When A Disease Scare Fizzles Out, Did Scientists Just Get It Wrong? What We Can Learn From The Pandemics That Weren't

The situation was made worse in August, when the Democratic Republic of the Congo (DRC) reported its own outbreak of the deadly hemorrhagic virus in its northern Équateur province. 

Although this turned out to be unrelated to the outbreak ravaging West Africa, international media interpreted it as part of the same narrative: the Ebola virus was spreading. The question was, how long would it be before it escaped Africa to become a pandemic?

The answer, as we know, was that it never did. Although there were isolated cases outside the region, they were quickly contained before they could spread any further. 

But the story of the 2014-2016 Ebola crisis highlights a tension that sits at the heart of every major disease outbreak: uncertainty. When reports of a new disease appear, they will often conjure a wide range of responses from disparate voices that make understanding what is going on and what might happen very challenging.

Pandemics or panic

Let’s return to the Ebola case again. Anyone reading this will likely remember the anxiety produced by that viral outbreak. And to be fair, it is somewhat understandable. 

Ebola is a severe and often fatal infection that can lead to internal bleeding. In some rare cases, people can visibly bleed from their eyes, gums or noses, a grim point that was emphasized by some media sites during the 2014-2016 outbreak.

Of course, given the gruesome nature of these symptoms, coupled with the perception that the disease was spreading from a "foreign land", it was only a matter of time before panic set in elsewhere.

In early October 2014, nurses in Madrid, Spain, began to protest when one of their colleagues became the “first Ebola case” in Western Europe, claiming that the government had done little to prepare them for the disease’s arrival outside of Africa. 

A few weeks later, schools in Ohio and Texas closed as a result of fears that traveling students had brought the disease across the Atlantic to the US. Then, at the end of the month, two Senegalese-American children were severely injured by classmates after they returned from Senegal – their assailants apparently attacked them while yelling “Ebola”.

Was this panic reasonable? Not according to the World Health Organization’s (WHO’s) then Director-General, Dr Margaret Chan, worried that information technology had allowed “fear” of Ebola “to spread faster than the virus”.

“This fear could not be contained by the well-documented facts that Ebola is not airborne and spreads only under conditions involving very close contact with infected bodily fluids. In reality, the risk of onward transmission following an imported case is very low in countries with high standards of living and well-developed health systems,” she explained to the Princeton-Fung Global Forum in November 2015.

And this was the ultimate fate of this disease. Despite the widescale concern, Ebola never gained a sustained foothold outside of West Africa. Although it killed over 11,000 people and infected more than 28,600 others, a terrible outcome, the virus was not capable of spreading fast enough to become a global pandemic.

This was partially due to its transmission mechanics and because its symptoms often immobilized its hosts before they could travel too far.

At the same time, effective national and international responses were able to limit its spread once the outbreak was finally identified. Strict quarantines were established wherever cases emerged, public health effectively traced those who were exposed to the disease, and vaccines – known as rVSV-ZEBOV – eventually offered localized immunity.

Compared to COVID-19, which quickly spread across the planet and lead to a global pandemic, the story of the Ebola crisis could be interpreted in multiple ways. It was unquestionably a devastating and tragic epidemic, with significant human impacts. In addition to the thousands of lives lost, the disease overwhelmed health systems, disrupted society, and caused enduring economic and social damages.

But framed as a global threat, the story of the virus becomes more ambiguous. It sits precariously within a broader and less clearly defined category of outbreaks that never became pandemics. Modern history has seen a few examples of such events, and unlike Ebola, some of them were ostensibly more capable of becoming a pandemic.

Take for instance the emergence of the Severe Acute Respiratory Syndrome (SARS) virus, an extremely virulent virus that was capable of spreading from person-to-person through the air. 

In 2002 and 2003, SARS became a significant international concern as it quickly spread between countries, starting off in Guangdong, China, and then moving to Hong Kong, Taiwan, Canada, and then elsewhere.

But while it had a high mortality rate – killing around 10 percent of those who caught it – infected people often experienced symptoms before they were at their most infectious. This meant the disease could be more easily contained through strict quarantine measures, border screening, and patient isolation. 

By the end of 2004, the virus had been effectively eradicated by these responses.

Then there was H1N1, or swine flu, as it was more commonly known. If Ebola lacked the mode of transmission to become a pandemic and SARS was transmissible but controllable, then swine flu ostensibly ticked all the boxes for a true pandemic-causing disease. 

It not only spread across the planet, but also infected a much larger number of people than SARS did. And to say concern was high would be an understatement.

The virus first emerged in Mexico in March 2009. A month later, the US declared a public health emergency as it prepared to deal with this little-known virus. 

But while this may have been sensible at the time, a more sensational response soon followed. 

In April, the Metro, a UK newspaper, warned that up to 120 million people across the world could be killed by the disease. A few months later, the UK’s then chief medical officer Professor Sir Liam Donaldson stated that, in the worst-case scenario, 30 percent of the British population could be infected by swine flu, resulting in 65,000 deaths. 

At best, he said, 5 percent of the population could contract the virus, leading to 3,100 deaths.

In the end, none of this happened. Fewer than 500 people died in the UK, despite thousands contracting the disease between 2009 and 2010 – though it should be noted that the infection was not harmless. Although estimates vary, the WHO believe that swine flu killed around 284,400 people across the world. 

And yet, the difference between the perceived threat and the actual lethality was considerable. In fact, preparations for the deadly virus that turned out to be relatively mild resulted in the UK government holding millions of doses of a vaccine in surplus.

“The disaster is the created social situation”

All these cases reveal the tricky nature of emerging diseases. Some viruses are lethal but can’t spread far enough to become a pandemic; some can spread, are lethal, but can be controlled; and some can spread but turn out to be less of a threat than initially believed. 

And then there are those that really do live up to the initial worries, such as COVID-19 (which could have been far worse if it wasn’t for effective vaccine responses).

What are we to make of these events now that we have the clarity of hindsight?

 Should they be merely seen as overreactions or false alarms – that is, examples of where scientists got it wrong – or do even these pandemics that never happened hold useful insights for us?

Scientists who do not follow their own recommendations during a pandemic deserve to be criticized, as do politicians.

Prof Ilan Kelman

Far from being simple indicators that scientists made mistakes, these cases reveal just how deeply embedded science and scientists are within society. 

This is something that can often be overlooked when we think of science as a careful methodical process that takes place within controlled laboratory settings. 

But nothing reveals just how human the activity is like a disaster, be it an earthquake, a hurricane, or even a new disease.

“A virus or other pathogen becomes a disaster due to human choices – choices by those who have power, opportunities, and resources – to avoid dealing with the virus or other pathogen,” Ilan Kelman, Professor of Disasters and Health at UCL in London, UK, explained to IFLScience.

“The disaster is the created social situation in which a virus is permitted to run amok, rather than dealing with it before it is too late.”

You may notice that Kelman doesn’t mention “natural” disasters in this context. That’s because, in his view, there is no such thing.

“[D]isasters do not come from nature and so the phrase ‘natural disaster’ is a misnomer and should not be used. They are simply ‘disasters’ caused by human choices, no matter what nature does”, he added.

Viewed through this prism, the past epidemics that never became pandemics take on a different appearance. They’re not just puzzles for medicine to manage, but rather examples of humans dealing with events that test the ways we’ve structured our societies. And ultimately, they’re lessons in how we handle uncertainty. 

But what does this uncertainty mean for science, especially when a disease turns out to be less worrying that it was forecast to be?

“Any situation has unknowns and uncertainties,” Kelman explained to IFLScience. “Science is about the search for explanations which for disease outbreaks should lead to evidence-based recommendations for action, while acknowledging unknowns and uncertainties.”

“Analysis after the fact can sometimes indicate ‘right’ or ‘wrong’, what was done well, what should have been done better at the time, and what should be done better in the future given what has been learned. When immediate decisions are needed as a disease spreads – in the context of limited time, political pressures, ideological influences, and previous long-term underfunding of pandemic science, medicine, and preparedness – blaming specific scientists for possible mistakes would be counterproductive.”

This, of course, addresses scientists that attempt to work within the constraints they are recommending for others. As Kelman notes, “scientists who do not follow their own recommendations during a pandemic deserve to be criticized, as do politicians.”

Science communication in uncertain times

When pandemics occur, public trust can take a hit. For instance, recent research into epidemics that occurred during the 20th century suggests that new disease can impact the public’s view of science and scientists. 

But this is not a simple relationship. The results do not show a decline in trust in science as an endeavor, but rather of scientists as practitioners. In particular, those with little training in science as a subject tend to be the people with the strongest distrust.

Published during 2021, the study noted, “If past epidemics are a guide [COVID] will not have an impact on the regard in which science as an undertaking is held.” 

“Members of the public will continue to believe that science has the potential to improve society. However, it will reduce trust in individual scientists, worsen perceptions of their honesty, and weaken the belief that their activities benefit the public.”

“This distinction is consistent with the literatures in psychology and cognitive science on how individuals assign blame in complex, high-stakes social settings and with their tendency to blame individuals rather than institutions.”

During this latest pandemic, the phenomenon was most obvious in the American context where politicians and the media criticized the work and public policy recommendations of scientists, such as Dr Anthony Fauci.

The researchers argued that individual scientists fell under suspicion because they were seen as members of the elite. 

As they explained, “Our finding that past epidemic exposure negatively affects views of scientists working for private companies but not as much of scientists working for universities suggests that suspicion of corporate agendas is especially salient in this connection.”

The authors explain how other studies show that many survey respondents regard disagreements among scientists – which is likely to occur during a fast-paced crisis – as a sign that their conclusions are based on personal belief, rather than an outcome of the scientific method. Alternatively, they see it as a sign that the scientist in question is incompetent.

This may highlight a wider cultural issue that exists in our society, though this is not something discussed in the paper. 

Science holds a powerful position within our culture. Scientists and the practice of science itself is embedded within every single aspect of our lives. However, scientific literacy – a person’s fundamental understanding of concepts, process, and methods involved in science – is not always equal to its societal value. 

This sometimes means that there is a gap between what some people expect scientists to know and be capable of doing, and what they actually know and can do.

This phenomenon is present in conspiracy theories related to medical topics, whereby scientists are accused of working for shadowy organizations to keep beneficial technologies or knowledge away from the public. 

Examples here would be the persistent argument that “Big Pharma” – influential pharmaceutical corporations – collude with individual doctors and sometimes government agencies to hide cures for diseases like HIV/AIDs or diabetes.

This is done, they say, because it is more profitable to have people dependent on medications that manage their condition across their lifetimes, than to issue them a single one-use cure.

Research on public perceptions of scientists backs this up. Scientists are often characterized as competent but potentially dangerous actors capable of immoral deeds. Coupled with the view that scientists are part of the elite may also make them easy targets for conspiracy theories.

Of course, this is a fringe view, but it may nevertheless be a grossly distorted version of a wider problem in society related to science communication and public expectations. The accuracy of the public’s beliefs in the power of science to achieve its ends impacts their ability to make decisions about meaningful policies.

Ensure that communication is an exchange among everyone in order to always learn and adjust.

Prof Ilan Kelman

There is also the possibility that science communication itself muddies the water. Research has suggested that the act of making scientific knowledge accessible to everyday people may lead some to believe they know and understand more than they do. 

This is because many science communication efforts simplify complexity and fail to sufficiently explain uncertainty. This can lead some people to put more faith in their own understanding and expectations, while discounting the role of experts.

More recent research has shown that this bias is not only persistent, but also stubborn. As social media has shifted towards shortform video formats (TikTok, Instagram Reels) that can explain complex ideas in simple terms, the “easiness effect” as it is called, becomes more prominent as our brains mistake the presentation of simplicity as our own mastery of the topic.

The extent to which this bias influences the public’s perception of epidemics or pandemics remains unclear. It is likely it plays a part, but ultimately it brings us back to the same point: communication during times of crisis is important for mitigating confusion and concern. However, this communication needs to be appropriate for the situation.

As Kelman explained, communication “is contextual and […] should be tailored to the audiences.”

“To avoid panic or complacency when communicating, learn from the audience what they seek, recognize that a variety of messages would be needed simultaneously for a variety of audiences, and ensure that communication is an exchange among everyone in order to always learn and adjust.”

Given that we are now six years past the start of the last pandemic, the extent to which these lessons have been learnt remains to be seen.