December 3, 2022

Caribbean governments missing the plot with Ebola travel bans

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0By Jovan Reid and Deborah Almond From AMG

With New York recording its first Ebola case, Caribbean travel bans on West African states are failing logical scrutiny

Several CARICOM governments have now individually imposed bans on travellers and nationals from the West African countries hardest hit by the Ebola virus.

Far from being a harmonized regional policy, the current patchwork application of travel restrictions sees some countries without entry bans at all, while others have imposed such vastly different restrictions that they are all collectively made weaker in the context of the region’s freedom of movement regime.

Loopholes in travel bans: Craig Spencer, a 33-year old American citizen who is now the United States’ second imported Ebola case, would have easily thwarted immigration controls in a handful of the now semi-locked Caribbean jurisdictions on his American passport alone. And with only a few states making provisions to quarantine their own residents, his border entry into a majority of CARICOM states would have been easier still were he also a dual-citizen of a Community state.

Despite populist support at home, the type of reactionary travel bans enacted within the Caribbean have been roundly criticized as being an illogical response to the West African Ebola outbreak. Echoing the political rationalisations for travel bans, Gaston Browne, Antigua & Barbuda’s Prime Minister and current CARICOM chairman, argued “even if we end up with a single case of Ebola, it has serious consequences for our tourism product” – consequences, Browne said, which would lead to “ immense hardship” for Caribbean people.

Limited net effect: With no direct flights between the African continent and the Caribbean, travellers from blacklisted West African states represent a minority of the Caribbean’s visitors to begin with.

Several major airlines have suspended flights to the countries at the centre of the outbreak anyway. For the Liberians, Guineans, Sierra Leoneans that make the convoluted journey across the Atlantic, a round trip between the continent and the Caribbean almost always requires transit of a major US or UK border – with responsibility for Ebola screening and surveillance falling first to the intermediary port.

In context, even without a ban and for all of its direct flights with West African countries, the United States has observed only two imported Ebola cases, with a further two spread by local transmission.

With tourism representing over 30% of GDP for some Caribbean states, there is no disputing the impact of Ebola hysteria on vulnerable Caribbean tourism sectors. Unfortunately, current travel bans will not eliminate the possibility of an Ebola case being entering the Caribbean, and the bans are fraught with too many inconsistencies to be relied on as a first defence.

A false sense of security: The major concern voiced by health agencies, including the Caribbean Public Health Agency (CARPHA), is that travel bans can give rise to a false sense of security, since they do not eliminate risk.

Island borders are less porous, but they are not impenetrable. If breached, bans may drive cases underground, where they take longer to detect and become far more dangerous. Visitors may be less truthful about their travel history or symptoms, increasing the risk of infecting others before their condition is detected. And infected travellers may also be less likely to seek medical attention, for fear of the consequences of putting themselves and others in danger.

History teaches that travel bans have not been successful in the past. HIV, bird flu, swine flu and SARS were not contained in this way, and the money spent on enforcing travel bans could better be spent to prepare medical staff and enhance public education on dealing with the disease.

If policy-makers’ intentions are to eliminate the possibility of even a single Ebola case being imported into the Caribbean on the premise that health systems cannot accommodate even one such event, there is a larger regional crisis to address

The current Ebola outbreak did not flourish in West Africa because there were cases of the disease, but because health systems were poorly prepared to contain the its spread.

Delegation of sovereignty: Rather than being an exercise of sovereignty and border protection, travel restrictions rely heavily on foreign airlines to enforce, with screening processes being carried out in the US and Europe where Ebola is present in small numbers, and where direct flights are common. Caribbean islands are at no comparative advantage for having bans in place, particularly if they serve to lower risk perceptions at home and at a public policy level.

Further, to fashion travel restrictions that are robust and responsive enough to prevent all potential cases and their contacts from entering the Caribbean is all but impossible. This is complicated even further by emerging cases and research which suggest that the currently accepted 21-day incubation period for Ebola may not be long enough.

Facing reality: To be fearful of a virus with an approximate 70% mortality rate is not irrational, but the lack of a coherent response from CARICOM countries is.

The role of governments at this time is not to give in to public opinion, but to manage fear and mitigate risk without causing hysteria. This involves thorough training of medical staff, infection control guidelines, effective disease surveillance and a clear public health message of vigilance.

Instead of requesting travel bans from their politicians, residents should demand to know how prepared their health systems really are and what help is available to strengthen infection control

The risk of Ebola landing in the Caribbean greatly reduces as the number of people who have the infection in West Africa reduces, and this requires united action from the global community. As a consequence, medical personnel from the Caribbean’s traditional source markets in North America and Europe must continue to meet shortfalls in Western Africa in order to halt the current outbreak.

As recent history has shown, when left to their own devices and poorer health systems, some of the hardest-hit countries will not be able to contain the disease, and the disease will not contain itself to the West African states currently blacklisted by regional governments.

While it is not possible for other Caribbean countries to respond in the same way as neighbouring Cuba – the country with the largest single contingent of front-line health care workers in West Africa – it is difficult not to relate to the words of the Cuban Ambassador to Liberia, Jorge Lefebre Nicolas, who said: “we cannot see our brothers from Africa in difficult times and remain there with our arms folded.”

On the basis of logic alone, now is not the time to close borders.

Jovan Reid is a social policy analyst and a specialist in media advocacy. Deborah Almond is AMG’s Health Editor and an infectious disease specialist. Both are graduates of the London School of Hygiene & Tropical Medicine.

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