Experts say a travel ban could do more harm than good. Why a travel ban wouldn't work

The political momentum for a travel ban on West African nations continued to swell Thursday, but health and transportation experts were uniform in saying it wouldn’t stem the spread of Ebola — and could do more harm than good.

That hasn’t stopped politicians and pundits — ranging from House Speaker John Boehner to former Obama press secretary Jay Carney — from calling for a travel ban. The appeal is obvious: It sounds like a no-brainer to build an infectious-disease moat around the U.S., blocking some flights and barring people who come from the countries suffering the worst Ebola outbreaks.


But the reality, the experts say, is that those kinds of measures have failed before. And this time, experts inside and outside the administration warned, throttling travel would hammer already devastated West African countries, make it difficult to send relief where it’s needed, and send an unknown number of infected travelers into the shadows, increasing the difficulty of knowing how many were entering the U.S.

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“Right now we know who’s coming in,” Tom Frieden, the director of the CDC, told a House subcommittee Thursday.

While Frieden didn’t slam the door entirely — he said CDC “will certainly consider anything that would reduce risk to Americans” — others in the administration fanned out to talk up the drawbacks of a ban.

A travel ban is “not something that we’re considering,” White House press secretary Josh Earnest said Thursday. FAA chief Michael Huerta, who says his agency is playing only a supporting role, echoed the CDC’s direction that a flight ban “in and of itself does not address the challenges that we have here.”

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The administration’s critics scoffed at those rationales, saying it’s time to close the doors to people who could bring the contagion here.

“We need to send the signal now: Our border is closed,” said House Energy and Commerce Chairman Fred Upton (R-Mich.). “Until we resolve this issue in West Africa, we are not going to allow folks with visas from that region to be coming to the United States until we can get the problem fixed.”

To date, about 30 countries have implemented restrictions for travelers coming from the West African countries at the heart of the Ebola outbreak — Sierra Leone, Guinea and Liberia. But all but two of those — St. Lucia and Colombia — are African nations.

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Here’s why administration officials and other health experts say the U.S. should not join that list:

1. It would choke off aid and could worsen the outbreak

Travel goes both ways, and cutting off transport from West Africa would hamper the flow of medical supplies and aid workers into the afflicted region. That could allow the disease to spread further, allowing more cases to crop up around the world, including the United States.

“If we do things that unintentionally make it harder to get that response in, to get supplies in, that make it harder for those governments to manage, to get everything from economic activity to travel going, it’s going to become much harder to stop the outbreak at the source,” Frieden said. “If that were to happen, it would spread for more months and potentially to other countries, and that would increase rather than decrease the risk to Americans.”

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Robert Mann, an aviation consultant, said there’s merit to that argument.

“If you literally sequester the markets, which is to say remove all scheduled service, you really eliminate the possibility of practical access to those markets by public health officials and public health [groups] who are trying to help,” Mann said. “You would force them into the charter market, which is very expensive and in some cases also not very practical.”

Mann said the economics of chartering a plane to operate in West Africa are particularly challenging — and, by extension, especially expensive, likely rising quickly out of reach for most non-government organizations or aid workers.

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He said a 16-seater plane capable of flying from North America to Western Africa nonstop, chartered from a reputable firm, would cost around $12,000 per hour for a 16-hour round-trip flight, not including ground handling costs, plus fuel costs for the return trip. He said some charter companies might be reluctant to even offer services to an Ebola hotspot, for the same reason an airline wouldn’t care to fly there.

“It’s really not practical for 16 people to pay what may be $200,000 to charter a jet — and compare that to the fares on scheduled airlines,” which might be about $1,200 per person.

Adam Kushner, a surgeon at the Johns Hopkins Bloomberg School of Health, agreed that a ban would create a chilling affect on aid workers, as well as non-government groups like Doctors Without Borders.

“It is already very dangerous to go over, but what if going in you know that you might not be able to come back,” said Kushner, who has worked as a surgeon in several developing countries, and who published a study in 2010 that found that U.S. hospitals during the Civil War were better equipped than present-day hospitals in Sierra Leone. He said the region already suffers a shortage of aid workers.

“I would estimate that the average ambulance in the U.S. has more supplies and equipment than most district hospitals in these countries,” Kushner said.

In addition to health supplies and workers, travel restrictions could seriously disrupt the three countries’ already fragile economies.

“There’s still a critical shortage in the amount of medical personnel that are needed but it’s also supplies — food and fuel and all sorts of other goods that are needed by the region,” said Jennifer Nuzzo, a senior associate at the University of Pittsburgh Medical Center’s Center for Health Security. “We still have to maintain their economies. This situation is already a disaster, we don’t want to exacerbate it by completely choking off travel and trade.”

2. It would make it harder to track infected people

Experts say a travel ban would make people less likely to seek treatment or be honest about any contacts they have had with Ebola patients. And it could encourage people to leave West Africa in other ways before heading to the U.S., making them harder to track.

During Thursday’s hearing, Frieden warned about Africa’s “porous” borders, saying they make it easier for infected people to migrate to neighboring countries before traveling elsewhere. By circumventing the initial screening measures in West Africa, passengers could come into the United States and officials would not know to check for Ebola-like symptoms.

“If we try to eliminate travel, the possibility that some will travel over land, will come from other places and we don’t know that they’re coming in, will mean that we won’t be able to do multiple things,” such as check the temperatures of travelers arriving from countries with Ebola outbreaks, Frieden said.

A travel ban is “something that sounds good but it’s difficult to enforce. You can’t really stop everyone from traveling,” Kushner said. “People who want to travel will find ways to travel. They may cross borders, go to other countries, fly from there or drive.”

3. Lawmakers are long on opinions, short on practical ideas

Several lawmakers, mostly Republicans, have suggested the administration impose travel restrictions but have offered little in the way of how to implement a ban.

Chief among the unanswered questions: Is it really practical to institute a ban for people who arrive through a connecting flight, since no direct flights now link U.S. airlines to Ebola-stricken countries? If the U.S. were to bar travelers from West Africa, would that restriction apply only to citizens from the three countries most affected, or would it also apply to aid workers, volunteers and people residing in those countries who have passports from elsewhere?

Mann, the consultant, said that despite Africa’s size, comparatively little air service exists, with West Africa being particularly sparse. Historically, few direct flights have linked North America and Africa, with almost all of them ending up routed through connecting flights in other countries, which would increase the complexity of a flight ban.

“It’s difficult because historically there’s been huge polarization of incomes, not a very big middle class,” Mann said. “In many of these countries the historical air routes have been to and from colonial interests, so to France, to Germany, to Belgium, to the U.K. in some cases. And so most of the service from North America to Africa also routes via Europe.”

One lawmaker, Rep. Steve Scalise (R-La.), advocating suspending visas for all non-U.S. citizens coming from Sierra Leone, Liberia and Guinea. Frieden was noncommittal on that idea, saying that “CDC doesn’t issue visas.”

4. The math doesn’t add up

Health officials say the best way to control the outbreak is to stop the disease at its source. The methods employed to stop it from spreading elsewhere involve conducting airport screenings for West African travelers, both when they leave the area and when they land at their final destination.

So far, those screenings have turned up little in the way of potential Ebola cases, making experts skeptical that more extreme measures, like a flight ban, would be more effective.

Health screeners have checked about 36,000 people leaving West Africa over the last two months, of whom 77 exhibited some sort of Ebola-like symptoms as of last week.

But none of those 77 people had Ebola, and many actually had malaria, Frieden said.

In newly begun screenings at U.S. airports, Customs officials said Thursday that of 155 people who have been screened at JFK, eight people were pulled out for additional screening but all were released. None had Ebola.

Frieden said similar travel bans in other countries during the SARS outbreak a decade ago proved “unnecessary and ineffective,” pointing to an estimated $40 billion in lost economic activity due to the travel restrictions.

In fact, during the outbreak of SARS, which unlike Ebola can be spread through the air, the United States did not ban travel. As now, officials instituted temperature screenings and health and travel questionnaires at points of departure and entry, and instituted close monitoring.

Mann said the travel industry’s response to SARS was “very effective, and travel in this country didn’t stop.”

“Capacity was way down in the markets that were directly affected — so to China, to Vietnam, to Thailand, to Hong Kong,” he said. But he reiterated that unless a person is actually showing symptoms, the possibility of infection is “vanishingly low.”

He also noted that so far, crews that serve the region aren’t bailing out — on a call with Delta Air Lines Thursday morning, the airline said its crews who service West African countries that used to have Ebola problems are not ditching those routes, “a good proxy for the concerns other people might have as well,” he said.

“We have to make rational decisions here,” Mann said. “There’s really no room for hysteria.”