The impulse to implement a travel ban to African countries is understandable. Essentially, it is taking the concept of quarantine to what seems like to be its logical conclusion.
In 2003, the SARS outbreak provided a deadly precedent to the Ebola threat that we now face, and the handling of the SARS outbreak provides an excellent example of how to combat a deadly and more contagious disease than Ebola.
SARS was limited to an estimated world-wide total of about 4,000 cases with less than 1,000 deaths attributed to the disease. While there certainly are meaningful differences between the two diseases (method of transmission and incubation period being the most prominent), most cases of both illnesses are first identified by the onset of a fever.
It’s interesting to note that the media looked at SARS when considering the MERS outbreak this Spring. But Ebola is largely being considered as a different category of disease, one infinitely more frightening to the media, politicians, and the public–it’s the stuff of horror films like Outbreak and Twelve Monkeys.
The lessons learned from previous experience and even the contemporaneous successes in African countries such as Nigeria and Senegal–both of which have been declared Ebola-free by the World Health Organization–are important to understanding how health authorities can respond to the disease. Using successful precedents as a model should play a significant role in establishing sensible, effective policy around Ebola. Past outbreaks have taught us that contagious diseases are usually contained by following gradations that begin with airport screenings and hospital preparedness, and only rarely escalate to include heightened quarantine levels and possible travel bans.
But the effectiveness of travel bans is questionable, too–if passengers book days-long layovers or change airlines mid-flight, determining their country of origin can be nearly impossible. Health experts warn that excessive constraints on air travel could have severe economic consequences that could destabilize the region and possibly disrupt essential health and humanitarian services. President Obama has publicly noted that if a ban was implemented, some travelers might attempt to enter the United States by avoiding screening measures, which could lead to more Ebola cases, not fewer.
Pragmatism has always been part of public health policy. The economic impact and unintended consequences of policy always shapes subsequent decisions. With SARS, public health authorities demonstrated that an outright travel ban was not necessary, and instead airport screenings were implemented. Later, studies showed that airport screenings during the SARS outbreak had questionable results, but were effective at making the public feel safer, which clearly demonstrates the challenge of balancing effective measures with the public’s perception of safety.
Meanwhile, the difficult work of actually containing the airborne virus fell to the hospitals and Emergency Departments that treated SARS patients, many of which were initially under-prepared–which is very much the same story we’re facing today with Ebola.
What is peculiar about Ebola is the near-mythological fear surrounding the disease. This shapes both political and public reaction, but does not make for good policy. Public health needs to use the proven, tested tools at their disposal to contain the spread of the disease and care for those who are afflicted. And we need to give them the chance to do so.