Needed: U.S. Quarantine Policy Based on Facts Not Fear
The governor of Louisiana, Bobby Jindal, announced last week that people who have traveled to Liberia, Sierra Leone or Guinea in the past 21 days, regardless of any known exposure to anyone infected with Ebola, are not welcome in the state, lest they be “confined to [their] room.” This follows poorly thought out quarantines issued by Governors Andrew Cuomo of New York and Chris Christie of New Jersey. The shortsightedness of these policies is now getting the media attention it deserves. These policies, based on fear and politics and not science, reinforce the growing global perception that the U.S. approach to the Ebola crisis is full of contradiction and inconsistencies.
While the U.S. government is a leading contributor in the global response to the West African Ebola crisis, the people of the United States are perceived as being backward and misinformed in their understanding of the disease and the threat it poses. Former Centers for Disease Control and Prevention Director and Bill and Melinda Gates Foundation Senior Fellow Dr. Bill Foege, credited with devising the strategy for the eradication of smallpox, recently wrote, “the critics [of a science-based approach to Ebola] themselves may be a bigger risk to public safety than this virus.”
The decision by Louisiana is one of a growing number of Ebola-related policy decisions at the state level that are having a chilling effect on the contribution of America’s brave medical workers and scientists to the fight against the Ebola epidemic. The recent case of Kaci Hickox, a nurse who resides in Maine, required judicial intervention in order for her to remain free from the quarantine ordered despite her negative Ebola status. She argued, and the courts upheld, that there were no grounds for quarantine given that Ebola is hard to transmit and is not contagious until a person is symptomatic, which she is not. Maine Gov. Paul R. LePage, seemingly more concerned with public opinion than scientific facts, had stated that he would exert “the full extent” of his authority in this case.
The implications of these policies are far reaching. The annual meeting in New Orleans this week of the American Society of Tropical Medicine and Hygiene is intended to bring together leading scientists and researchers to exchange on the world’s greatest infectious disease threats. However, due to Louisiana policy, some of the global leaders most involved in the fight against Ebola were not able to attend the conference because, in the past 21 days, their work included travel to the three countries currently most affected by the crisis. The upcoming annual meeting of the American Public Health Association, scheduled to take place in New Orleans in November, is also subject to the same restrictions.
The absence of these voices will be notable, and may result in diminished collaboration, alignment and progress on fighting the disease abroad and preventing its spread domestically. If other U.S. states adopt this type of misguided policy, progress against Ebola could come to a standstill since pre-eminent scientists and public health leaders from institutions such as the CDC and the National Institutes of Health would be confined to home. Similarly, U.S. health workers will be further deterred from volunteering to treat patients abroad and might even hesitate to respond to needs as they arise here in the U.S.
The U.S. has a long, rich history of leading the fight against infectious disease including smallpox, polio, HIV/AIDS and now Ebola. While our decentralized system of government allows for decision-making at the state and local levels, it does not condone the abdication of responsibility for rational policy-setting. If LePage had relied on science to resolve the case of Hickox, he would have become a role model for leadership at the state, national and global levels. Jindal has similarly failed to rise to the leadership challenge of parsing unfounded threats from fact in managing the question of Ebola in his state.
At the same time however, Congress’ interest in expert testimony has been demonstrated through Ebola-focused briefings on the Hill, with hearings held over the past few weeks and another planned for Nov. 12. These hearings provide an excellent platform for weighing the implications of proposed quarantine measures, and we encourage members to take full advantage of their convening power to do just this. We can only hope that the good women and men elected in the midterm elections grasp the opportunity they have to exert leadership in the area of global health through evidence-based policy-making.
Dr. Christine Sow is the executive director of the Global Health Council and has more than 20 years of experience working in infectious disease, maternal and child health and health systems strengthening in West Africa.