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Ebola travel: Vigilance, not bans

Dr Isabelle Nuttall, Director, Global Capacities, Alert and Response, WHO

5 November 2014

Stopping the entire world from travelling is not the solution to containing this outbreak of Ebola virus disease. We know what is needed to stop this outbreak and it doesn’t include banning people from traveling from West Africa to the U.S. or Western Europe. Travel bans are detrimental and ineffective.

Cutting off beleaguered West African nations would be catastrophic to families and economies. People in countries, far from the hot zone, may be lulled into a false sense of security, believing Ebola can never reach them if flights are halted. In reality, it is impossible to stop the movement of people motivated to see loved ones or seek a better life for their children. Every day there are millions of people crossing the planet, not only by airplane but traversing uncontrolled land borders in remote areas, or as crew on the thousands of ships trading goods up and down the world’s coastlines.

Isabelle Nuttall, Director, Global Capacities, Alert and Response, WHO

The key to stopping the international spread of this disease is global vigilance. A significant role of the World Health Organization is to prepare countries to respond effectively to public health threats of international concern. These are not just infectious disease outbreaks, but can include foodborne, chemical or nuclear hazards.

All countries need to have strong systems in place to identify people at risk at the earliest possible moment, and apply stringent prevention and control measures for any case detected.

Measures to halt international spread of Ebola

Governments may choose to implement routine screening, such as measuring temperatures and obtaining a travel history for every passenger at international airports, border crossings and seaports. While not foolproof, screening may identify some at-risk travellers, and will certainly serve to reinforce awareness of how to stay safe in these uncertain times.

Ports of entry need to have effective plans in place in case fever or other symptoms are detected in a traveller from an Ebola-affected country. WHO is working closely with the aviation and maritime sectors to provide guidance to airline and shipping crews and staff working at points of entry on how to recognize Ebola symptoms and what to do to protect themselves and others while getting that sick person to care safely.

The key to stopping the international spread of this disease is global vigilance.

Dr Isabelle Nuttall, Director, Global Capacities, Alert and Response, WHO

Every frontline health care worker needs to be on the lookout for people presenting with a fever or other symptoms of Ebola (flu-like aches, vomiting, diarrhoea, rash and bleeding) and must routinely ask about that patient´s travel history. Every medic, nurse and doctor in every ambulance, emergency room, urgent care or doctor´s office must be prepared. Local health departments will need to be able to trace back every contact that infected person has had in the past 21 days and monitor each of those people for symptoms.

All countries also need access to trained technicians who can safely collect a blood sample, transport it and test it at a qualified diagnostic laboratory.

Symptomatic patients will need lifesaving care in isolation wards with health workers trained specifically in the meticulous infection control procedures needed to protect themselves and others. Intense hydration so the immune systems can fight the virus is a proven way to save lives.

Preparedness needed to respond

To compliment these measures, countries should provide their citizens traveling to Ebola-affected countries with accurate and relevant information on the outbreak and measures to reduce their risk of exposure.

These are proven, effective measures to halt the international spread of Ebola. Nigeria and Senegal implemented these measures effectively. Both countries have now been declared Ebola free. The current Ebola epidemic in West Africa is unprecedented in scale. The disease is deadly but you need to have close, direct contact with the bodily fluids of an infectious person who is currently showing symptoms to be at risk of being infected.

To end this epidemic and prevent future disease outbreaks, we must focus less on the travel ban debate and more on ensuring all countries are prepared to deal with a possible case of Ebola.

If the world wants global security, we have to work together to ensure poor countries have stronger health systems, including early warning systems to report outbreaks earlier.

WHO's role

Right now, WHO’s priority for preparedness are the countries at potential highest risk of Ebola outbreaks. These countries, near those at the epicentre of the outbreak, include Côte d’Ivoire, Guinea Bissau and Mali. WHO and partners have developed a consolidated check list to be used by countries to ensure they are prepared to prevent, detect and respond to the introduction of a case of Ebola. Missions are being conducted in these countries and 12 more African countries identified as potentially at risk of introduction of an Ebola case.

Being ready to deal with the introduction of an Ebola case will lay strong foundations for systems that will last beyond this outbreak of Ebola so that these countries are better prepared for any other health emergency that is likely to arise in the coming years.

This text is an updated version from an opinion piece published on 10 October 2014 in US News.