Ebola: is it real? Risk communication under scrutiny – by Alessandro Burato

Everything probably stared with the death of a two years old child on the 6th of December in Guéckédou, Guinea. The cause of the death was an infection with the Ebola virus [1]. Since then, the spread of the pandemic has become “viral” with more than 2.400 suspected or confirmed cases and 1.350 deaths reported by the WHO on the 20th August 2014 [2].

Although the crisis started nine months ago, international media agenda setting has influenced the coverage of the issue, starting to give it more space only from July. So, that is when the “big public” knew about the pandemic. Nothing strange: filtering the news is how the information delivering apparatus works [3] and an infectious outbreak is not a new phenomenon at all. In fact, in the recent past the world had to face several pandemics, from the BSE to the avian and swine flue. However, Ebola has something “special” not only because the last outbreak is dated more than 35 years ago (Zaire, 1976), when it was actually discovered, but also because in the collective consciousness it is thought to be somehow “unreal” and only present in American action movies as a bacteriological weapon.

It is known how information and risk communication have a central role in the crisis management cycle: as reported by the WHO “When the public is at risk of a real or potential health threat, treatment options may be limited, direct interventions may take time to organize and resources may be few. Communicating advice and guidance, therefore, often stands as the most important public health tool in managing a risk” [4]. An effective risk communication thus will suggest protective behaviours, arise awareness about the disease and reduce possible misunderstanding limiting the spread of the pandemic and saving lives.

However, it is necessary, both in order to analyse or plan a risk communication campaign, to refer to what really stands at the base of an effective effort, which is not intended as “public relation” but as a scientific method and practices adopted to mitigate the risk in question: that is risk perception [5]. In this regard, it is interesting to take into account two distinct situations: some good example of on-site risk communication efforts and the international approaches to the issue with a special focus on the Italian one.

Although Guinea, Liberia and Sierra Leone are currently the most affected states, the whole West Africa region is facing its first major Ebola outbreak. That is the main reason for a misperception of the gravity of the phenomenon as people from the communities of those regions do not have similar examples available for a comparison with the on-going pandemics making a personal risk assessment more difficult [6]. As a matter of fact, one of the higher concerns of those who have being trying since the beginning to mitigate the risk was that people do not think that Ebola is real, that it kills between 60 to 90% of affected people. Moreover a deep ignorance on the causes of the disease and of useful preventive measures constitute the best driver for the pandemic to spread: under the hashtag #EradicateEbola, one of the several ones opened to inform about the virus such as well as #Ebola and #EbolaFacts, there is an interesting tweet at this regard: @Jiggar_ “If ebola can be spread directly by bodily fluids, does it mean it can be spread through exchange of currency notes?”[7].

Thus, since the outbreak was declared, conventional and unconventional communication campaigns have been set up. Door-to-door activities as well as posters have been used to disseminate a surveillance and security culture: the Nigeria Centre for Disease Control and Prevention for example provided a set of posters, in different languages (English, Hausa, Igobo, Pidgin and Yoruba) explicating signs and symptoms of the disease and simple preventive measures such as avoiding eating improperly cooked bush meat, wash hands and avoid contact with infected persons or animals and blood, urine and faeces of animals like bats and monkeys [8].

The role of Social media during crises is confirmed. As already proved by other major events, people are always more used to turn to them in order to get first-hand, unfiltered and immediate information about what they are looking for. The diffusion of SM such as Facebook and Twitter in Africa has increased recently and according to an analysis of the geographically pinpointed tweets exchanged during the last three months of 2011 Nigeria is the third country after South Africa and Kenya with 1.646.212 tweets [9]. On the other hand, Facebook in January 2012 could count on more than 5 million users in Nigeria and around 79.000 both in Sierra Leone and in Guinea [10]. Both Twitter and Facebook were used to share and disseminate one of the most interesting tools to mitigate Ebola risk: music.

In Liberia, two local groups in collaboration with UNICEF composed pop songs on how to prevent the spread of the virus. The lyrics not only give advices on correct behaviours as in the posters, but also strongly stress the central idea around which every prevention efforts are built: Ebola is real. In fact, both the refrains use this sentence and in particular, the song produced by Crusaders for Peace says: “Ebola is real, let’s protect ourselves and our family. Ebola can kill, it has no cure but it can be prevented. Let’s fight it together. Let’s protect ourselves, our family and our Nation”. This is certainly an unconventional way of disseminating awareness and useful information but it is in line with the idea of using all the available cultural tools. Music has both a cultural and popular appeal in the affected regions, it is able to “speak” to a larger number of targeted people and its loose links with the promoting Institutions and organizations decrease the dependency between the achievement of the efforts’ goals and the level of trust in those who are managing the emergency.

And trust is the perfect issue to link the on-site situation with the international one. It has been said that public trust in policy-makers and emergency institutions is fragile and easy to destroy [11, 12, 13]. Due to failures in managing critical situations, both in terms of disseminating relevant information and taking the right measures to mitigate risks as well as the perception of the “arrogance of expertise” [14], distrust has become a crucial issue for regulatory and emergency bodies. This phenomenon can be traced in the high number of “nasty emails” that the U.S. Centers for Disease Control and Prevention (CDCP) received after the decision to bring back to the United State Kent Brantly and Nancy Writebol, both infected by the virus, for special treatments. Dr. Tom Frieden, CDCP director, related people reluctance to repatriate sick aid workers to a sort of “fear of the unfamiliar”, which in other words can be that people are not sure that Institutions are able to manage that situation properly.

So the question is: do we have to worry about Ebola? Who can we trust? The World Health Organization says that Ebola is spreading more rapidly than the organization’s capabilities of managing it [15] and Medecins Sans Frontieres, through is president Joanne Liu, says that the emergency has been managed in a “disastrous” way because the WHO woke up too late for an already tardive alert [16]. Meanwhile America decided to test all the heads of state convened for the African countries summit held in Washington [15]; the British Airways, as well as other flight companies, suspended all the flights from and to the affected areas till 31st August [17], in the UK all the universities were alerted with special guidelines for symptoms early detection due to the high number of enrolled Nigerians (about 9.600 in 2012/2013)[18] and the foreign minister Mr. Philip Hammond declared “Ebola is a threat for the UK”[19] although the European Union adopted a more reassuring approach saying that “the risk from Ebola to EU territories is extremely low. This is because relatively few people travelling to the EU are likely to be infected with the virus”[20].

If all over the world the picture on the possibility of the pandemic to spread in other continents is not clear at all, in Italy the situation in not better. The Italian virologist Fabrizio Pregliasco, researcher of the department of public health, microbiology and virology of the Università degli Studi di Milano, when interviewed he said that in Africa the pandemic could be a carnage as the virus is transmitted via direct contacts and that, since people can move easier, the risk of a broader spread of the infection is real although the few cases that might be attested abroad could be managed and contained without scaremonger [21]. On the other side, the Italian Health minister Beatrice Lorenzin, on the 3rd August said that Italians can keep their shirts on [22]. It is useless to remind that the last time someone told Italians to do not worry about a possible worsening of an already alarming situation (e.g. the L’Aquila case), the risk communication campaign was not one of the most successful. That is way reassurance is not a way to inform. In times of crisis people need to be given all the information useful to get the most clear picture of the situation in order to assess its seriousness and to align their cognitive system with the dissonance caused by the emergency itself [3].

Relating to the need of information, two are the most “hot drivers” for people concerns: transmission by immigration and planned preventive measures. Immigration, which is a phenomenon that heavily interests Italy, is always at the top of the agenda of Italian policy-makers and journalists but during summer, mainly due to good weather conditions, the number of landings that interest the coasts of the south of the peninsula exponentially increase making the issue even more pressing on the newspapers. The fragmentary information if not a sort of “information vacuum” on the possibility that the affluence of immigrants could be the vector for the virus has left space for political exploitation and more generally for probably unjustified worries, especially after that a case of leprosy was reported in Treviso [23]: a 37 years old Bengali man, in Italy for about 8 years, was diagnosed with a form of that disease. The case, although neither related to Ebola nor to immigration flows, has immediately raised anxiety in the public. Are preventive measures in place? What are they? Do they work? The Health Minister speech, during which she said that all the necessary measures were taken with a particular attention to harbors and airports, did not add relevant or more specific information about them to the extent that people on social media started asking whether they have to be worried by the fact that aid workers in Lampedusa were wearing face masks [17], although that practice has always been used, well before Ebola.

That reaction is exactly what a proper risk communication should prevent: a lack of information does not mean no information at all and spaces that are not filled with correct information leave the chance to other “speakers” to use those gaps to make their information credible. As a matter of fact fakes and fakers are common to every crises and, since they can unlikely be completely stopped, there are no other ways to decrease their credibility but to increase trust in scientific/official sources. So, there has to be a reason why the fake news that Ebola “landed” in Lampedusa has been shared via Facebook more than 26 thousand times…[24]

And to be honest there are more than one reason. It has already been mentioned the worldwide decrease of trust in Institutions but another reason, recurring in Italy, is that the will to reassure the public so to avoid unjustified panic have taken over the need for transparency [25], at least of information, during emergencies. That is the perfect step towards a deeper distrust. A pandemic should neither imply any relevant State secrets nor it should put the national security so highly at stake to justify even the smallest reduction of the dialogue space with the public. Nevertheless, the way the public itself deals with risk information is quite unknown by Institutions, the information that people really need is quite unknown by its providers so the easiest solution is to limit the breadth of risk communication relegating it to merely political, bureaucratic and sometimes vague statements.

We all hope this will not be the case, but if Ebola will ever, even accidentally, cross the Italian borders it will find there a poor risk communication waiting for it.


[1] ANSA. Ebola, Epidemia iniziò da bimbo. In Italia falsi allarmi. Available online at: http://www.ansa.it/sito/notizie/mondo/africa/2014/08/10/ebola-new-york-times-il-paziente-zero-e-un-bimbo-di-due-anni_c054bf20-3831-46a1-b31f-3c34bdba9f1c.html [Accessed 23/08/2014]

[2] WHO. Ebola virus disease update – west Africa. Available online at:http://www.who.int/csr/don/2014_08_20_ebola/en/ [Accessed 23/08/2014]

[3] Lombardi M. (2008). Comunicare nell’emergenza, Milano: Vita e pensiero.

[4] WHO, World Health Organization Outbreak Communication Planning Guide, 2008. Available online at: http://www.who.int/ihr/elibrary/WHOOutbreakCommsPlanngGuide.pdf [Accessed 04/08/2014]

[5] Slovic, P. (1987) Perceptions of Risk. Science, 236, 280-285.

[6] Tversky, A. and Kahneman, D. (1974). Judgement under uncertainty: Heuristics and biases. Science, 185, 1124-1131

[7] Uvie-Emegbo, A. Launching a Kick Ebola out of Nigeria campaign. Available online at: http://www.punchng.com/i-punch/launching-a-kick-ebola-out-of-nigeria-campaign/ [Accessed 04/08/2014]

[8] Ebola Virus Information Unit. IEC Materials. Available online at: http://www.health.gov.ng/ebolainfo/index.php/iec-materials [Accessed 04/08/2014]

[9] Smith, D. African Twitter map reveals how continent stays connected. The Guardian, 26 January 2012. Available online at: http://www.theguardian.com/world/2012/jan/26/african-twitter-map-continent-connected# [Accessed 04/08/2014]

[10] Summary of Facebook users in Africa. Available online at: http://www.zoomsphere.com/charts/linkedin/countries/africa [Accessed 04/08/2014]

[11] Slovic, P. (1993). Perceived Risk, Trust and Democracy. Risk Analysis, 13(6), 675-682.

[12] Cvetkovich, G. and Löfstedt, R.E. (1999) eds, Social trust and the management of risk. London: Earthscan

[13] Bostrom, A. and Löfstedt, R.E. (2003). Communicating Risk: Wireless and Hardwired. Risk Analysis, 23(2), 241-248.

[14] Leiss, W. (1996). Three phases in the evolution of risk communication practice. Annals of American Academy of Political and Social Science, 545, 85-94

[15] Micalessin, G. “ Paura ebola: test sui leader africani” Il Giornale, 3 August 2014

[16] Pappagallo, M. “Ebola, medico guarito con il siero sperimentale <<Giornata miracolosa>>”. Corriere della Sera, 22 August 2014.

[17] Osmetti, C. “Primo caso di Ebola in Europa ed esplode il panico profughi”. Libero, 7 August 2014

[18] Pappagallo M. “Studenti dall’Africa. Le università inglesi allerta per Ebola”. Corriere della Sera, 19 August 2014

[19] Withnall, A. “Ebola outbreak is a ‘threat’ to UK says Philip Hammond, as Government calls emergency Cobra meeting in response to deadly virus”. The indepentend, 30 July 2014.

[20] European Commission. Statement by Commissioner Borg on the Ebola outbreak in West Africa. Available online at: http://europa.eu/rapid/press-release_STATEMENT-14-251_en.htm [Accessed 09/08/2014]

[21] Cusmai, E. “Via libera al siero anti Ebola. Ma è finite”. Il Giornale, 13 August 2014

[22] Bolloli B. “Troppi profughi: incubo Ebola per la polizia”. Libero, 3 August 2014.

[23] La Stampa. “ Caso di lebbra a Treviso, scatta l’allarme” Available online at: http://www.lastampa.it/2014/08/06/italia/cronache/caso-di-lebbra-a-treviso-scatta-lallarme-XZ1DpXnb3gzdjOJvJ8RbXJ/pagina.html [Accessed 07/08/2014]

[24] Il fatto quotidiano. “Ebola a Lampedusa”, bufala su Facebook. “Chiederemo 10 milioni di danni”. Available online at: http://www.ilfattoquotidiano.it/2014/08/10/ebola-bufala-su-casi-a-lampedusa-chiederemo-10-milioni-di-risarcimento/1087332/ [Accessed 20/08/2014]

[25] Löfstedt, R.E. (2005). Risk Management in Post Trust Societies. (2nd eds). London: Earthscan