America’s Ebola outbreak, now contained to two people, began with a flight from Liberia.
Relying on that fact alone, the answer to the most recent issue dividing Congress—whether or not President Obama should impose a travel ban on West Africa—is simple. Yes. Operating under the assumption that halting flights in and out of the affected region would indeed stop the epidemic, it’s easy to imagine why 59 Republicans on Capital Hill are nearly shouting at Obama to make this call.
A look back at previous travel restrictions in the U.S. proves it’s not that simple. Extensive analysis from multiple governments, institutions, and agencies has failed to show a ban’s positive impact on public health. And in fact—with crippled economies and pervasive fear—the opposite has been shown. The failure of past travel bans to increase safety to public health, combined with the demonstrated risk such mandates poses to human rights and public safety, challenge the notion that a travel ban is the cure-all for America’s outbreak.
On Oct. 30, 2010, Obama said as much during a speech announcing the end of more than two decades of HIV-related travel restrictions. “Twenty-two years ago, in a decision rooted in fear rather than fact, the United States instituted a travel ban on entry into the country for people living with HIV/AIDS,” said the president. “Now, we talk about reducing the stigma of this disease—yet we've treated a visitor living with it as a threat.” Obama focused as much on the stigma that the ban created as the reality of the current situation: “There are still 1.1 million people living with HIV/AIDS in the U.S.,” he said. “More than 56,000 new infections occur every single year.”
The circumstances of this decision, of course, differ. America was different; the disease of HIV is not remotely the same. But while the circumstances of the ban may have been different, the goal was the same: keep the bad guys out.
The Obama administration’s decision to end up the ban—hailed as a victory by AIDS activist and the LGTB community at large—was undoubtedly influenced by public health policy. Just three years earlier, the Joint United Nations Program on HIV/AIDS launched a task force to study the impact of the move. In a 46-page report released in October 2008, the task force found 63 countries, territories, and areas to be actively imposing restriction on the entry, stay, and residence of people living with HIV.
The 43 members of the team, ranging from inter-governmental organizations to networks of people living with HIV, found the restrictions to be nearly useless. The task force found zero evidence that such bans protect public health and, “may in fact impede efforts to protect the public health.” Travel restrictions interfered with “rights to life, privacy, liberty, work, the highest attainable standard of health, the rights of women, the rights of the child, the rights of migrants, and the rights to seek asylum and to protect the unity of the family.”
Hopes that the travel restrictions would contain the disease failed, as the task force reported its continued spread. The World Health Organization reported that in the final months of 2007, an estimated three million people were receiving antiretroviral treatment—950,000 more than the year before, and more than seven times greater than earlier.in 2003
Ultimately the task force determined that the dangers posed by HIV-related travel restrictions regarding public health and human rights to far outweigh any potential benefits of a ban. In conclusion, the authors recommended the global health community work towards the “elimination of all HIV-specific travel restrictions.”
To public health experts steeped in the topic, the conclusion was no surprise. As early as 1988, the World Health Organization had deemed the HIV screening of international travelers to be “ineffective, impractical and wasteful,” suggesting that the epidemic could only be stopped at the source. It has been similarly opposed to the idea in this epidemic, as has the National Institute of Allergy and Infectious Diseases, whose Director Anthony Fauci told Congress during a hearing this week that a travel ban would result in “a big web of things we don’t know what were dealing with.”
CDC Director Tom Frieden has elaborated on this point. “Isolating countries won’t keep Ebola contained and away from American shores,” he said this week. “Paradoxically, it will increase the risk that Ebola will spread in those countries and to other countries.” Frieden’s point, echoed by the White House, is an important one. Sealing off West Africa, a region already drastically underprepared for this epidemic, would not only cut off lifesaving resources, but drive the epidemic underground. “People will move between countries, even when governments restrict travel and trade,” Frieden said this week. “And that kind of travel becomes almost impossible to track.”
Joshua Michaud is the Associate Director of the Global Health Policy Team at the Kaiser Family Foundation, an independent, non-partisan operating foundation that works to inform the public. He agrees with what other public health experts have been saying. “Travel bans might not achieve the goals that are set out for them. If the goal is to seal off the countries in West Africa and not allow cases of Ebola into the United States, [they] may actually make the problem more complicated and difficult."
With hundreds of alternate routes, he worries that some infected individuals would be sneak in through other countries or faking a visa to gain entry. “Making a full-out ban is driving people underground and if they truly want to get into the United States, they would find a way.”
Micuad says that pushing people below the radar puts a significant amount of pressure on public health officials. “It’s difficult to imagine how (a travel ban) would operate sufficiently. ... It would appear to exacerbate the problem rather than protect us.”
Natalie Eisenbarth, Policy & Advocacy Officer for the International Rescue Committee, says that if the goal is to protect the U.S., a travel ban is the worse possible decision. “It’s important to look at humanitarian and moral implications,” she says. “Stopping the spread of it in West Africa is in our best interest and that means getting the right people and the supplies in as fast as possible. The idea of issuing a travel ban runs against that.” On top of hindering the IRC’s ability to deliver supplies and essential medical equipment to the area; Eisenbarth says a travel ban would have a dramatic effect on people’s willingness to travel to these countries and help.
And if a travel ban were imposed, the help would be needed more than ever. The potential economic consequences that could arise from a travel ban on West Africa, says Eisenbarth, could be catastrophic. In addition to reducing trade, the ban would increase fear and suspicion of residents of this region, hindering the work of businesspeople, further sinking the economy. President of The World Bank Jim Yong Kim backed this up at a meeting of the European Union in Paris Friday. "I still don't think the world has understood what the possible downside risk is,” said Kim. “Not just to the West African economy, but to the global economy.”
Dr. Irwin Redlener, Director of the National Center for Disaster Preparedness at Columbia University, says a travel ban is a “very complex situation,” that needs immediate attention. While he leans against a travel ban initially, he has yet to come to a conclusion on the debate. He agrees with Michuad’s concern that sealing off the borders has the potential to drive patients to other, illegal means of getting to America. “If people are determined to thwart the travel ban we won’t even know it because we will be forcing people to make what is, in their minds, a life and death decision and in desperation to do or say whatever is necessary to get here.”
This concern leads Redlener to believe that a travel ban may not work.
“It makes some sense on one level, but it creates a bigger challenge of people trying to game the system. This is not a panacea.” Failing to address the problem at its root, he says, could prove deadly. “We don’t want to institute a policy that feels good but drives people into the country clandestinely,” he says. “If we don’t address the Ebola problem at its root in those three countries, we’re going to be in a persistent amount of trouble that’s going to get a whole lot worse.”