Ebola - Can you quarantine West Africa?

Since the death of Liberian national Thomas Eric Duncan in Texas on 8 October and the Ebola infection of two US nurses that treated him, there have been increasing calls by US lawmakers to ban travel from the countries most affected by the virus - Guinea, Liberia and Sierra Leone.

On 16 October, Florida representative Dennis Ross (R-Fla.) revealed a draft bill that would ban travel from countries experiencing an outbreak of the Ebola virus. The congressman said in a statement: “Ebola has a death rate of 50 percent. How can you ignore this fact, and take a gamble with American lives by allowing people to travel to and from countries where the virus is quickly spreading?”

Rep. Ross’s proposed bill, the Contain Ebola and Stop the Epidemic (CEASE) Act, is slim on details.

It would “ban the arrival of any commercial aircraft from a country in which the Ebola virus disease has reached epidemic proportions as determined by the Director of the Centers for Disease Control (CDC) and to deny a visa to any individual whose travel itinerary includes a departure from such a country.”

The idea of a travel ban is one that has already garnered the support of more than 70 members of Congress. Lawmakers are taking this position despite the fact that there are not currently any regularly scheduled commercial flights from Guinea, Liberia or Sierra Leone to the US. The travel ban would not affect the US military’s Ebola assistance efforts to West Africa or the CDC’s response.

Opponents of the ban in Congress have been outspoken. Rep. Jan Schakowsky (D-Ill.) said on 16 October: “Do we really want to essentially quarantine West Africa so that people have a hard time coming or going?... We cannot build a wall around the United States."

But can you build a wall around three countries in West Africa?

• Not really. Guinea, Liberia and Sierra Leone are all members of the Economic Community of West African States (ECOWAS), which, like the European Union, allows for the free movement of West Africans across the borders of the 15 member states, at least in theory. In practice, a few ECOWAS member countries have closed their borders to transport (planes, trains, buses and ships) coming from the three countries. Cape Verde, Côte d’Ivoire, Gambia, Guinea-Bissau, Nigeria and Senegal have all, at times, restricted travel from the countries where Ebola is at its most virulent.
  
  Other African countries have also enacted Ebola-related travel bans. International SOS, the global medical emergency response company, keeps an up-to-date list of travel restrictions. But the borders are porous. So, following that logic, the US government might eventually have to expand the parameters of its travel ban to include all of West Africa.
• Given that there are no scheduled flights, many people from Liberia, Sierra Leone and Guinea travelling to the US fly to Europe first (Thomas Eric Duncan flew in via Brussels). Would the travel ban be extended to flights coming from Europe? And what of the many Americans and Europeans either currently in the affected countries or planning to travel there soon - either as humanitarian workers or as US or European citizens of African origin. It is not clear how the US government could control this flow of people.
  
  Michael Leavitt, former Secretary of Health and Human Services during the Bush Administration and a critic of the travel ban, said: “It’s such an appealing idea, it sounds so easy. But it’s when you get to the second layer of activity and then the third and fourth it gets complicated. For example, imagine a Liberian citizen goes to Spain and in Spain he manifests symptoms and people in Spain get it. Do you now expand the travel ban to include Spain? Somebody from Spain goes to the UK and now it’s there, so do you include the UK? Now somebody who gets it there turns out to be a US citizen and wants to come home to get treated. Do you let the citizen in?”
  
  
• The US could borrow a page from Senegal, which despite maintaining a ban on transport coming from Guinea, Liberia and Sierra Leone, opened a humanitarian corridor to allow doctors and aid workers safe passage to and from the affected regions. That means that they can come and go through a special part of the airport and can ship through their equipment. But already, most of the regional and international airlines that used to fly to Guinea, Liberia and Sierra Leone have suspended their flights. There were commercial flights from countries like Nigeria and Ghana and Senegal, but now these are mostly in limbo. Many in the international community say that these regional travel complications are keeping people from responding to the crisis. If flights are few and far between, then it is difficult for aid workers, epidemiologists and other medical professionals to get themselves and their equipment in and out of the country.
  
  Sean Casey of the International Medical Corps, who has been opening up treatment centres in Sierra Leone and Liberia, told the Los Angeles Times that what used to be a short flight from Sierra Leone to Liberia has turned into a complex ordeal. “So every single roadblock that’s put up, it means it’s that much harder to get the response that’s required,” said Casey. Lawrence Gostin, director of the O’Neill Institute for National and Global Health Law at Georgetown University, told The New Republic: “Advocates for a ban are assuming it would only be the US and US aid workers. But the US launching a travel ban would cascade around the world virtually sealing a whole region off. Not only would aid workers be impeded but also essential medicines, food, and humanitarian supplies. Ultimately it would cripple those countries.” The US government would have to facilitate a full logistical system of humanitarian charter flights and military flights to replace the commercial flights that CEASE would restrict.
  
  
• The proposed US travel ban would be mostly symbolic, serving to assuage the frayed nerves of a hyper-vigilant US public. But a travel ban might operate on the American psyche in other ways, too. Tourism operators working across Africa are worried about the psychological contagion of the Ebola crisis. Already, tourism in corners across the continent has been suffering, even if the countries are thousands of miles away from the epicentre of the crisis. That means safaris in Kenya, wildlife tours in Namibia and wine tours in South Africa. Stefano Cheli, a Nairobi-based tour operator, told Bloomberg that tourists are just not buying. “They’re paranoid that there’s Ebola in Africa and not realizing the distances involved. It’s closer to fly from Liberia to London than it is to fly from Liberia to Nairobi.”
  
  jl/oa/cb