- The Washington Times - Wednesday, September 9, 2015

Last of three parts

The threat of a major Ebola outbreak has faded, but the travel bans imposed at the height of the epidemic are usually still in place, leaving tourists, business travelers and aid workers grappling with confusing and even contradictory policies that may be harming the very countries that need help the most.

President Obama resisted calls for a travel ban, instead imposing screening at select airports. But some countries went further, embracing weekslong bans or quarantines.

On the island of Hispaniola, Haiti still bars travelers who’ve been to the outbreak’s epicenter within the past 28 days. Their Dominican neighbors’ ban, meanwhile, lasts 30 days, according to Diversity Travel, a British website that’s tracking the restrictions. Both are longer than the incubation period for Ebola.

And it’s particularly hit aide workers who have to negotiate a web of rules.

“We’re constantly having to do research about this. It’s been a pain,” said Brett Sedgewick, an adviser for Global Communities, a nonprofit that had been working on sanitation projects in Liberia when the Ebola epidemic broke out.


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Border authorities tend to be more lenient with their own citizens, in some cases allowing them entry with enhanced screening instead of forcing them to spend time in an intermediary country.

Leah Ghoston, a Philadelphia native who lives in Jamaica and went to fight Ebola in Liberia last year, faced a short quarantine even after she was locked out of the country for weeks.

Initially she was told by two Jamaican officials that she’d have to spend three weeks in a stopover country after leaving West Africa. But by the time she was set to return in June, she was told the restriction was actually 28 days.

The duration seemed arbitrary, though, since the incubation period for Ebola is only 21 days.

“Any time outside of that, it’s open to interpretation,” said Ms. Ghoston, 32, who worked with a nonprofit, Project Concern International.

She waited out the four weeks in D.C. and touched down in Jamaica on July 13. The authorities interviewed her and let her leave the airport, only to call and say they’d made a mistake.

The problem? She arrived at 8 p.m. on the 28th day of the lockout, so they ordered her into home quarantine for three more days, stretching her ordeal to 31 days and leaving her no choice but to comply.

“I wasn’t going to risk getting deported,” she said.

The World Health Organization, the public health arm of the U.N., does not condone travel bans or automatic quarantine, and has only recommended exit screening for air passengers from each of the Ebola-affected countries. That screening should be maintained for at least twice the incubation period — 42 days — after the last case in West Africa, the organization says.

The WHO has been monitoring the travel situation since March 2014, and a spokesman said the organization got 10 countries to lift or modify their restrictions, although there are still 38 countries applying health measures that interfere with international travel.

Travel bans implicate social, economic and political concerns that vary from country to country, and there are few right answers, experts said. Health systems also vary, so the travel restrictions may reflect what each nation thinks it can handle in terms of isolation and monitoring should Ebola reach its shores.

“There’s really no consensus about what works, and it does vary from pathogen to pathogen,” said Aditya Bhattacharji, an analyst with the Eurasia Group.

With the Ebola epidemic winding down — Guinea and Sierra Leone each reported just one new case for the week ending Wednesday — the pressure to remove the bans is unlikely to be as intense as the pressure to impose them in the first place.

Analysts said the lingering restrictions could also slow West Africa’s post-Ebola rally.

“Getting as close to normal as possible will put these countries on the road to recovery,” said Amesh Adalja, a senior associate at the University of Pittsburgh Center for Health Security.

Complicating matters, Liberia was declared Ebola-free in early May and then confirmed a death from the virus in June, raising concerns about how long the virus will remain dormant in the region at large.

“There is a fear of that — you never really know when it’s over,” Mr. Bhattacharji said.

Mr. Sedgewick said Global Communities lost a promising recruit from Colombia this year after the would-be manager came to a daunting conclusion: So long as he worked out of West Africa, he wouldn’t see his family at all.

Because Colombia denies entry to travelers who have been in Ebola-affected nations in the past 28 days, the recruit would have to exhaust that time in an intermediary nation before heading home. By that point, it’d be time to head back to work in West Africa.

“It was effectively a deal breaker,” Mr. Segdewick said.

This month, Global Communities is holding a conference in Rwanda for about 50 of its employees. Their colleagues in Liberia will miss out on the training, though, because the host country maintains a 22-day ban on people from Ebola-afflicted nations.

The WHO’s director-general, Margaret Chan, said last week that overly strict travel and trade restrictions caused “some of the world’s poorest people” to run short on food and fuel, setting a poor precedent for reining in future epidemics.

“If countries are punished in this way, where is the incentive for rapid and transparent reporting?” she told a committee in charge of international health regulations in Geneva, Switzerland.

In the U.S., Mr. Obama resisted calls from Congress last fall for a travel ban or automatic quarantine of people entering from hard-hit countries.

Instead, his administration funneled travelers from Liberia, Sierra Leone and Guinea to five major airports for enhanced screening and, depending on their exposure to Ebola in West Africa, active monitoring by local health agencies after they left the airport.

The Centers for Disease Control said it doesn’t have a target date for scrapping those measures as the situation in West Africa remains fluid, although it no longer recommends that U.S. residents avoid nonessential travel to Liberia.

Between Oct. 11 and mid-August, Customs and Border Patrol had screened more than 25,000 people at U.S. airports JFK in New York, Newark Liberty in New Jersey, Dulles in Washington, O’Hare in Chicago and Hartfield-Jackson in Atlanta. Of them, only 40 were transported to a medical facility for further evaluation.

While there hasn’t been another Ebola scare, analysts say it’s difficult to say who was right or wrong in last fall’s debate.

“There’s a counterfactual — we don’t know what would have happened had we put a travel ban in place,” said Mr. Bhattacharji, who noted the U.S. would have been seen as undermining the WHO if it had barred travelers.

Rep. Marsha Blackburn, Tennessee Republican, said a mandatory 21-day quarantine would have been the right approach. U.S. troops were isolated after stints in Liberia, and the administration’s strategy “caused uncertainty and fear.”

“Instituting the travel ban would have been the right thing to do from both a public policy standpoint and for public perception,” she said through a spokeswoman.

For their part, aid groups told The Washington Times they were pleased with the administration’s approach.

“The process was very professional for all of our travelers returning from Ebola-affected nations,” said Richard Parker, vice president for marketing and communications at PCI.

As transmission slows in West Africa, nonprofits are reporting cracks of daylight in nations that took a tougher stance. Kenya, for instance, recently loosened its travel restrictions on citizens who return from affected countries, and several airlines resumed service to Sierra Leone this summer, according to World Vision, a Christian nonprofit operating in the region.

Also, the slowdown in new cases has allowed groups to transition more of their efforts to local agencies, meaning fewer foreign workers need to travel in and out of the hot zone.

Dr. Robert Quigley, senior vice president for medical assistance at International SOS, a company that advises clients on global medical and security issues, said calls about travel restrictions are giving way to inquiries about moving forward in West Africa.

“Most of them are calling [saying], ‘What do we do when we resume operations?’” he said.

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