Ebola, hantavirus, diphtheria: how distrust in health care is fuelling multiple outbreaks across the globe

The first half of 2026 has been marked by three different disease outbreaks: Ebola, hantavirus and, in Australia, diphtheria. Each has exposed vulnerabilities in how we detect, communicate and respond to infectious disease outbreaks.

Each of these outbreaks has its unique challenges. But a common thread has been distrust in health care or a lack of information where misinformation has filled the vacuum.

We’ve seen this play out in different ways across the globe, with devastating results.

So how do we address this distrust so we can better respond to future outbreaks?

Ebola

Distrust, rumours and misinformation have repeatedly emerged as major barriers to controlling Ebola. This includes in the current outbreak in the Democratic Republic of the Congo (DRC).

For example, past surveys of community members have identified misunderstandings about Ebola (including believing it’s not real), about how people are diagnosed, and revealed low levels of trust in health care.

These issues have hampered how cases of Ebola are identified, discouraged people to seek timely health care or to hide cases, and have undermined public health interventions.

For example, in late May, we heard how some DRC residents set fire to a tent set up by the humanitarian group Médecins Sans Frontières for suspected and confirmed Ebola cases. This led to 18 people suspected of having Ebola leaving the facility.

The trigger for this and similar examples was the announcement of a ban on large funeral wakes and gatherings. Authorities, rather than families, would now also start to manage the burials of suspected victims due to the infection risk associated with infected bodies, body fluids, contaminated clothing, and other personal items.

In 2014 the World Health Organization developed a safe and dignified burial protocol for local health authorities, in response to past clusters. This stressed the handling of human remains should be kept to a minimum and that cultural and religious concerns must be considered. It also stressed no burial should begin until the family agreed.

For families to accept the safe burial practice, they must both trust the health-care providers implementing the protocols and the institutions directing the response.

This was clearly not the case where the unrest occurred at the Ebola treatment centre, and at another centre where family members tried to retrieve the body of a man suspected of dying of Ebola.

Hantavirus

Misinformation often thrives and spreads where trust is weak and communication is absent. For instance, when transparent public health messaging is delayed, rumours and speculation can quickly fill information vacuums. We’ve seen an example play out with the recent cruise ship hantavirus outbreak.

Several public health experts based in the United States have argued the US Centers for Disease Control (CDC) was less visible, slower to communicate publicly and less internationally prominent than in previous outbreaks.

At the start of the outbreak top CDC officials didn’t appear on TV shows or give interviews about the risk to the US public. In the past, the agency would often take the lead in coordinating responses to such events.

Instead, others have filled the vacuum, including influencers and others spreading misinformation via social media about the virus’ pandemic potential, unproven treatments, and false links to vaccination.

Diphtheria

The recent diphtheria outbreak in Australia is another example of how information vacuums can undermine an outbreak response.

Warlpiri man Eugene Penhall told Guardian Australia locals were frustrated with the lack of information about diphtheria – including what caused it and how to prevent it. In particular, they wanted information that applied to daily life in a community where housing is overcrowded and living standards are poor.

Here, the challenges are complex, including inequitable access to health care in remote communities, and dealing with a disease many health workers and communities had not encountered for decades.

But unlike an outbreak of hantavirus, diphtheria can be prevented by vaccination. So, if vaccination is to succeed,
health authorities need to better target communication about the vaccine and explore ways to enhance local delivery to build and maintain trust.

What can we do to restore trust?

Transparency in a complex outbreak response should acknowledge what is known. That is, it should provide clear explanations for the reasons behind certain decisions. It should also acknowledge what is unknown. That means recognising policy drawbacks or scientific uncertainties.

When we learn more about a disease, public health messages can change and this should be communicated transparently and honestly. It’s not a back-flip. Science evolves and so should public health advice.

From the lessons learnt during past events, such as the COVID pandemic, frequent press conferences, social media updates and direct engagement with the public helps build trust. Different messengers and tailored formats are required for different target audiences.

Upskilling local health staff, working with community-based or civil society organisations, outreach workers, and local leaders can also support successful communication. These groups are likely to be met with less scepticism than “outsiders” such as international public health agencies.

We also need community-driven action, as we’ve seen with the Social Mobilisation Action Consortium in Sierra Leone. This engaged communities to take ownership over preventing Ebola. It resulted in behaviour change around safe burials, early treatment, and social acceptance of Ebola survivors. There were thousands of community mobilisers and trained religious leaders, partnering with more than 30 radio stations. There have not been any Ebola cases in the country since its 2014 outbreak.

But trust can be difficult to establish during a crisis, when emotional and financial stresses are high.

So we also need to proactively build rapport and shared understanding between health-care workers, stakeholders, community organisations and the community before an outbreak.

That way we can identify and address concerns and allow better design, uptake of, and trust in measures to control the next outbreak.