First comes the disease. Then the scapegoating.

Whether it’s Ebola, cholera and now COVID-19, Jesse Verschuere has witnessed “a pattern of stigma against others in every disease outbreak” he has responded to as part of the international medical humanitarian organization Doctors Without Borders.

The objects of prejudice have included health-care workers, minorities, immigrants, indeed any outsider or other who looks or acts different from those in the local community, says the Belgium-based Verschuere, who works to improve the ability of communities to obtain health care.

This bias occurs around the world.

And it’s not anything new.

Villainizing an unknown other as guilty of spreading, causing or exploiting disease has a long, hate-filled history, says Debora MacKenzie, author of the new book Covid-19: The Pandemic That Should Never Have Happened and How to Stop the Next One.

Back in 14th-century Europe, Jews were blamed — and thousands of them slaughtered — by Christian mobs who baselessly accused them of spreading the deadly bubonic plague by poisoning wells and streams. In 19th-century America, immigrants from Ireland, Italy and China were censured, variously and also baselessly, for bringing with them cholera and polio, among other feared infections.

So perhaps it shouldn’t be a surprise that in the wake of COVID-19, the blame game is playing out once again.

A global sampling:

• In the United States, where some leaders have used the racist term “Kung flu” to describe COVID-19, increased verbal and physical assaults against Asian Americans have been linked to the virus. In one documented incident, a woman who is originally from Taiwan and has lived in New York City for 16 years filmed a video on the subway of a man accusing her of spreading “Kung flu.” Responding to the surge in anti-Asian verbal and physical assaults, the New York Police Department has this month announced the formation of an Asian Hate Crime Task Force.
• In the Democratic Republic of Congo, Kinshasha-based photo journalist Justin Makangara reports, misinformation has led to a number of different potential scapegoats for COVID-19: “There is a lot of misinformation, there is a rumor that it is a disease of the rich, a disease of foreigners according to many people. In a state where religion and belief are important, the virus is also associated with punishment from the gods. The government is also accused of inflating the numbers of cases in order to receive funding from structures like WHO, and to allow donor countries like China to sell a lot of masks. Many continue to be suspicious of imported masks.”
• In Haiti, medical workers are often distrusted and ostracized. According to reports from Doctors Without Borders, one pervasive myth is that hospital patients who seek help for COVID-19 will instead receive a fatal injection. The more people who die, it’s alleged, the more money the government will receive as part of a corrupt ploy to exploit unsuspecting citizens.
• In Malaysia, authorities have used COVID-19 as a pretext to target — and exacerbate prejudice against — immigrants, refugees, asylum seekers and the Rohingya community, says Doctors Without Borders head of mission Dirk van der Tak. Immigration raids purportedly aimed at stopping the spread of the disease by these groups coming from outside the country in fact ended up sparking new disease clusters in the overcrowded detention centers where the detainees were sent. This has further served to reinforce anti-immigrant sentiment, hate speech, stigma, and the blaming of groups from outside the country for the transmission of COVID-19.

This link between disease and blame is rooted in evolution, says Mark Schaller, a professor of psychology at the University of British Columbia and co-author of Social Psychology of Prejudice. According to Schaller, aversion to unfamiliar outsiders is an instinctual, unconscious response to avoid the risk of infection. It forms part of what he calls the behavioral immune system, a kind of psychological parallel to the physical immune system.

This aversion to outsiders may have served a purpose long ago in avoiding unknown (and unfamiliar-looking) groups that could harbor unknown illnesses. “This underlying psychology evolved in a different world, before modern medicine or public health, and is no longer adaptive,” Schaller says. “But we’re stuck with our ancient psychology, leaving us wary and with negative consequences for today” — notably, prejudicial and discriminatory responses to people perceived to be different.

Singling out immigrants in particular for scapegoating is one such negative consequence, says Tahseen Shams, assistant professor of sociology at University of Toronto and author of Here, There, and Elsewhere: The Making of Immigrant Identities in a Globalized World. As examples, she points to the 1980s, when Haitian refugees and Africans were among those blamed for the AIDS epidemic, and to the current surge of anti-Asian racism.

When external threats occur, immigrant groups are often seen “as the link bringing the threat inside our borders, closer to home,” she explains. And that, she says, leads to stigma and harassment.

The Ebola outbreak has such examples. In 2014, when a traveler from Liberia developed Ebola while visiting family in Dallas, the city’s African immigrant community was targeted and stigmatized, says Kevin J.A. Thomas, professor of African American and African Diaspora studies at the University of Texas, Austin and author of Global Epidemics, Local Implications: African immigrants and the Ebola Crisis in Dallas.

“People were already traumatized by losing family to Ebola in Africa,” he says, citing one pastor in the community mourning the loss of six family members in a single week. Then they had to deal with demeaning racist tropes in local media as well.

In this instance, the community found ways to counteract the prejudice they were facing, Thomas said. For example, they assisted with contact tracing of those who had interacted with the infected person.

Even those who come specifically to help in a medical crisis can be blamed, stigmatized, distrusted as outsiders who hurt rather than heal.

For international emergency medical teams who come from afar to succeed, building trust with the larger community is the cornerstone to countering such prejudice, says Karin Huster, an emergency coordinator for Doctors Without Borders. She worked in countries in West Africa during the Ebola outbreak in 2014-2016, a period when some health clinics and their workers were attacked by community members they aimed to help.

“We were arrogant” and did not take the time to explain what Ebola was, or try to understand their concerns, Huster says. “All of a sudden someone dressed in a moon suit starts bringing sick people into a newly built unit, and drags dead people out in a plastic bag. Wouldn’t you run away if you saw this?”

Having learned from those errors, the organization deploys a variety of strategies to include the community, reach out to local leaders, present accurate medical information and track and correct rumors, says Verschuere, with social media being one way to mitigate stigma and fear.

In the same way that prejudice manifests in every setting, the goal in counter-acting it is also the same: to bring out the humanity. By contrast, stigma does just the opposite, he says: It strips people’s humanity away.

Diane Cole writes for many publications, including The Wall Street Journal and The Jewish Week, and is book columnist for The Psychotherapy Networker. She is the author of the memoir After Great Pain: A New Life Emerges. Her website is dianejcole.com.