What Ebola and hantavirus are revealing about America’s public health system

Eighteen Americans exposed to hantavirus are quarantining in Nebraska. An American medical missionary who tested positive for Ebola as part of an ongoing outbreak of over 600 suspected cases in Central Africa was flown to Germany for treatment.

And some Americans don’t trust what they’re hearing about either virus.

Public health experts, including those who were on the frontlines of Covid-19 during the first Trump administration, say neither hantavirus nor Ebola represents an immediate threat to the average American. But the trust deficit leftover from Covid is showing up in the public response to the two viruses — and laying bare the challenge for public health officials if either escalates, or when the next major pandemic arrives.

That mistrust could be particularly pronounced within President Donald Trump’s base, including some Make America Healthy Again supporters who embraced the so-called medical freedom movement during Covid.

"Almost any time you hear 'infectious disease' these days, you're going to have the automatic eye roll of portions of MAHA because the wounds that public health caused during the coronavirus effort still run pretty deep in some places,” said David Mansdoerfer, a health policy consultant who served at HHS during Trump's first term and has advised medical groups aligned with Health Secretary Robert F. Kennedy Jr.

Far-right activist and MAGA influencer Laura Loomer framed the current Ebola outbreak as “another virus to steal another election” and demanded the firing of any “Fauci holdovers” in the government, referring to longtime public health official and former Chief Medical Adviser Anthony Fauci. Conservative actor James Woods said the media would use both viruses to promote the use of mail-in ballots. And former Rep. Marjorie Taylor Greene said, “I did not cooperate last time and I won’t the next time.”

That Trump and Kennedy, a longtime skeptic of public health institutions, are at the helm of any disease response has not entirely abated fears that the government, the media and pharmaceutical companies are hyping up the viruses as part of a secret plot to profit or to curtail freedoms. And that’s even as states and the federal government have done little more than recommend staying away from affected regions and infected people and have stressed the low risk to the American public.

The speed and intensity of the reaction to both viruses has alarmed some veterans of Trump’s first-term public health response, who worry it presages something far worse.

“What I am concerned about is that if we get a virus like Covid again, our response to both hantavirus and Ebola has shown us we are not only not in a better position but potentially in a worse position to respond in regards to the public willingness, or lack thereof, to believe what they’re being told and to take appropriate public health measures to stop the spread,” said Jerome Adams, who was surgeon general during Trump’s first term. “To me, that is the most worrisome thing.”

So far, the infectious disease outbreaks have yet to make it deeply into MAHA’s orbit, said Alex Clark, who hosts a popular MAHA podcast produced by the conservative outlet Turning Point USA.

“No one in my audience seems to care or is freaking out about either,” Clark said, adding that she hadn’t seen any news coverage on the outbreaks.

On Tuesday, two people who were previously in a voluntary quarantine in Nebraska after disembarking the cruise ship at the center of the hantavirus outbreak were ordered into a mandatory quarantine. But at this point, the vast majority of the public has not been asked to change their behavior, a critical inflection point in public reaction.

If, for example, public health leaders started talking about a new mRNA vaccine, a vaccine platform that Kennedy has criticized but is backed by safety studies, “that would trigger significant distrust,” predicted Robert Malone, an infectious disease expert and vocal critic of the most widely used Covid vaccines who has close ties to MAHA leaders.

The MAHA movement isn’t a monolith, and misinformation about the two outbreaks seems to resonate with a sliver of it, said Craig Spencer, an emergency medicine physician who survived Ebola after treating patients in Africa during the 2014 outbreak.

“I don’t think it’s as big as many people fear,” Spencer said of how widely conspiracy theories around the viruses are being embraced, though he said they are still “damaging.”

In statements, HHS and White House spokespeople cast blame on the Biden administration and said they are prioritizing restoring trust in the public health system.

“While the Biden CDC was being run by teachers unions during COVID, Dr. Jay Bhattacharya – a leading voice of reason during the pandemic – and other Trump administration officials across the CDC and HHS remain focused on Gold Standard Science-based decision-making to ensure the health and safety of Americans," said White House spokesman Kush Desai.

HHS spokesperson Andrew Nixon stressed that the department “has responded aggressively to both the Andes virus outbreak and the Ebola situation, deploying CDC expertise domestically and internationally, coordinating with global partners, and providing timely guidance and technical support to protect the American people and strengthen global health security."

A senior White House official, granted anonymity to speak candidly, voiced confidence in CDC’s handling of both hantavirus and Ebola.

“There's been very limited cases of Ebola, so I think we're okay there,” the official said, noting a separate outbreak that was quickly "snuffed out" last fall.

“With the hantavirus, I mean, everyone's cordoned off in the Nebraska facility. No one has left the best place for these patients to be in there," the official added.

The CDC implemented a travel ban on Monday in response to the Ebola outbreak, suspending entry into the U.S. for 30 days for travelers who have visited areas where there is an ongoing outbreak of the virus and who are not U.S. citizens, U.S. nationals or lawful permanent residents.

In addition to the cruise passengers quarantining, state health officials are monitoring seven other Americans who got off the ship before the hantavirus outbreak was declared.

That kind of response — keeping some in mandatory quarantine while others isolate at home — is what breeds mistrust without clear communication, said one public health expert who worked on Covid, granted anonymity to speak candidly.

“We have 21st-century solutions — and the American people can see that — and then we use an 18th-century quarantine,” the person said, adding that testing people at home “would have looked rational.”

“So what’s going to happen?” the person said, speaking about a future outbreak. “People will get off the ship if they ever sense this happening, without any communication, because they’re like, ‘Well, if I tell people, I’m going to be put in jail for 30 days.’ And then they wonder why people get upset with us.”

The two crises, meanwhile, have landed at a moment when HHS is without much of its top leadership and the White House lacks a biodefense chief. The department has no permanent CDC director, no permanent surgeon general and is searching for a new FDA commissioner after Marty Makary's recent resignation. Rich Danker, the department's top spokesperson, also recently resigned in protest, depriving HHS of the communications infrastructure that could help it more effectively mount a coordinated public response.

“There is no conductor of the train, and no one really knows who’s making decisions, whether decisions are going to get made, what a decision-making structure could look like,” said Chris Meekins, a deputy assistant secretary focused on public health emergency response during the first Trump administration.

Administration allies defend the U.S. response so far as measured and appropriate, brushing off the leadership gaps and pointing to both Kennedy and Jay Bhattacharya, the NIH director and acting CDC director, as two of the department’s strongest messengers — particularly for a skeptical audience. Others frame hantavirus and Ebola, however serious they turn out to be, as a manageable test for a team that hasn’t yet had to deal with a viral threat of this size.

“This is an opportunity for HHS to get out ahead of the messaging and demonstrate that the grown-ups are in charge,” Malone said.

Malone said he has so far appreciated the administration’s response because he views it as proportional to the risk. “I’m not seeing fear porn,” he said, which he accused the Biden administration of propagating during Covid.

That could help the administration message effectively should Ebola become a higher domestic risk, he said. He predicted people will take it seriously if it does: "People will accept — because the nature of the disease is so clear, and so severe — they'll accept interventions that they're not going to accept for a virus that is survivable."

Kennedy, some allies argue, may be uniquely positioned to do exactly that. As a longtime vaccine skeptic who built his political identity around distrust of public health institutions, Kennedy carries credibility with some of the audiences most prone to dismissing official guidance. Roughly 3 in 10 Americans say they identify with MAHA, according to a POLITICO Poll from April — a constituency that has historically tuned out establishment voices but trusts Kennedy.

“In a way, he's almost ideally positioned to put oil on the water to calm things, and make it clear that they're tracking this, they're handling it responsibly, they're not ignoring it, but they're not overreacting to it,” Malone said.

Loomer, in an interview, said she’s happy with Trump at the helm, “but that doesn’t mean that everything is going to get done.” She added that the only way to restore trust in public health — beyond firing people who worked with Fauci — is transparency.

“There just needs to be better communication,” Loomer said. “But people don’t communicate.”

While Trump-aligned health experts dismiss the conspiracy theories, they warn that overreacting to the viruses — or overselling their severity — risks doing equal damage to an already fragile public health information environment. The conspiracy theories, they say, are symptoms of a deeper problem.

Say too little, and the conspiracy theories take root; but say too much, and a skeptical public may tune out entirely, leaving you worse off when it’s time to truly sound the alarm.

"If you try to sell hantavirus and Ebola as the next Covid, polls show Americans are unlikely to take it seriously,” said Michael Caputo, top HHS spokesperson during the first Trump administration. “There are public health concerns, of course, but neither of these viruses appears headed to crisis. The fact is, after Covid, our nation needs to fix our public health reputation, and what we have in front of us is two very interesting ways to exaggerate concerns and ruin it further."

"Ebola is a localized public health emergency of international significance, but it’s no Covid for America,” Caputo added.

But the concerns run deeper than messaging. Some, like Adams, believe that it will take a galvanizing event to repair trust in public health.

“I don’t mean to sound cynical, but I actually believe it is going to take something bad happening before America wakes up and says, ‘OK, we have to change the way we’re doing things.’ I hate it. But I feel like someone is going to have to be hurt,” Adams said. “We’re going to have to have an Ebola case in the United States, and people really get scared. We’re going to have to have human-to-human spread of hanta, or we’re going to have to have another virus that is similar to Covid, before people are actually willing to listen.”

Diana Nerozzi contributed to this report.