New York — In September, I spent time with an American woman who had recently been in Lofa County, Liberia, an Ebola hot spot bordering the village in Guinea where the first case was identified. We were nowhere near west Africa; we were both attending an international conference with participants from around the world.
We had dinner together and talked afterwards until late. She had been working with Liberian youth groups who were delivering health information house to house and to religious organizations. I wanted to hear everything.
After the conference, my American-born dinner companion returned to eastern Europe, where she lives. I flew through Doha, Qatar to Washington, DC. If an immigration official had asked about my travel history – and no one did – the theoretical risk I presented would not have been revealed.
There are hundreds of such examples weekly. But the pressure to implement travel restrictions has proved irresistible – and many infectious disease specialists fear there is worse to come.
I am not in the advocacy business. But the established ethics of my profession are compatible with wanting to make a difference – through pursuing and telling the truth. The media professionals I know get up every morning wanting to do something that matters.
As Charlayne Hunter-Gault, a prize-winning, widely respected journalist who has held high positions at the New York Times, the New Yorker, CNN and National Public Radio once told a group of South African reporters: the only advocacy permitted a journalist is to respect and support the dignity of every human being.
In that spirit, I'm not reluctant to say there is strong evidence that trying to seal borders against people who may be carriers of Ebola is both futile and counter-productive.
I can understand the people who tweet me that they can't trust government officials. In east Africa, I watched President Barack Obama announce a scaled up U.S. response to Ebola - groaning when I heard him say, "We know how to contain" this epidemic. It wasn't true, because no one had ever seen hundreds of cases of Ebola in a densely populated urban environment. What was clear was that a massive worldwide response – which still has not happened – was necessary.
Later, when Americans were assured by health and political officials that medical facilities in the United States were prepared to handle Ebola cases, anybody familiar with the abysmal record of doctors in major medical centers observing simple hand-washing rules for infection control should have been skeptical.
Texas Presbyterian demonstrated what Medicines Sans Frontiers/Doctors Without Borders (MSF) already knew – and have proved – that health workers can be protected, but only with the right materials and intensive training and a buddy system that enforces strict protocols. That we do know how to do.
The unfounded assurances that Ebola was unlikely in the United States and that hospitals were ready to receive Ebola patients has added to the widespread perception that officials cannot be believed. But the policy-maker argument that a travel ban would pose new dangers is evidence based.
My own experience in global health issues and communications has made Ebola my 'beat' in the last few months. My training in statistics and data science, and my contacts with infectious disease practitioners and epidemiologists has convinced me that banning travel from the most-affected areas would be, at best, ineffective and probably risky.
Here's how.
Every logistician involved with responding to the epidemic in Liberia, Sierra Leone and Guinea agrees that the cancellation of flights and marine shipments in the first wave of Ebola fear was a factor in the epidemic's spread. As many as half of Liberia's medical workers died, primarily from a shortage of protective supplies.
We can hope that supply flights will not be slowed. MSF uses 40,000 protective gloves daily just in its Liberia isolation and treatment centers. The organization's officials – who have begged for months for more resources – have had more local volunteers than they could put to use. But the organization has been unable to import enough protective gear to take care of additional volunteers or to get volunteers in to train them or to build and staff enough facilities to 'bend the curve' away from exponential increase.
A travel ban would further reduce the commercial options for getting supplies in and essential medical professionals in and out. Some commentators have proposed military transport as an alternative. But many of the people pushing for a travel ban are also criticizing sending military personnel, who they fear could themselves become vectors, or people who spread the virus. And the need to rotate personnel frequently, coupled with a quarantine, could quickly compromise the vigorous increase that is needed.
Anything that hinders the pace of response allows the current upward trend of new cases to continue. The new U.S. policy of 21-day monitoring for arrivals from three west African countries will – if nothing else – discourage the flow of volunteers to staff African isolation and treatment centers.
Yet, if Ebola is not curbed in the three countries, there will be more cases exported – to the region, as well as to Europe and North America and Asia. There is no feasible way, in a global world, that it won't happen.
Meanwhile, a few days after the announcement by New Jersey educations officials that two elementary school students from Rwanda in east Africa were being kept at home for 21 days, the government of Rwanda said it would screen travelers from the United States and Spain for 21 days [the decision has since been reversed] . Rwanda already was restricting travelers who had been in Ebola-affected west African countries in the past 21 days.
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I can't decide whether the new Rwandan restriction is done with a bit of tongue-in-cheek, but when I arrived in the capital Kigali in September, all of us who entered had thermometers aimed at our foreheads, filled out extensive questionnaires and were given written materials about Ebola symptoms. The sleek, pristine airport was plastered with posters about preventing Ebola.
Nevertheless, as Rwanda Foreign Minister Louise Mushikiwabo told me, Rwanda – despite being a poor country with extensive health-care needs of its own – is sending medical professionals to west Africa as part of an African Union mission to help fight Ebola.
"Rwanda has invested in preparedness," she said. "We didn't have a budget for that, but we realize it's an emergency and so we all dug in our budget and put some money together for the Ministry of Health to deal with it."
Rwandan officials are sure they will be able to provide assistance without endangering their own people. "We've invested in not cutting off the countries or the people that are affected, but insuring that we protect our own citizens."
