Fighting Ebola: The American Argument Against an African Travel Ban

By Charles Kenny October 06, 2014

In the wake of the revelation that the Dallas man infected with Ebola flew on United Airlines flights from Liberia, more than a few people have seized on a blunt response: ban flights from West Africa. Texas Representative Ted Poe, a Republican, has written to the Centers for Disease Control asking it to recommend travel restrictions. Representative Alan Grayson, a Democrat from Florida, has called for a 90-day ban on travel from Ebola-touched countries to the U.S.
The White House is resisting those calls, and that’s the right thing to do. Restricting travel to and from the affected region will have little impact on the already minimal risk to Americans from the Ebola virus while further worsening the situation in West Africa. And the history of the global fight against infection has demonstrated that we shouldn’t raise the drawbridge or run away, but fight disease wherever we find it.

Travel restrictions have a long history as a tool against spreading infections. Quarantine was first used against the plague bacillus in 14th-century Europe. The case for plague quarantine was a lot stronger 600 years ago: It was pretty much the only potentially effective public health strategy at the time (neither prayer nor pogroms had the desired impact). The Black Death still exists—there were four cases of human infection in the U.S. in 2012—but we now have a vaccine against the disease. It can be treated with antibiotics, and sanitary and housing conditions in the 21st century are considerably higher than in Europe in the 1300s. The plague bacillus led to the deaths of tens of millions in the 14th century; it kills a few hundred people worldwide each year today.
Blog: The Ebola Outbreak Shows Why the Global Health System Is Broken

We don’t have a vaccine against Ebola, nor a fully developed cure. But, like the plague, the disease is an unlikely candidate for epidemic status in the U.S. or elsewhere in the developed world. The only way to get Ebola is for the bodily fluids of someone who’s exhibiting symptoms to come into contact with your soft tissues—the eyes or mouth, for example. In the worst of circumstances, the average Ebola victim infects from one to two other people, compared with 10 or more who can be infected by someone with measles.

Even partially effective isolation of people with symptoms is enough to stop an epidemic—and that’s why all previous Ebola outbreaks have sputtered, leaving the world with no reported cases in 2010, for example. The U.S. has top-notch isolation facilities, and health authorities have considerable experience of “contact tracing”, or finding all the people the victim has spent time with since they began exhibiting symptoms and checking that they don’t have the disease. All of which is why CDC Director Dr. Tom Frieden has expressed confidence that Ebola will be stopped in its tracks in America.

Controlling illness by quarantine of an entire country or region involves trade-offs. It’s always theoretically possible to avoid risk by completely cutting yourself off from contact, but then you’ll be alone. We take some risk of infection through contact because the benefits of that contact outweigh the risks. Trade is worth one-quarter of U.S. gross domestic product. People want to travel to see family and friends, visit new places, work, or invest. We think all that is worth the price of somewhat increased risks of illness.

Other global diseases pose a far greater threat to the U.S. than Ebola: In an average year, more than 23,000 deaths in America are associated with influenza. Staff at the CDC have estimated the potential economic cost of an influenza pandemic in the U.S. at about $100 billion. But this toll isn’t enough for us to shut the borders in an attempt to keep influenza at bay. And, realistically, the idea that we could completely seal off the U.S. from the rest of the world is laughable—at best we might delay a disease from arriving by a few days or weeks. We’re not even willing to take considerably more targeted and effective measures, such as banning kids from school if they haven’t taken the flu vaccine or providing shots for free at pharmacies.

Even without a formal travel ban, most of the economic harm from epidemics comes from reduced commerce. A 2006 World Bank staff estimate of the global costs of a flu pandemic suggested it could reduce global GDP by $1.5 trillion. One-third of that sum was accounted for by death, illness, and absenteeism. But two-thirds was due to the cost of efforts, including reduced travel, to keep away from infection. The bank has estimated the cost to Liberia of the Ebola outbreak in 2014 to be equal to more than 3 percent of the country’s GDP.  Add in a formal travel ban, and the impact on some of the world’s poorest economies could be catastrophic.

Culled from http://www.businessweek.com