The Obama administration is battling for control of the media narrative about Ebola as conditions worsen in West Africa and fears of an outbreak mount in the United States.
Health officials insist the virus will be contained and stress the potential for infection is remote. While Ebola is frightening, says Centers for Disease Control and Prevention (CDC) Director Tom Frieden, health officials "know how to stop it."
"Ebola is scary. And we understand that people are very concerned. And we're very concerned," Frieden said Sunday.
It can be difficult to gauge the administration's sense of the Ebola threat, as the language from leaders has shifted at times depending on their audience.
Frieden this week warned world leaders that Ebola could be "the world's next AIDS" as he sought to drum up more international funding for the response effort.
"I've been working in public health for 30 years," Frieden told a World Bank and International Monetary Fund meeting in Washington, D.C.
"The only thing like this has been AIDS. And we have to work now so that this is not the world's next AIDS," Frieden said.
The remarks — his most urgent to date — came just days after the CDC director touted "encouraging" signs of progress against Ebola during a more upbeat appearance on CBS.
The conflicting tones could hurt the CDC's credibility as the crisis unfolds, crisis communications experts said.
Peter M. Sandman, a Brooklyn-based consultant, said the agency should underscore the idea that Americans are resilient, that there is a "huge amount" that is unknown about Ebola, and that outbreaks in other parts of the developing world are the disease's "biggest threat."
"Officials who over-stress that 'we know how to deal with this' set the public up to become shocked and mistrustful when errors occur," Sandman wrote in an email.
"Acknowledging uncertainty and predicting errors, on the other hand, prepares the public to roll with the punches."
Steven Fink, president and CEO of Lexicon Communications Corp., said health officials should err on the side of disclosure and guidance for people fearful about the virus.
"The more information, the better," Fink said.
"I have the highest regard for the CDC … but I think they're lacking a strategic message and I think that's obvious."
Frieden defended his approach in a statement to The Hill.
"I have used language of certainty only for aspects of the messaging when I felt it was warranted," the director said.
"I've warned the public when I think we don't have all the information or when an outcome is possible. For example, I have said we can't rule out the virus mutating, or the potential of other types of spread.
"But we have been studying this virus for 40 years and if all that research has been consistent — for example, that people can't spread the virus unless they're ill — we have to recognize the value of the science and people deserve to hear the truth, plain and simple."
Ebola became top national news at the end of September when a Liberian man, Thomas Eric Duncan, arrived in the United States with the virus.
The case raised new questions about the U.S. health system's readiness for an outbreak and turned public attention to the crisis in Africa, where more than 4,000 people have died of Ebola since late last year.
Frieden, a former New York City health official, is a leading voice urging further action from within the administration.
He has also become the government's lead spokesman on the virus, appearing almost daily on television to calm public fears.
The evolution in his public statements reflects how the administration has come to grips with the reality of the out-of-control epidemic.
In early August, for example, Frieden suggested to reporters that a minor U.S. mission of disease detectives could deal a blow to Ebola in West Africa. Roughly 900 people had died at that point.
"We have stopped every outbreak of Ebola to date," Frieden said then. "I am confident we are going to stop this outbreak also."
But after a trip to West Africa later that month, his statements underwent a dramatic change.
By Sept. 2, Frieden told CBS that Ebola was "spiraling out of control," a phrase echoed by President Obama in a speech two weeks later. The remarks helped push the administration toward a more robust response.
Reacting to fears that Ebola will travel again to the United States undetected, Frieden has started to repeat that the risk to the U.S. public cannot be "zero" until the epidemic is contained. This idea is a core component of his message, he said in a statement.
Since Obama's speech, cable news has blanketed the outbreak with round-the-clock coverage, producing segments both informative and heavily criticized for accuracy and tone.
Much of the debate now centers on whether the United States should ban flights from the three main countries affected by Ebola.
Polls show a majority of the public supports the idea, and a rising number of lawmakers in both parties agree. This has pushed the issue to the top of the headlines.
But Frieden and his colleagues have spent nearly a week throwing cold water on the idea, arguing it would only hamper the response effort, among other reasons.
"We don't want to isolate parts of the world, or people who aren't sick, because that's going to drive patients with Ebola underground, making it infinitely more difficult to address the outbreak," Frieden wrote Thursday at FoxNews.com.
In a nod to public pressure, the White House announced new steps to screen passengers arriving from West Africa at five major U.S. airports earlier this week.
While the temperature checks cannot catch every Ebola case, the White House argued they will "add some confidence in our ability" to prevent an outbreak.
The administration often appears caught between efforts to relay information and tamp down public fears. But experts argued that a "remain calm" message sometimes do more harm than good.
It is both natural and useful for people to over-react when they learn of a new risk, Sandman said.
Those reactions are "an emotional rehearsal for the possibility that things could get worse, and a reason to seek out information and figure out how best to cope," he said.
"If officials don’t trust the public to learn alarming information without panicking, the public will not trust officials to lead them through difficult times."
Fink stressed that there are "a lot of unanswered questions" about the epidemic.
"But that's OK as long as you can tell people how to avoid exposure," he said.
"There needs to be a better education process by the CDC to let Americans know when they should feel comfortable and safe and when they should be concerned."
The American Psychological Association echoed these views this week, urging officials to take the public's concerns seriously and not to hold back details.
"Information flow to the public about very bad news should not be controlled in the name of trying to avoid an outbreak of mass panic," a panel of experts wrote in a blog post Oct. 8.
"The public should be armed with information."
Barbara Reynolds, director of CDC's division of public affairs, agreed with these principles and said Frieden and the agency are succeeding at their task.
"[Frieden] has daily contact with the media in open forums and speaks in plain language," Reynolds wrote in an email.
"I don’t see a mixed message in acknowledging that progress is being made," she continued. "A committed leader is going to acknowledge what is going right, correct what isn’t and warn about the hard job ahead."
Reynolds wrote, "As a risk communication expert myself ... I’ve been teaching for more than 15 years that 'the right person, at the right time, with the right message can saves lives.' I’ve seen it go wrong in the past. Today, I’m seeing it go right."