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Oct 17 2014

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The Case for an Ebola Travel Ban

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Prudence is More Important Than Symbolism...

Prudence is More Important Than Symbolism…

To understand the American reaction to Ebola, consider Mega Millions, the multi-state lottery that regularly offers hundreds of millions as a top prize.

The chances of matching all six numbers and winning the big bucks are precisely 1 in 259 million, an inexact but ballpark figure akin to the current risks of  contracting Ebola in the US today. Compare that to, say, the chances of developing cancer in your life time (1 in 2) or dying from cancer (1 in 4), and the relative odds – and risks – become very clear.

But Americans still buy lottery tickets. The bigger the prize, the more money they drop. It’s not rational, given the odds, but it points to a psychological factor at work in both lotteries and Ebola.

You never know.

Lottery officials proudly strut out the latest winners who have almost always improbably humble origins – someone plucked from obscurity and chance to become an overnight millionaire, and we collectively think, “that could be me.”

Ebola does the same thing in the negative. Suddenly, something as ordinary as taking a domestic flight from Cleveland to Dallas – far away from West Africa –  has become a potentially lethal health risk. It is frightening, even if not entirely rational, sparking the same reaction. “That could be me.”

Which brings us to the issue of a travel ban for persons coming from the countries where the disease is widespread – Liberia, Sierra Leone and Guinea. While the current risks of contracting Ebola remain low, the fear of Ebola and its corrosive impact on citizen trust in government is high and growing. The government needs to act before citizen skepticism eventually catalyzes increased Ebola risk.

 67% of Americans are in favor of a travel ban.  Members of Congress are clamoring for it. But the Obama administration and the Center for Disease Control (CDC) have been adamant  that a travel ban won’t work, and would make the global Ebola crisis worse.

Addressing a House Committee yesterday, CDC head Thomas Frieden , “cautioned that such a ban would make it more difficult for health officials to monitor travelers from those countries. A ban, he explained, would force potentially infected people to fly indirectly into the U.S., possibly from countries that don’t screen for high temperatures indicative of the virus.” Frieden also stated that a travel ban would complicate the work of aid workers trying to get supplies to the source of Ebola, to contain the virus.

Frieden’s case however, is simply not persuasive.

First, a key fact.  There are no direct flights between the US and the three countries coping with the Ebola outbreak.  Delta was the last US carrier to have direct flights, and canceled the route in August for lack of passengers. Thus, anyone trying to get from infected countries to the US would, as a matter of necessity, have to fly indirectly.

Yet, even with indirect routes as the only path to the US, 1,000 people arrive from the infected countries each week. Indeed, Thomas Eric Duncan, the Liberian national who was the first casualty of Ebola on US soil, flew from Liberia on connecting flights from Europe and Dulles International in Virginia, before arriving in Dallas.

Thus the travel method that Frieden fears creating is exactly the how Ebola came to the United States in the first place. Prudence and pragmatism would dictate that this is the people pipeline you shut down as a common sense step until the health crisis in West Africa is brought under control, but the government dithers.

Frieden maintains that a travel ban would force the desperate or infected underground, to lie about their nationality or recent travel to infected areas, in order to get to the US. But the idea that the current policy keeps people 100 percent honest is ludicrous, as Duncan’s situation clearly shows.

Moreover, international air travel to the US (thankfully) is not conducted in the same manner as say, US management of our southern border. You need to have a passport and you need to have a US visa, provided by the local US Embassy or Consulate, to get here. Since 9-11, those controls have only grown stricter, to prevent terrorists from entering the US.

Are we now to believe that this robust system is unable to identify a West African national, or a passport stamped from one of the infected countries?

As a matter of context, its important to note that a travel ban is not a radical solution. More than two dozen African countries have already imposed restrictions or outright travel bans for the infected West African countries. Both British Air and Air France, as well as numerous regional carriers have suspended flights to West Africa. Even Caribbean nations have now instituted travel bans.

However, Frieden states that a travel ban will complicate aid efforts and the rotation of personnel in and out of West Africa. But that is true only to the extent that that the choices are between a total ban and the current, open-door policy. It is clearly a false choice.

Processing West African nationals into the United States has little to do with international aid efforts for those countries. Indeed the dwindling number of flights into and out of West Africa already demands greater reliance on charter and military flights to maintain the supplies of food and medicine necessary to fight against Ebola, and the personnel and construction materials necessary to build camps to treat and contain the ill.

Nothing should prevent Americans from voluntarily traveling to West Africa who wish to go to these countries as part of aid efforts. And nothing should stop the US from dedicating resources to contain the epidemic in West Africa. But as a matter of prudent public health, those individuals who venture into West Africa should understand that they will be held to a higher standard of proof and, necessarily of inconvenience, requiring screening and isolation for the full incubation period of the disease, before being allowed to travel back to the US.

According to the Customs & Border Protection (CBP) website, nearly 1,000,000 people, foreigners and Americans, clear customs in the US each day, or roughly 7 million a week . That makes the numbers currently traveling from West Africa symbolic at best, an apparently important sign that while a pandemic is raging overseas, everything is fine at home and we should not to be alarmed. This is an act of reassurance for us that is supposed to set a standard for other nations.

But the potential risk of those 1,000 West African passengers is asymmetrical; particularly after arriving in the US – again, as the Duncan case clearly points out.

For that reason, a travel ban is not a signal that Americans should suddenly panic. Indeed, it is simply a prudent public health measure that will expand the confidence of the American people in the officials charged with protecting us, a confidence that has been sorely tested as the CDC has repeatedly undermined its own credibility since Duncan arrived.

America is a wealthy and compassionate country. Our people consistently give more to charity than any other nation on earth. As POTUS himself has noted, when there is a crisis overseas, those leaders dial up the US first. Our generosity has touched every region of the globe, through war, natural disaster and disease. A travel ban is not inconsistent with that historic legacy of generosity.

Instead, stated plainly, it is unnecessary and even foolhardy to invite Ebola into our country to prove our compassion and willingness to help.

Put a travel ban in place. Centralize Ebola treatment in the US among the larger hospitals most capable of handling and containing it – as opposed to the current policy of expecting every hospital in the country to be prepared. Do a public information campaign that informs citizens about the truth of Ebola – and get the news networks to repeat it. Get a smart, savvy medical professional with gravitas to chair the national effort. And of course, do everything we can to assist to contain the virus in West Africa.

To paraphrase a Bush official  speaking on a different kind of crisis – we are fighting there so we don’t have to fight it here.

Solid advice then. Solid advice now.

 

 

 

 

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