Ebola – What’s Flu Got to Do With It?

NIVWThis week is National Influenza Vaccination Week. Local health departments across the country use this awareness campaign to remind people in their communities that it’s not too late to vaccinate because as long as flu viruses are circulating, the flu shot can provide protection.

Flu has been in the news since October but not for the reasons one might think. Rather, the media attention on Ebola prompted many public health proponents to make comparisons between the risks associated with Ebola and the risks associated with seasonal flu. At the height of the media attention on Ebola, local health departments encouraging flu shots were featured in news articles with headlines like these:

While it is certainly true that people have a much higher risk from flu than from Ebola, the message may have been lost on the majority of people who were concerned about Ebola. This letter to the editor sums up why a message to get a flu shot may not have made sense to those who wanted to know how to protect themselves from Ebola. The author explains that the message was confusing because, as was the case in many media reports, there was no logical explanation offered to explain how getting a flu shot would offer protection from Ebola.

The fear of Ebola may have seemed irrational to those who understand statistics regarding risks from infectious diseases. However, a look at the psychology of fear makes it clear why Ebola was so frightening to many people. The virus is deadly, novel, and people feel as if they can’t control it or protect themselves from it – all factors that increase the perception of risk [1]. Seasonal flu, on the other hand, is familiar, often poses low risk to healthy adults, and people can chose whether or not to protect themselves through a vaccine.

To further understand how fear may have influenced people’s reactions to Ebola, it may be helpful to look to social science theory. Theory suggests that people often take one of two paths to decision making – a cognitive path where decisions are carefully thought out or a non-cognitive path where decisions are guided by emotions, instincts, or other heuristics (i.e. shortcuts). The Extended Parallel Process Model is one such theory and provides a framework to describe two paths that people take when faced with risk. According to the model, people faced with a risk who believe they have the ability to mitigate their danger from the risk through a recommended behavior are more likely to take steps to mitigate their danger by adopting the recommended behavior. However, people who feel that they do not have the ability to mitigate their danger from a risk will take action to mitigate their fear as opposed to their danger, resulting in avoidance of anything that causes fear by reminding them of the risk. The model suggests that it is critical for messages that describe risk to be paired with self-efficacy messages to increase the likelihood of adaptive behavior to mitigate danger [2]. The takeaway for Ebola messaging is that in order for people to have an adaptive response to their risk from Ebola, they may need to hear a message that both accurately conveys their risk and provides them with an actionable solution for protecting themselves from Ebola. Otherwise, people may avoid any message that reminds them of their risk from Ebola, including those that suggest a flu shot, because they feel as if they can’t do anything to protect themselves from Ebola.

During a public health emergency, simple messages with clear actions are best received. This is because when people are under stress, they may have trouble processing complex information [3]. This is important to note because, while there is a logical reason that people should get a flu shot that is related to Ebola, the message is not simple. The symptoms of flu and Ebola are very similar at the onset. If more people get flu shots, there will be fewer people with flu symptoms. Fewer people with flu symptoms means fewer people who meet some of the criteria for a suspected Ebola case. Fewer people who meet the criteria means less time and resources spent on suspected Ebola cases and more available to treat and prevent Ebola, which protects us all. This reason was not fully articulated in many media reports connecting Ebola and flu, and given its complexity, it’s easy to see why. Now that fear of Ebola seems to have subsided, this message may be a little easier for more people to digest.

With less than 50 percent of the U.S. population getting a seasonal flu shot on an annual basis, local health departments have a critical need for effective methods and adequate resources to encourage vaccination. This need is even more apparent given the recent CDC announcement that this year’s flu shot may be a poor match for the viruses that are currently circulating. This flu season, local health departments would benefit from seeking out examples of evidence-based seasonal flu communication campaigns that are informed through translational research and theory to help encourage vaccination. Local health departments also require adequate funding and resources to support the development and dissemination of effective seasonal influenza messaging that is customized to their communities.


  1. Reynolds B. & Seeger, M. (2014). Crisis Emergency Risk Communications. Retrieved from: http://www.bt.cdc.gov/cerc/resources/pdf/cerc_2014edition.pdf
  2. Witte K. (1992) Putting the fear back into fear appeals: The extended parallel process model. Communication Monographs, 59(4): 329-349.
  3. Reynolds B. & Seeger, M. (2014). Crisis Emergency Risk Communications. Retrieved from: http://www.bt.cdc.gov/cerc/resources/pdf/cerc_2014edition.pdf


About Frances Bevington

Frances Bevington is the Senior Marketing and Communications Specialist for Public Health Preparedness at NACCHO. Her work includes emergency and risk communications planning, strategic messaging, and multichannel marketing for the adoption of best practices in public health preparedness. Twitter: @Wilkington

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