Medical mistrust in the context of Ebola: Implications for intended care-seeking and quarantine policy support in the United States

By Katie Tarantowicz

“America in the end is not defined by fear. We don’t just react on our fears. We react based on facts and judgment and making smart decisions” President Obama, 2014

The Ebola outbreak of 2014 came with a great deal of stigma. For example, several asymptomatic physicians who were treating Ebola in West Africa underwent unnecessary quarantine procedures when they returned to the United States. At the time, the Centers for Disease Control and Prevention only stated that these people should be monitored for a certain period of time with no quarantine at all.

Public reactions to infectious diseases may have to do with medical mistrust, which involves a suspicion of and lack of confidence in medical organizations and providers. This can be a significant problem when patients feel they cannot rely on physicians or hospitals and so don’t seek treatment from them.

Medical mistrust can manifest in the form of conspiracy beliefs, which are beliefs that medical organizations and providers are plotting to harm people. Valerie Earnshaw, Laura Bogart, Michael Klompas, and Ingrid Katz were interested in learning about the effects that conspiracy beliefs can have on health behaviors in the context of an infectious disease outbreak like Ebola.

How did they get their data?

The data were collected using an online survey. The participants were 202 people from the United States over the age of 18. They measured agreement with conspiracy beliefs with four items including “There is a cure for Ebola, but it is being withheld”.

In order to measure each participant’s intended care seeking, the survey also asked what they would do if they had Ebola when given four options (such as “go to the hospital”). They were then asked to rate these options from what they were most to least likely to do.

Additionally, they were asked about their opinions on quarantine policies, medical mistrust in general, and xenophobia (prejudice towards foreigners). Questions on their levels of knowledge and fear of Ebola were also included.

How was it analyzed?

The sample was divided into participants who rejected conspiracy beliefs and those who neither rejected nor agreed with them, from the people who agreed with conspiracy beliefs. They looked at how their responses to conspiracy belief questions were associated with participants’ intended care seeking and their thoughts on quarantine.

What did they find?

16% of participants agreed with the Ebola conspiracy beliefs. On average, participants said that they were likely to engage in care-seeking and supported quarantines.

Participants who agreed with conspiracy beliefs reported:

Lower levels of: Higher levels of:
·       Ebola knowledge

·       Intended care-seeking

·       Support for quarantining people who have had contact with Ebola patients

·       Medical mistrust

·       Xenophobia

So what does this mean?

These results are similar to national rates of agreement with other kinds of conspiracy beliefs, such as the belief that there was a deliberate infection of Black Americans with HIV (12% of U.S. adults agree with this) and the belief that vaccines can affect autism (20% agree).

Because participants who believed conspiracy theories would be less likely to seek care, this form of mistrust of medical professionals could negatively impact a person’s health during a disease outbreak.

People who were believed in conspiracies were not likely to support quarantine. This could be because most conspiracy theories are based off of powerful figures imposing strict regulations on people, which is exactly what was happening in the context of strict quarantine procedures during the Ebola outbreak. People who believe conspiracies may distrust quarantines.


President Obama very wisely pointed out in a speech on the Ebola outbreak that Americans should not define their beliefs based off of fear, but instead based off of facts and judgement. These findings suggest that some US citizens actually may have reacted to this outbreak based on fear, mistrust, and conspiracy beliefs rather than facts and judgment. If we could aspire to learn the facts and make informed judgements rather than letting our fear take over, stigma surrounding infectious diseases such as Ebola could be greatly reduced.

Reference: Earnshaw, V. A., Bogart, L. M., Klompas, M., & Katz, I. T. (in press). Medical mistrust in the context of Ebola: Implications for intended care-seeking and quarantine policy support in the U.S. Journal of Health Psychology.