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How America can defeat Ebola [Letter]

While much of the response to the Ebola epidemic in West Africa is contingent on the United States government's public health and military actions ("Ebola hits home," Oct. 2), health professionals and government officials have been quite reluctant to come to terms with how America's history of public health espionage and medical mistreatment complicate the battle against Ebola. America has a long history of medical mistreatment and imperialism which are now providing the fuel for Ebola conspiracy beliefs. Past and recent medical mistreatment include: the British military utilizing smallpox as biological warfare against Native Americans during colonial times, the United States Public Health Service's syphilis experiments on people domestically and abroad, the CIA using a Hepatitis B vaccination campaign as a cover for its spy operations to capture Osama bin Laden and USAID-sponsored program engaging in HIV prevention education as a means to spy on Cubans and foment rebellion.

Given this history, we should not be surprised that some West Africans and some Americans deny the origins of Ebola as a naturally occurring zoonotic disease. As Hannah Bloch has written, denying Ebola is a very human response and Americans are not immune to having our own disease conspiracy beliefs, whether it's the putative connection between vaccines and autism or possessing certain HIV conspiracy beliefs.

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Though many have recognized the pressing medical threat that the Ebola virus presents, few have understood that the existence and proliferation of disease conspiracy beliefs are a dire threat to public health. American parents who believe in the autism-vaccine connection do not vaccinate their children, putting other children and people at risk to a wide range of diseases that are no longer common. People who hold HIV conspiracy beliefs are less likely to engage in safe sex practices such as wearing condoms or getting tested for the disease.

Ebola conspiracy beliefs function in a very similar manner. People who hold Ebola conspiracy beliefs in West Africa will be less likely to cooperate with medical authorities and less likely to follow the instructions needed to stop the spread of the deadly virus. Our national and international response efforts are also complicated by the region's history of civil wars and the population's adherence to traditional practices such as herbal medicine and burials. Thus, cultural and historical factors will have to be addressed if Ebola is to be defeated.

Defeating the rapid spread of the Ebola virus means addressing Ebola conspiracy beliefs head on. It will require a level of honesty and truth-telling that we have rarely mustered as a nation. It will also require a disavowal of the notion that people who hold Ebola conspiracy beliefs are "fringe" or "lunatic" people. Past and recent medical mistreatment gives rise to legitimate concerns about Ebola's origins and Western intervention. The basis of any relationship is trust and if people at home and abroad cannot trust the American military nor its public health or medical personnel to serve their health needs without any ulterior motive, then we only increase the likelihood of the CDC's catastrophic projections becoming a reality.

To defeat the Ebola epidemic, the American government and American Ebola responders must begin a campaign of truth-telling and atonement, asking for the forgiveness of the domestic and global community for its past history of medical mistreatment. Ebola responders must be ready to give an accounting of what our government has done wrong and sincerely apologize, if they have any hope of making things right. The framing of the fight against Ebola as a matter of national security might allow for the mobilization of key military resources, but it sends the wrong message. By invoking the justification of national security in the militarization of humanitarian aid, America is sending the message that "we are here in West Africa, not to protect you, but to protect ourselves from you." In doing so, we are continuing the legacy of viewing Africa as a dirty and diseased place while obscuring our history of past and even recent unethical medical mistreatment.

Our fight to defeat Ebola does not depend on military might and should not rest on a national security rationale. Our efforts to stop Ebola should be rooted in our ethical impulse and moral courage to admit that past American medical mistreatment has, for many people in the world, undermined the very foundation of doctor-patient or public health-population relationships—trust.

To repair the damage caused by our actions and renew trust in our efforts, we need a moral reckoning and repentance. Our moral reckoning and repentance which should be front-and-center to all response efforts must be accompanied by a clear scope of America's military mission in its response to the Ebola epidemic. Benchmarks should be set to outline when the military personnel will leave the affected nations. The benchmarks should be publicly announced so that the world community can hold the military accountable. After the virus is contained, American efforts should move toward collaborating with West African governments to accelerate the building of a sustainable national and regional health infrastructure.

The post-Ebola work of building a sustainable national and regional public health infrastructure to preemptively address the social determinants of health and prevent the spread of disease should be led by public health professionals and coordinated by health officials in the State Department. This work should include public health experts and medical professionals from a wide-range of universities, including historically black colleges and universities with public health programs such as Meharry Medical College, the Morehouse School of Medicine, and Morgan State University. HBCUs are important to this work because our institutions often have significant portions of students and faculty from West Africa and our universities specialize in attuning public health to cultural and historical concerns that affect people of African descent in America and abroad.

The post-Ebola work must focus on empowering West African health care systems so that Africans can take care of their own people. Instead of encouraging and fostering capacities and skills in countries themselves, foreign experts continue to manage many essential tasks. Many aid programs still treat symptoms and manage emergencies rather than supporting investments for the long term so that crises either do not occur or can be handled and resolved with limited or no international assistance.

By acknowledging and apologizing for our contribution to the persistence of Ebola conspiracy beliefs and working to restore and build trust domestically and internationally, America can more swiftly defeat the Ebola virus epidemic and avoid catastrophic forecasts. The time and energy expended to confront past medical mistreatment is high, but the benefits of shifting our frame from national security to moral reckoning and repentance, boosting West African health care infrastructure, investing in long term sustainability, and empowering Africans with long term investments post-Ebola are greater.

Lawrence Brown, PhD, Baltimore

The writer is an assistant professor in the Department of Health Policy and Management — Environmental Health Sciences at Morgan State University.

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