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The United States confronts Ebola: suasion, executive action and fragmentation

Published online by Cambridge University Press:  27 June 2016

Scott L. Greer*
Affiliation:
Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, USA European Observatory on Health Systems and Policies, Brussels, Belgium
Phillip M. Singer
Affiliation:
Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, USA
*
*Correspondence to: Scott L. Greer, Department of Health Management and Policy, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109-2029, USA. Email: slgreer@umich.edu

Abstract

The United States’ experience with the Ebola virus in 2014 provides a window into US public health politics. First, the United States provided a case study in the role of suasion and executive action in the management of public health in a fragmented multi-level system. The variable capacity of different parts of the United States to respond to Ebola on the level of hospitals or state governments, and their different approaches, show the limitations of federal influence, the importance of knowledge and executive energy, and the diversity of both powerful actors and sources of power. Second, the politics of Ebola in the United States is a case study in the politics of partisan blame attribution. The outbreak struck in the run-up to an election that was likely to be good for the Republican party, and the election dominated interest in and opinions of Ebola in both the media and public opinion. Democratic voters and media downplayed Ebola while Republican voters and media focused on the outbreak. The media was a key conduit for this strategic politicization, as shown in the quantity, timing and framing of news about Ebola. Neither fragmentation nor partisanship appears to be going away, so understanding the politics of public health crises will remain important.

Type
Perspective
Copyright
© Cambridge University Press 2016 

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References

Alman, A. (2014), ‘Maine Gov. Paul LePage sends state police to enforce Ebola quarantine’, The Huffington Post, 27 October, http://www.huffingtonpost.com/2014/10/29/paul-lepage-ebola-quarantine_n_6069740.html [10 April 2016].Google Scholar
Ambrose, S. (2014), ‘When Ebola hit U.S., CDC guidelines were weaker than those 15 years ago’, Dallas Morning News, 27 December, http://www.dallasnews.com/news/metro/20141227-when-ebola-hit-u.s.-cdc-guidelines-were-weaker-than-earlier-ones.ece [10 April 2016].Google Scholar
Baker, S. and Novack, S. (2014), ‘Is your state quarantining Ebola doctors?’, National Journal, 30 October, http://www.nationaljournal.com/health-care/is-your-state-quarantining-ebola-doctors-20141030 [10 April 2016].Google Scholar
Botoseneanu, A., Wu, H., Wasserman, J. and Jacobson, P. D. (2011), ‘Achieving public health legal preparedness: views on public health law threaten emergency preparedness and response’, Journal of Public Health, 33(3): 361368.Google Scholar
Bradner, E. (2014a), ‘GOP stokes border fears over Ebola, ISIS’, CNN Politics, 9 October, http://www.cnn.com/2014/10/09/politics/gop-stokes-border-fears-over-ebola-isis/ [10 April 2016].Google Scholar
Bradner, E. (2014b), ‘GOP stokes border fears over Ebola, ISIS’, CNN.Google Scholar
Brown, L. D. (2010), ‘The political face of public health’, Public Health Reviews, 32(1): 155173.CrossRefGoogle ScholarPubMed
Centers for Disease Control and Prevention (2015a), ‘Fact Sheet: Screening and Monitoring Travelers to Prevent the Spread of Ebola’, Centers for Disease Control and Prevention, http://www.cdc.gov/vhf/ebola/travelers/ebola-screening-factsheet.html [10 June 2015].Google Scholar
Centers for Disease Control and Prevention (2015b), ‘State Ebola Protocols’, Centers for Disease Control and Prevention, http://www.cdc.gov/phlp/publications/topic/ebola.html [4 September 2015].Google Scholar
CNN/ORC (2014), ‘CNN/ORC poll’, CNN, http://i2.cdn.turner.com/cnn/2014/images/10/27/ebola.poll.7pm.pdf [10 June 2015].Google Scholar
Cortese, D., Abbott, P., Chassin, M. and Lyon, G. M. III (2015), The Expert Panel Report to Texas Health Resources Leadership on the 2014 Ebola Events, Texas Health Resources.Google Scholar
Daku, M. and Dionne, K. Y. (2015), ‘“The ISIS of Biological Agents”: media coverage of Ebola and political responses’. International Conference on Public Policy, Milan, 2 July.Google Scholar
DellaVigna, S. and Kaplan, E. (2006), ‘The Fox News Effect: Media Bias and Voting’, National Bureau of Economic Research, http://www.nber.org/papers/w12169 [10 June 2015].Google Scholar
Druckman, J. N., Peterson, E. and Slothuus, R. (2013), ‘How elite partisan polarization affects public opinion formation’, American Political Science Review, 107(1): 5779.Google Scholar
Eilperin, J. (2014), ‘Obama appoints lawyer to handle Ebola response’, The Washington Post [10 April 2016].Google Scholar
Eilperin, J. and Sun, L. H. (2015), ‘Ebola czar Ron Klain to leave after leading U.S. response to outbreak’, The Washington Post, 29 January, http://www.washingtonpost.com/national/health-science/ebola-czar-ron-klain-to-leave-feb-15-after-leading-us-response-to-outbreak/2015/01/29/aa9c503c-a0d7-11e4-b146-577832eafcb4_story.html [10 April 2016].Google Scholar
Emanuel, E. J. (2014), Reinventing American Health Care: How the Affordable Care Act Will Improve Our Terribly Complex, Blatantly Unjust, Outrageously Expensive, Grossly Inefficient, Error Prone System, New York: Public Affairs.Google Scholar
Enserink, M. (2014), ‘Been to an Ebola-affected country? Stay away from tropical medicine meeting, Louisiana says’, Science, 29 October, http://news.sciencemag.org/health/2014/10/been-ebola-affected-country-stay-away-tropical-medicine-meeting-louisiana-says [10 April 2016].Google Scholar
Etheridge, E. W. (1992), Sentinel for Health: A History of the Centers for Disease Control, Berkeley: University of California Press.CrossRefGoogle Scholar
Fauci, A. S. (2014), ‘Ebola – underscoring the global disparities in health care resources’, New England Journal of Medicine, 371(12): 10841086.CrossRefGoogle ScholarPubMed
Fearnley, L. (2010), ‘Epidemic intelligence: Langmuir and the birth of disease surveillance’, Behemoth, 3(3): 3656.CrossRefGoogle Scholar
Feldman, L., Maibach, E. W., Roser-Renouf, C. and Leiserowitz, A. (2012), ‘Climate on cable: the nature and impact of global warming coverage on Fox News, CNN, and MSNBC’, The International Journal of Press/Politics, 17(1): 331.Google Scholar
Ferguson, T. (2015), ‘Big Money, Mass Media and the Polarization of Politics’, in W. Crotty (ed.) Polarized Politics: The Impact of Divisiveness in the US Political System, Boulder, CO: Lynn Rienner, 95129.Google Scholar
Fidler, D. P. and Gostin, L. O. (2008), Biosecurity in the Global Age Biological Weapons, Public Health, and the Rule of Law, Stanford, CA: Stanford University Press.Google Scholar
Fiorina, M. P. and Abrams, S. J. (2008), ‘Political polarization in the American public’, Annual Review of Political Science, 11: 563588.Google Scholar
Fox News (2014a), ‘Fox News poll: voters lack confidence in Obama, Ebola czar’. Fox News, http://www.foxnews.com/politics/interactive/2014/10/28/fox-news-poll-voters-lack-confidence-in-obama-ebola-czar/ [10 June 2015].Google Scholar
Fox News (2014b), ‘Fox News polls: US voters weigh in on ISIS and Ebola’. Fox News, http://www.foxnews.com/politics/interactive/2014/10/15/fox-news-polls-us-voters-weigh-in-on-WoSs-and-ebola/ [10 June 2015].Google Scholar
Fox News Network (2014), ‘Election coverage’, Fox News Network.Google Scholar
Frieden, T. R. (2014), CDC update on Ebola response and PPE. http://www.cdc.gov/media/releases/2014/t1020-ebola-reponse-update.html [14 June 2016].Google Scholar
Frieden, T. R., Damon, I., Bell, B. P., Kenyon, T. and Nichol, S. (2014), ‘Ebola 2014 – new challenges, new global response and responsibility’, New England Journal of Medicine, 371(13): 11771180.Google Scholar
Glueck, K. (2014), ‘Rick Perry’s Ebola test’, Politico, 17 October, http://www.politico.com/story/2014/10/rick-perry-ebola-112004.html [10 April 2016].Google Scholar
Green, D. P., Palmquist, B. and Schickler, E. (2004), Partisan Hearts and Minds: Political Parties and the Social Identities of Voters, New Haven: Yale University Press.Google Scholar
Greer, S. L. (2016), ‘Governance and Intergovernmental Relations in Health’, in S. L. Greer, M. Wismar and J. Figueras (eds), Health Systems Governance, Maidenhead: Open University Press, 187207.Google Scholar
Grossman, M. and Hopkins, D. A. (2016), The Not-So-Great Debate: Party Asymmetry and the News Media in American Politics, Chicago, IL: Midwest Political Science Association.Google Scholar
Hacker, J. S. and Pierson, P. (2005), Off Center: The Republican Revolution and the Erosion of American Democracy, New Haven, CT: Yale University Press.Google Scholar
Hamel, L., Firth, J. and Brodie, M. (2014), ‘Kaiser Health Policy News Index: special focus on Ebola’. The Henry K. Kaiser Family Foundation, http://kff.org/global-health-policy/poll-finding/kaiser-health-policy-news-index-special-focus-on-ebola/ [10 June 2015].Google Scholar
Hess, S. and Pfiffner, J. P. (2012), Organizing the Presidency, Washington, DC: Brookings Institution Press.Google Scholar
Hood, C. (2010), ‘Accountability and transparency: Siamese twins, matching parts, awkward couple?’, West European Politics, 33(5): 9891009.Google Scholar
Iyengar, S., Sood, G. and Lelkes, Y. (2012), ‘Affect, not ideology a social identity perspective on polarization’, Public Opinion Quarterly, 76(3): 405431.Google Scholar
Iyengar, S. and Westwood, S. J. (2015), ‘Fear and loathing across party lines: new evidence on group polarization’, American Journal of Political Science, 59(3): 690707.Google Scholar
Jaschik, S. (2014), ‘Rejecting all Nigerians? Letter from college in Texas said all applicants from countries with Ebola were being turned away’, Inside Higher Education, 15 October, https://www.insidehighered.com/news/2014/10/15/college-texas-told-nigerians-they-were-rejected-coming-country-ebola [10 April 2016].Google Scholar
Katz, R. and Rosenbaum, S. (2010), ‘Challenging custom: rethinking national population surveillance policy in a global public health age’, Journal of Health Politics Policy and Law, 35(6): 10271055.Google Scholar
Kettl, D. F. (2007), System Under Stress: Homeland Security and American Politics, 2nd edn, Washington, DC: CQ Press.Google Scholar
Khimm, S. (2014), ‘Here’s what Ebola czar Ron Klain has been up to’, http://www.msnbc.com/msnbc/ebola-czar-ron-klain [31 October 2014].Google Scholar
Klain, R. (2016), ‘Confronting the pandemic threat’, Democracy: A Journal of Ideas, 40: Spring 2016. http://democracyjournal.org/author/rklain/ [14 June 2016].Google Scholar
Lakoff, A. and Collier, S. J. (2008), Biosecurity Interventions: Global Health and Security in Question, New York: Columbia University Press.Google Scholar
Lee, F. E. (2009), Beyond Ideology: Politics, Principles, and Partisanship in the U.S. Senate, Chicago, IL: University of Chicago Press.Google Scholar
Malhotra, N. and Kuo, A. G. (2008), ‘Attributing blame: the public’s response to Hurricane Katrina’, The Journal of Politics, 70(1): 102135.Google Scholar
Markon, J. (2014), ‘Department of Homeland Security has 120 reasons to want streamlined oversight’, The Washington Post, 25 September, http://www.washingtonpost.com/blogs/federal-eye/wp/2014/09/25/outsized-congressional-oversight-weighing-down-department-of-homeland-security/ [10 April 2016].Google Scholar
Martin, G. J. and Yurukoglu, A. (2014), ‘Bias in Cable News: Real Effects and Polarization’, The National Bureau of Economic Research, http://www.nber.org/papers/w20798 [10 June 2015].Google Scholar
McCarty, N., Poole, K. T. and Rosenthal, H. (2008), Polarized America: The Dance of Ideology and Unequal Riches, Cambridge, MA: MIT Press.Google Scholar
Miller, W. and Shanks, J. M. (1996), The New American Voter, Cambridge, MA: Harvard University Press.Google Scholar
Morhard, R. and Franco, C. (2013), ‘The pandemic and all-hazards preparedness act: its contributions and new potential to increase public health preparedness’, Biosecurity and Bioterrorism, 11(2): 145152.CrossRefGoogle ScholarPubMed
Motel, S. (2014), ‘Ebola Ranks Among Highest in News Interest Since 2010’, Pew Research Center, http://www.pewresearch.org/fact-tank/2014/10/21/ebola-ranks-among-highest-in-news-interest-since-2010/ [10 June 2015].Google Scholar
Nina Pham v. Texas Health Resources Inc. Case DC-15-02252, District Court of Dallas County, Texas, filed 2 March 2015.Google Scholar
Nutt, A. E., Phillip, A. and Achenbach, J. (2014), ‘Dallas hospital learned its Ebola protocols while struggling to save mortally ill patient’, The Washington Post, 15 October, http://www.washingtonpost.com/national/health-science/dallas-hospital-learned-its-ebolo-protocols-while-struggling-to-save-mortally-ill-patient/2014/10/14/32ff2414-53cf-11e4-892e-602188e70e9c_story.html [10 April 2016].Google Scholar
Okma, K. and Marmor, T. (2015), ‘The United States’, in K. Fierlbeck and H. A. Palley (eds), Comparative Health Care Federalism, Farnham: Ashgate, 139148.Google Scholar
Oliver, T. R. (2006), ‘The politics of public health policy’, Annual Review of Public Health, 27: 195233.Google Scholar
Peters, G. (2014), ‘Seats in Congress gained/lost by the President’s party in mid-term elections’, http://www.presidency.ucsb.edu/data/mid-term_elections.php [5 June 2015].Google Scholar
Pew Research Center (2014), ‘Ebola Worries Rise, But Most are “Fairly” Confident in Government, Hospitals to Deal with Disease: Broad Support for U.S. Efforts to Deal with Ebola in West Africa’, Pew Research Center, http://www.people-press.org/files/2014/10/10-21-14-Ebola-Release.pdf [10 June 2015].Google Scholar
Preston, M. (2014), ‘CNN Poll: Americans confident in Ebola response’, CNN, http://www.cnn.com/2014/10/27/politics/ebola-poll/ [10 June 2015].Google Scholar
Prior, M. (2013), ‘Media and political polarization’, Annual Review of Political Science, 16: 101127.Google Scholar
Roberts, D. and Glenza, J. (2014), ‘White House “does not support” Kaci Hickox’s flouting of Ebola quarantine’, The Guardian, 30 October, http://www.theguardian.com/world/2014/oct/30/white-house-kaci-hickox-nurse-ebola-quarantine [10 April 2016].Google Scholar
Root, J. (2014), ‘Perry says feds should screen for Ebola’, The Texas Tribune, 6 October, http://www.texastribune.org/2014/10/06/perry-says-feds-should-screen-ebola/ [10 April 2016].Google Scholar
Savoie, D. J. (2010), Power: Where is It?, Montreal and Kingston: McGill-Queens University Press.Google Scholar
Skocpol, T. and Williamson, V. (2012), The Tea Party and the Remaking of Republican Conservatism, USA: Oxford University Press.Google Scholar
SteelFisher, G. K., Blendon, R. J. and Lasala-Blanco, N. (2015), ‘Ebola in the United States – public reactions and implications’, New England Journal of Medicine, doi:10.1056/NEJMp1506290.Google Scholar
Stehling-Ariza, T., Fisher, E., Vagi, S., Fechter-Leggett, E., Prudent, N., Dott, M., Daley, R. and Avchen, R. N. (2015), ‘Monitoring of persons with risk for exposure to Ebola virus disease – United States, November 3, 2014–March 8, 2015’, MMWR. Morbidity and Mortality Weekly Report, 64(25): 685689.Google Scholar
Sullivan, G. (2014), ‘For the right, Ebola is the latest rallying cry for closing the Mexican border’, The Washington Post. https://www.washingtonpost.com/news/morning-mix/wp/2014/10/10/from-the-right-ebola-is-the-latest-rallying-cry-for-closing-the-mexican-border/ [14 June 2016].Google Scholar
Sylves, R. (2014), Disaster Policy and Politics: Emergency Management and Homeland Security: Emergency Management and Homeland Security, Washington, DC: SAGE Publications.Google Scholar
Talev, M. (2014), ‘Ebola spikes in campaign ads ahead of midterms’, Bloomberg Politics, 28 October, http://www.bloomberg.com/politics/articles/2014-10-28/ebola-spikes-in-campaign-ads-ahead-of-midterms [10 April 2016].Google Scholar
Walters, E. and Root, J. (2014), ‘Control eluded state leaders in Ebola crisis’, The Texas Tribune, New York. http://www.texastribune.org/2014/10/22/texas-issued-few-control-orders-ebola-crisis/ [10 April 2016].Google Scholar
Warren, J. (2014), ‘“Where the Hell Czar You?” White House says Ron Klain working hard: in early, out late, lot of meetings!’, New York Daily News, 28 October, http://www.nydailynews.com/blogs/dc/hell-czar-white-house-ron-klain-working-hard-early-late-lot-meetings-blog-entry-1.1990186 [10 April 2016].Google Scholar
White, J. (2009), ‘The United States: Risks for Americans and Lessons for Abroad’, in T. Marmor, R. Freeman and K. Okma (eds), Comparative Studies and the Politics of Modern Medical Care, New Haven, CT: Yale University Press, 2460.Google Scholar
White, J. (2013), ‘The 2010 US health care reform: approaching and avoiding how other countries finance health care’, Health Economics, Policy and Law, 8(3): 289315.Google Scholar
World Health Organization (WHO) (2000), The World Health Report, 2000. Health Systems: Improving Performance, Geneva: World Health Organization.Google Scholar
Wulfhorst, E. and Morgan, D. (2014), ‘U.S. CDC says returning Ebola medical workers should not be quarantined’, Reuters, 27 October, http://www.reuters.com/article/us-health-ebola-usa-newyork-idUSKBN0IG12920141027 [10 April 2016].Google Scholar
Zaller, J. (1992), The Nature and Origins of Mass Opinion, Cambridge: Cambridge University Press.Google Scholar