As governments in West Africa struggle to contain the Ebola epidemic, World Health Organization officials are warning that the suspension of flights and imposition of travel restrictions raise fears of shortages and could undermine the capacity to respond.
While advising countries to perform exit screening at airports, seaports and major border crossings, the WHO is recommending against any ban on international travel or trade.
But several international airlines have announced bans. Kenya Airways suspended flights to Sierra Leone and Liberia, effective Tuesday. British Airways, which stopped flights to the two nations earlier this month, will continue the suspension until Aug. 31 “due to the deteriorating public health situation in both countries,” spokeswoman Caroline Titmuss said.
Meanwhile, the health ministry in Kenya, the travel hub of East Africa, announced over the weekend that it was closing its borders to travelers from Liberia, Sierra Leone and Guinea.
Liberia and Sierra Leone declared a state of emergency a few weeks ago, restricting public gatherings and deploying the military to help health-care workers implement quarantine measures.
All borders in Liberia have been closed except for major entry points, where screening has been set up, according to the Centers for Disease Control and Prevention.
Fatalities across the four affected countries — Liberia, Sierra Leone, Guinea and Nigeria — reached 1,229, with 2,240 cases as of Aug. 16, according to the WHO.
“If you try to shut down air travel and sea travel, you risk affecting to a huge extent the economy, people’s livelihoods and their ability to get around without stopping the virus from traveling,” said Gregory Hartl, a WHO spokesman. “You can’t ship goods in. Sometimes these goods are basic staples people need to survive — food and fuel.”
He emphasized that official border closures would constrain resources to address the epidemic and would not stop all means of travel outside of affected areas.
“Any discontinuation of transport will affect humanitarian aid, doctors, nurses and human resources entering the country, the transfer of biological sampling and equipment for hospitals. All of this needs international transporting, international airlines,” said Daniel Menucci, a representative for the WHO Travel and Transport Task Force. “This will create more problems in helping the countries most affected.”
The WHO activated the travel and transport task force Monday to monitor the situation. It has convened for past crises, including the Fukushima nuclear disaster in Japan and the H5N1 bird flu pandemic. Menucci said the task force would advise air transport companies and the maritime sector so as to avoid “excess measures based on fear and not real risk assessment.” He gave as an example the shipment of fuel to ports, which he said is very low-risk.
The presidents of Liberia, Sierra Leone and Guinea are trying to restrict movement in and out of “hot zones,” which include the hard-hit cities of Gueckedou in Guinea, Kenema and Kailahun in Sierra Leone, and Foya in Liberia.
Liberian Vice President Joseph Boakai said the government hesitated to implement such measures earlier because of fears that Liberia would become a “pariah” state, with damaging consequences for businesses, airlines and the fragile post-conflict economy.
“There are restrictions on movement, and we’re concerned about inflation — prices of commodities will begin to rise as there might not be any new imports,” Boakai said in a telephone interview. “Liberia has no intention of exporting this to any other country, so there are travel restrictions. We’re going to be hurt, but it’s important it remains in certain regions.”
The Liberian minister for foreign affairs, Augustine Kpehe Ngafuan, said that although it is understandable for countries to take measures to protect their citizens, he had asked governments to heed WHO recommendations.
“This disease is not airborne, it requires physical contact,” Ngafuan emphasized. “Some of their actions might be disproportionate since there is very little risk as result of air travel. There is a panicked reaction across the globe, but disproportionate actions will only compound the problem here and limit our ability to contain the virus.”
People have begun to stock up on food as the prices of basic items rise, and the slew of flight suspensions to Liberia was contributing to concerns, he added.
The crucial question is whether restrictions on travel are effective in containing the epidemic.
Michael T. Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, warned that restrictions on travel are “doomed to fail” and said they would only create an underground system of travel across informal border crossings to neighboring countries with no accountability.
“If people really want to get out of there, they are going to cross a border somewhere,” said Osterholm, adding that restrictions will add to the panic and mistrust that has helped fuel the epidemic.
“I’d be the first one to say close the borders if it worked,” he said. “The chance of protecting people from leaving is greater with an open system. The more transparent you make it, the better you can control it.”
The quarantining of affected areas inside countries could be beneficial if the patients can be provided with health care, shelter, food and water to encourage them to stay, he said.
The “zillion-dollar question,” he said, is what happens if there is a shortage of basic supplies in affected countries as a result of restrictions.
The WHO also has stressed this point and is working with the World Food Program to provide emergency assistance.
“With the massive quarantine, people can’t move, people are afraid there will be no food; they’re hoarding food,” said Sahid Khan, the brother of Sheik Umar Khan, a lead doctor in Sierra Leone who died of Ebola in July. The price of basic commodities such as rice and palm oil are rising.
Weekly markets in Gueckedou, where the epidemic is thought to have originated, used to draw thousands of people from all three countries, especially this time of year, during the fruit season. Since the state of emergency, announced days after Umar Khan’s death, they have been abandoned.
Yet many people continue to travel in boats across rivers traversing the countries experiencing Ebola, Khan explained, and border officials are reluctant to pursue them because they fear they may become infected.
“I blame the WHO. If they had declared this an international emergency earlier, it could have localized the epidemic, but now the cat is out of the bag,” he said.