When people think of disease, they think of HIV/AIDS, Ebola and now Zika. Disease takes the most sacred moments of our humanity and corrupts them with pain and death. Ebola took away the act of washing the dead, a common practice in many sub-Saharan cultures, leaving many with yet another pit of grief in their lives. Zika takes from us the gift of birth, leaving us with microcephaly and miscarriages.
Perhaps it’s for this reason politicians are unable to fully handle a disease outbreak. After all, to handle a disease outbreak one must forsake these schemas of our basal humanity and replace them with cold, bleak scientific fact. Their job is connecting the technocracy and bureaucracy needed to run a government with the population, not to effectively parse through scientific data to determine how best to fight an outbreak. When a serious outbreak does occur, who do you want handling it, the politicians who seek public approval or the epidemiologists and scientists trained to handle such situations?
Let’s look at overreactions first. Overreactions are very understandable for both the population and politicians. That doesn’t make them right, or even effective actions to take, but it does tend to serve as a “feel good” stopgap until real measures can be taken. However, while this does win voter approval, it often has no basis in scientific fact or reality. Forgoing reality and facts to win in the polls is as shameful as it is damaging to the public perception of the threat of disease.
Take, for example, the Ebola crisis. The media and politicians parroted lines about the dangers of Ebola on the never-ending 24-hour news cycles. As a result, the public perceived Ebola as a hyper-lethal, extremely bloody and massively infectious disease. This is simply an untrue and sensationalist narrative. For example, one of the books frequently mentioned during the crisis was “The Hot Zone.” "The Hot Zone" helped craft the narrative that Ebola is frequently hemorrhagic and liquefies organs. It fostered the idea that Ebola is easily transmitted. These ideas have no basis in fact, nor should we expect them to; the author of "The Hot Zone" was a science fiction writer, after all. Regardless of the fact that hemorrhagic symptoms only appear in 18 percent of subjects, out of those cases the most common symptoms are blood in the stool or bruising, or the fact that transmission is only common with close contact to the dead or the symptomatic infected — which makes cleaning the dead or treating the infected the two highest risk activities — the public bought the lie that Ebola was an existential threat to the US.
This, of course, was not helped by the meddling of Chris Christie, Andrew Cuomo and Bobby Jindal, among others. In massive overreactions, they negatively impacted both public health and the public perception of Ebola. Whether it was for votes, approval ratings or to improve their perceptions as “decisive” governors of their respective states (an already laughable idea), we may never know. All three governors enacted mandatory 21 day quarantines for anyone returning from West Africa (limited to only healthcare workers in the case of New Jersey and New York). This, of course, is a massive overreaction if one actually understands Ebola. Ebola is easily transmitted if proper personal protective equipment (PPE) precautions are not followed, but this is simply not the case for the vast majority of Western public health workers volunteering to help with the Ebola crisis.
As a result, Christie, Cumo and Jindal discouraged desperately needed volunteers from going to help with Ebola in West Africa, as they would be held in quarantine after their return. Furthermore, they only increased the public’s anxiety over potential Ebola spread in the US, an already unlikely outcome as Ebola transmission has more to do with hygiene and PPE, things correctly followed in American hospitals, than it does with other risk factors. Public fear serves no other purpose than to lessen the public trust in the measured and logical health decisions made by the CDC and others. It also encourages many to attempt to skirt around the hefty regulations for fear of quarantine, making the job of tracking those at risk for infection all the more challenging. Overreactions do more to harm to public health than they do to help it.
Underreactions can be as dangerous, if not worse, than overreactions. An underreaction to a public health crisis runs the risk of not being able to stop an outbreak should it get out of hand. This means more lives lost, more money spent in the long run and massive social and economic disruption on at least the local level. Underreactions are often a product of political partisanship and an unwillingness to accept advice. While being politically principled may endear you among voters, it has no place in the realm of public health. A public health response to an outbreak is built around facts and pragmatism, because principle and intuition get people killed.
Perhaps the most fitting example of this was Mike Pence’s decision to not open clean needle exchanges while he was governor of Indiana. Public health officials had warned Pence that the large number of intravenous drug users within the state was only increasing and that many of them had no access to clean needles. In Indiana, it is illegal to own syringes without a prescription. Pence, governor at the time, “was morally opposed to needle exchanges on the grounds that they supported drug abuse.”
As one would expect, just having laws against something doesn’t stop people from doing it. This was the case in Indiana. As drug use soared, so did HIV rates. Pence only furthered issues with his delayed response, waiting as long as two months before changing his mind. During that period of time, public health officials pleaded with Pence to allow needle exchanges on the basis that data from other states demonstrated that needle exchanges do not increase drug use and actually help to lower HIV rates. Pence stood by his principles. In the end, 190 people ended up infected in a state that only saw 406 new HIV infections in 2013.
While trusting feelings over facts may work in politics, it has no place in public health. It leads to massive underreactions to deadly serious problems. We should remember this as we deal with Zika outbreaks in Florida. Public health officials have warned Congress time and time again that a lackluster response to Zika could leave many states without the proper prepared resources to deal with local transmission. Congress failed to pass a bill that would have released $1.1 billion in funds to fight Zika in the US. Democrats blocked it because the Republicans inserted poison pills on pesticide use and funding contraceptive access through Planned Parenthood and other similar entities. Both sides argue the other is to blame.
In a sense, they are both right. By deciding that they, the politicians, are experienced and qualified enough to handle a disease outbreak, they are throwing the advice of the experts to the side in favor of political brownie points. Now that Zika is being spread on the local level in several areas of Miami, we are officially unprepared for the for the consequences of our actions. We will pay for our mistake in miscarriages and microcephaly cases, all because public health wasn’t able to do its job. For the sake of Florida, for the sake of people’s lives, let public health do its job. Public health doesn’t overreact like politicians do. Public health doesn’t underreact like politicians do. They don’t use the tragedy of disease as a pawn in some disgusting political game. Public health saves lives, political meddling only ends them.