicillin-resistant Staphylococcus aureus (MRSA) – a staph infection that is becoming more and more of a problem, especially in hospital settings. And quite frankly, I’m more worried about the drug-resistant microbes that we’ve been coexisting with for years. We might find ourselves dying of pneumonia again if we’re not careful.