Ebola: Travel Bans, Quarantines, and Political Courage
The political reaction to Ebola has been a study in contrasts. On the one hand, we see some leaders insecurely trying to prove their “Ebola-fighting bona fides” by racing to go beyond what public health experts recommend. Some are actually fanning the flames of public fear. On the other hand, we have also seen some political courage in the response, including from the Obama administration.
Ebola is a frightening disease that is very deadly for those who catch it. But scientists say that while additional "sparks" of the disease are likely to land in the United States as long as an epidemic continues to rage overseas, it's extremely unlikely that Ebola will "go viral" here. "The system that's in place, with our health care infrastructure, would make it extraordinarily unlikely that we would have an outbreak," as Dr. Anthony Fauci of the NIH said recently, agreeing with (as the Chicago Sun-Times put it) “just about every leading infectious disease expert in the world.” Both Nigeria and Senegal stopped the epidemic in their countries, despite having many fewer resources than the U.S. The chances of any person who has not been in close contact with a known Ebola victim coming down with the disease in the United States are, according to experts, close to zero.
The role of our political leaders should be to help the public understand the scientific facts of this disease, and to solicit and follow the guidance of public health experts in crafting a calm and rational response to it.
One over-reaction to the disease that has emerged is a proposal for a blanket travel ban from the affected countries in West Africa. Public health experts say that such bans are not necessary, would not be effective, and would be a poor use of resources. Worse still, experts say they would most likely make matters worse by further isolating the countries where the outbreak is taking place, worsening the situation in those countries and therefore the threat to the United States. Travel bans “hinder relief and response efforts risking further international spread,” as the World Health Organization warned. Experts say such bans would also inevitably drive travelers underground, making it difficult to retrace the path of a disease when a case does appear.
Proposals to close the border to all travelers from affected nations are not a scientifically and medically legitimate exercise of government power and therefore would be arbitrary and discriminatory whether applied to citizens or non-citizens.
Now, of course, we are also seeing the questionable use of quarantine powers in some states. Medical experts have opposed such steps given that Ebola is not transmissible until after a fever begins and is not a highly transmissible disease generally, and given that individuals have strong incentives to carefully monitor themselves. Doctors Without Borders, for example, has condemned these quarantines as a threat to its battle against the disease in Africa. It cites the effect the quarantines will have in deterring doctors and nurses from taking the already remarkably brave step of entering the fight against the disease—and in stigmatizing them when they do. In short such quarantines threaten to weaken the most effective weapon we have in stopping the disease at its source. (It’s also shameful to treat returning health care workers, who have put their own lives at risk to help others, as anything less than heroes.)
Where individuals cooperate with the authorities in allowing close monitoring of their health and other reasonable precautions, the imposition of quarantines on those without symptoms appears to be driven by politics rather than science, and therefore raises serious civil liberties concerns.
While some political leaders have acted out of fear, Obama Administration officials deserve praise for largely sticking to science and not caving in to some of the fear mongering that is swirling around them. The White House has prioritized medicine over politics. It has resisted calls for travel bans, tried to persuade the governors of New Jersey and New York to reconsider their quarantines, and has largely followed the advice of public health experts in the recommendations that they have made. The Administration has also taken helpful steps such as expediting emergency FDA authorization for the use of new machines for rapid detection of the Ebola virus—which could allow detection of the disease before symptoms appear.
In fact, the Obama Administration has a history of good policy on communicable diseases. As we described in a 2009 white paper on that year’s H1N1 flu scare, the Administration acted calmly and appropriately in response to that epidemic, and overall, President Obama has turned away from his predecessor’s military/law enforcement approach to fighting disease, which we criticized in detail in our 2008 report on pandemic preparedness.
As ACLU Executive Director Anthony Romero said in a statement Monday (and as I wrote in a previous post on Ebola), the ACLU recognizes that civil liberties must sometimes give way when it comes to fighting a communicable disease. Overall, however, the public health community has learned over time that treating people with dignity and minimizing incursions on their freedoms is the best way to fight disease. Unnecessary incursions on civil liberties are counterproductive from a public health standpoint.
The Centers for Disease Control and White House are to be commended for remaining level-headed and professional in the midst of what one quarantine expert called a “political parade of follies.” Experts say that there will likely be additional sparks of Ebola landing in the United States for as long as the epidemic rages overseas. Let us hope that in the midst of what will no doubt be breathless coverage of those cases, cooler heads continue to prevail.