Why travel bans will only make the Ebola epidemic worse

One of the Ebola remedies that's gaining traction is to isolate West Africa — the hot zone — and close America off to travelers from the region. Yesterday, the calls for a travel ban escalated at a congressional hearing on the epidemic, making it seem like a political eventuality. "It needs to be solved in Africa, but until then, we should not be letting these people in, period," said Fred Upton, member of the House Energy and Commerce oversight and investigations subcommittee.

The fear of spread is understandable, especially as an Ebola outbreak appears poised to grow closer to home. America recently recorded its first Ebola death with the passing of a Liberian visitor Thomas Duncan, and the CDC announced the first-ever cases of Ebola transmission to two of Duncan's nurses.

As Ebola panic peaks, conspiracy theories are spreading fast. So now is the time when we need to check our irrational reactions to this horrible crisis and avoid policies that will divert scarce resources from actual remedies. And we know from past experience that airport screening and travel bans are more about quelling the public's fears and political expediency than offering any real boost to public health security.

Airport screening is political theater

Spencer Platt/Getty Images

Ebola screenings underway at New York's JFK airport. (Spencer Platt /Getty Images)

In October, the US government announced a new airport screening regime for incoming travelers from West Africa. Passengers arriving from Sierra Leone, Guinea and Liberia to five US airports will now be questioned about potential Ebola exposure and have their temperatures checked.

Exit screening has already been underway in West Africa since the summer, and famously failed in the case of Duncan. He flew to Dallas with Ebola incubating in his body, and did not disclose the fact that he had close contact with a dying Ebola patient days before his trip.

A Canadian study showed that airport screening during the 2003 SARS pandemic didn't detect a single case.
This failure shouldn't be a surprise. We know from past outbreaks that these techniques don't work. Entry and exit screening was used during the 2003 SARS pandemic. A Canadian study of the public-health response following the outbreak found that airport screening was a waste of money and human resources: it didn't detect a single case of the disease.

This screening was "inefficient and ineffective," the authors of the assessment concluded, noting that the Canadian public health agency should seriously rethink using it again in the future.

Another study found that those clunky and costly thermal scanners used to detect fever in airports were similarly useless when it came to singling out sick people who are trying to enter a country. So spending extra money to identify feverish people at airports — especially those with Ebola who can be undetectable for days until they are symptomatic — is an expensive and ineffectual exercise.

Closing borders would be a disaster

Liberian Army and US Marine engineers work to set up a landing zone next to an Ebola treatment center in Tubmanburg, Liberia. (John Moore/Getty Images)

Taking airline panic one step further, US lawmakers are now pushing to close off West Africa to the rest of the world. Allow Ebola to fester over there, and keep people safe over here.

In opposing this idea, public health experts unanimously agree: sealing borders will not stop Ebola spread and will only exacerbate the crisis in West Africa — and heighten the risk of a global pandemic.

There are three reasons why it's a crazy idea. The first is that it just won't work to stop the virus. The weeks following 9/11, when people stopped getting on planes, provided influenza researchers with a natural experiment in what a travel ban might do to viral spread. They found it didn't stop influenza from moving, it only delayed flu season by a couple of weeks.

What's more, the researchers didn't measure whether this delay actually reduced flu cases or saved lives. But a look at the CDC data shows that flu deaths actually massively spiked during the 2001-2002 flu season, rising from about 3,900 the year before to more than 13,000 post-9/11.

Writing in the Washington Post, Laurie Garrett — senior fellow for global health at the Council on Foreign Relations — pointed out: "Many nations have banned flights from other countries in recent years in hopes of blocking the entry of viruses, including SARS and H1N1 'swine flu,'" she added. "None of the bans were effective, and the viruses gained entry to populations regardless of what radical measures were taken to keep them out."

In CDC Director Tom Freiden's words, "Even when governments restrict travel and trade, people in affected countries still find a way to move and it is even harder to track them systematically." In other words, determined people will find a way to cross borders anyway, but unlike at airports, we can't track their movements.

90 percent of any outbreak's economic costs "come from irrational and disorganized efforts of the public to avoid infection."
The second reason a travel ban won't work is that it would actually make stopping the outbreak in West Africa more difficult. Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said, "To completely seal off and don't let planes in or out of the West African countries involved, then you could paradoxically make things much worse in the sense that you can't get supplies in, you can't get help in, you can't get the kinds of things in there that we need to contain the epidemic."

Some have suggested a half-measure: close borders allowing exceptions for doctors, aid workers, and medical supplies only. The problem with this idea is that responses to humanitarian crises are not well-organized affairs. They're chaos. A bureaucratic regime that systematically screens who can go in and out of affected countries would only slow down or make impossible the much-needed relief. Plus, many aid workers — like reserve staff for Doctors Without Borders — would be responsible for booking their own tickets to get to the affected region. How would they do this then? And how long would it take to get them over there?

The third reason closing borders is nuts is that it will devastate the economies of West Africa and further destroy the limited health systems there. The World Bank already estimates this outbreak could cost West African economies up to $33 billion. That's a lot for any country, but especially when you're talking about some of the world's poorest. World Health Organization director Margaret Chan reminded us that 90 percent of any outbreak's economic costs "come from irrational and disorganized efforts of the public to avoid infection."

The best way to protect Americans is by protecting West Africans

Nurses wearing a protective suit escort a man infected with the Ebola virus to a hospital in Monrovia, Liberia. (Zoom Dosso)

We live in a world where many crises are predictable. We don't know when the next one will strike, or where, but we know it will eventually come. In the health field, we even know approximately what it will look like. Every few years, for example, we seem to get another global pandemic that spreads across borders as if they don't exist. In 2002 it was SARS, then in 2009 it was Swine Flu. Today it's Ebola. In five year's time it will be something else.

If we know these health crises are coming, why is it that we never seem ready? It's true that we can't prepare for every kind of outbreak in every place at every time; having a large standing army of white coated doctors at the ready would just be too expensive. But there is no reason we can't use the lessons learned from past outbreaks to make better choices in this time of Ebola.

We also need to stop diverting precious resources on policies and procedures that do nothing to help the public. Instead of using airport screening and entertaining plans to seal borders, the government should focus its attention and resources on West Africa where the outbreak is out of control and where real action could actually be helpful in protecting America's health security. Because we know this for sure: the longer Ebola rages on in West Africa, the more people get the disease there, the more of a chance it has of spreading elsewhere.

Three people in the US have been stricken by Ebola; more than 8,000 have in West Africa. The best way to avoid more cases in America is by protecting West Africans.