How to stop Ebola: ban air travel from West African countries

Countries in which Ebola virus has appeared in the past.

I never thought I’d find myself agreeing with Louisiana governor Bobby Jindal. But this week, Governor Jindal called for a ban on air travel to the U.S. from the countries where the epidemic is present. He’s right: a flight ban is the best way to keep Ebola from spreading. 

In the world of infectious diseases, we often hear the phrase that the next epidemic is “one flight away” from the U.S. That’s true—but we don’t usually know where that flight will originate, so we can’t simply ban all flights to the U.S. from everywhere. With Ebola, though, we know the source: the epidemic is confined to Liberia, Sierra Leone, and Guinea. 

As the Ebola crisis has grown in West Africa, the need to stop its spread has grown ever more urgent. The number of cases is now over 20,000, and the CDC estimates that by January, Liberia and Sierra Leone will have 1.4 million people with Ebola infections. These are frightening numbers.

The Ebola virus has no treatment and no cure, although some promising research is under way (as I’ve written about previously). According to the WHO, the Ebola fatality rate is 50%. This makes it one of the deadliest diseases known to affect humans.

And now, alarmingly, Ebola has appeared in the U.S., in an airplane passenger who traveled from Liberia to Texas. This one individual has exposed as many as 114 others, all of whom are now being followed by the CDC.

In a press briefing yesterday, CDC Director Tom Frieden offered this reassurance:

“We know how to stop outbreaks of Ebola.  In this country, we have health care infection control and public health systems that are tried and true and will stop before there's any widespread transmission.  The core of that, the way to stop Ebola in its tracks is contact tracing, and follow-up.”

Dr. Frieden is correct that we can stop an outbreak, if we can find everyone exposed and quarantine those who might be infected. But he dismissed the notion of simply banning travel: 

“Although we might wish we could seal ourselves off from the world, there are Americans who have the right of return.  There are many other people who have the right to enter into this country.”

I'm not arguing that we should “seal ourselves off from the world." (Nor, I suspect, is Governor Jindal.) We are arguing to seal off just three small countries in West Africa, until the epidemic passes. This would not be a difficult ban to implement and enforce. For Americans who wish to return from those countries, we can require a quarantine protocol, which the CDC already has in place at many airports. As Jindal said:

"How exactly would stopping the entry of people potentially carrying the Ebola virus be counterproductive? This seems to be an obvious step to protect public health in the United States.”

CDC Director Frieden also revealed yesterday that in the month of September, screening at airports in African countries has turned away 77 people who had signs of possible Ebola infection, including 17 in the month of September. Although Frieden used this example to illustrate the effectiveness of CDC’s screening program, it also shows that sick people are trying to board planes to the U.S. As the outbreak grows, it will grow increasingly difficult to keep all Ebola-infected passengers—who don't show signs of infection for several days—off those planes.

Director Frieden is correct that we can stop outbreaks of Ebola here, because we live in a modern country with good infection control systems. But prevention is better than control. So much as I hate to admit it, Bobby Jindal is right: we need a travel ban if we want to keep the Ebola virus out of the U.S.