Why Ebola Travel Bans are Misguided

The Ebola outbreak has hit a panic button at the core of the political, social and economic establishment across the continent. In a herd-like fashion, one country institutes a blanket ban, triggering others to follow, apparently with no careful assessment of unintended consequences.  Some countries like Cameroon and Equatorial Guinea have even extended the reach of their bans to all travellers from West African countries. But the most significant heavy-handed ban so far is by Kenya, the fourth largest economy and major hub of air travel in the continent.

Those extraordinary, fear-based measures only go to demonstrate the wide distance between policy and evidence in Africa. The targeting of people from the affected countries instead of Ebola is misguided and a non-starter in the chain of death of the disease, which will only end up in not only doing harm to those beleaguered economies but to all countries, even those who have put in place bans.

Targeting people instead of disease

In practice, Ebola, transmission risks by air transport is statistically very low.  In fact, it is over a month when a Liberian passenger brought Ebola to Nigeria, there has been not more than one confirmed case of the virus travelling by airplane, since then. There is only a very small chance that someone on a plane will be sick of Ebola and the likelihood of other passengers and crew having contact with the body fluid is even smaller. Ebola patients are often too sick to even board a plane. Through a rigorous scientific assessment of the risks of transmission, WHO and IATA have advised against blanket ban.

While Kenya has recently been alerted as a high-risks destination by WHO, banning air travel to and from Sierra Leone, Liberia and Guinea is far less effective than targeted public health measures at the port of entry. The fact that Kenyan citizens returning from those countries are exempted and passengers flying from Nigeria, an Ebola hit country shows the practical limit of the policy.

But a greater irony in the panicky ban, is the assumption that Kenya’s borders are watertight, something that flies in the face of reality. The recent spike in incidences of terrorism indicates how porous Kenya’s 3477km long borders are, such that militants from neighboring Somalia could cross and undertake frequent attacks.  Even if one assumes that Government has taken necessary measures to adequately police them, it is unlikely that border personnel would have the necessary equipment to detect and quarantine suspected patients. In fact, for fear of being contaminated, border officials may be unwilling to chase Ebola-suspected patients crossing illegally into the country.

Paranoid policies will end up hurting everyone more, like a vicious cycle. Because of the fear of stigma, Ebola hit-countries will have little incentive to put in place extraordinary measures at home if they believe they will continue to distinct them as pariahs. This could happen even when a real assessment of the risks necessitates such heavy-handed measures, unfortunately.  The Liberian Vice President Joseph Boakai, for example has remarked that the government hesitated to implement quarantine measures earlier because of fears that Liberia would become a “pariah” state, with damaging consequences for businesses, airlines and the fragile post-conflict economy. As a consequence of stigmatizing whole populations, the disease may continue in its uncontrollable trajectory with an increased probability of spreading to all countries even those that have taken extraordinary fear-based measures to contain it.

Counting the cost

But the immediate impact of the ban will be felt by the Kenyan economy, too.   The West African route is one of the most profitable to Kenya Airways (KQ), which undertakes 70 flights a week across the countries in the region including those hit by Ebola. Because of the direct cost, KQ was reluctant to go down the banning route but finally bowed to pressure by the Government and public who accused the management of putting profits ahead of safety.  The company is losing its natural competitive advantage as an African major career. The fact that ,  major competitors like Brussels Airlines  and Air France have not discontinued their services, means KQ will have to invest very much in regaining the trust of the west African clients in future, who feel  now abandoned by their own African carriers in the hour of need.

The self-inflicted damage will hurt not only the economy but the company the most. Insecurity and terror advisory by western governments have already drilled a huge hole in the company’s balance sheet, with losses of over 40 million dollars last year. KQ’s newly bought jets to better compete in the West African region which accounts for around a third of the company’s turnover, would likely remain idle. A rough estimate of losses could reach $10 million each month. Assume that Ebola scare continues in the next six months, KQ could loss up to 70 million dollars of unearned revenues.  That figure is 8 times more than the 671 million shillings which the Kenyan Parliament has recently refused to approve for the Ministry of Health to prepare against Ebola.

The need to protect tourism has been frequently presented in part as a reason for the extraordinary measures. But even before Ebola, runaway insecurity has been frightening tourists away.  Al -Shaabab has transformed its tactics from sporadic cross-border terror to something akin to domestic insurgency. Kenya’s tourism sector which provides 15% of the country’s GDP, generating $1.1 billion in revenues annually has taken a big hit. In May alone, it was estimated that the industry lost more than $10million due to cancellations in part from the fallout of the recent terrorist attack in the country. Simply put, the biggest fear of tourists is government’s incompetence and even more so the emerging tendency to politicize terrorist attacks. When Western countries issued travel advisory against their citizens travelling to kenya, the Government fought back angrily claiming that it was an attempt to sabotage the Kenyan economy. Now the Government seems to be carrying out a similar act of sabotage to the Ebola-hit economies

Well it appears the ban is not all that irrational. Kenya's government seems to have taken into account, in part, the invisible hand of ‘’real eonomik.’’   The Ebola-hit Nigeria, Africa’s largest economy— of almost thirteen times that of Kenya—  was spared from the ban. Trade between Kenya and Nigeria has been largely in Kenya’s favor, with an average of Sh 1.2 billion ($135million).  While trade between Kenya and the three Ebola-hit countries combine only amounts to $3 million in favor of Kenya.

Solidarity in reverse

To be fair, Kenya has taken some encouraging actions to provide emergency health support to the affected countries with a team of health specialists. While Kenya, has its own acute human resources for health challenges, token support provided to the desperately affected countries is an important mark of solidarity. African health workers have in a small way help to beef acute shortage of human resources. For example, there are only 200 doctors for the over 3.5 million people in Liberia.  And the reaching-out also demonstrates the gap at the continental level for a-ready-to-deploy mass of health workers in times of public health emergencies of international concern.

But African solidarity ends at the doorstep of self- interests.  One would be naïve to assume that states are concerned with something more than their interests. Nevertheless, unintended consequences of an interest-only foreign relation could be higher in the long-term with lasting damage to trust. Last year, Kenya stretched African solidarity to limit, rallying African countries to walk out of the International Criminal Court— stressing the need for African solutions to African problems.  Now when it comes to support Ebola-affected economies, every other thing does not matter except self-interest.

Preparedness postponed
Success in fighting Ebola requires more investment in health system than travel bans. It requires surge capacity to detect, investigate and manage the disease.  The International Health Regulations—IHR(2005), a set of globally agreed rules to bring every country including Kenya at the same speed of pandemic preparedness and response, outlines a set of core capacities that countries must put in place including quality laboratories, motivated and sufficient health workers, secured point of entry.

While Kenya has made some progress in implementing IHR, there’s an apparent dearth in capacities in many minimum core requirements to fight pandemics including Ebola— even when compare with peers. In a recent review of the IHR implementation, Kenya scored below  the  global  and African averages in the areas of human resources (57%) , laboratories  (40%)and points of entry (65%), risks communication 57% Kenya has even requested for an additional two years extension after the deadline expired in June 2014.

The Kenyan government has ignored the real health emergency facing the country: the chronic under-investment in healthcare systems. Even though, the country has committed to achieve the continental target of 15%, only 6% of government revenues are allocated to health. Not only is Kenya spending a relatively low amount as a percentage of GDP on healthcare, but the allocation of funds to public facilities has been uneven. According to a 2011 Healthy Action report, secondary and tertiary facilities have historically been allocated 70 percent of the health budget. And it is not clear if present devolution strategies will improve health care delivery. Last year, health workers were on strike against decentralization reforms as well as insisting on a pay rise and improved working conditions.

The Ebola outbreak provides an opportunity to reflect on the building blocks of the Kenya’s health system, their weaknesses and how to better provide services and tackle health insecurities in a forward looking manner, anchored on evidence rather than stigmatizing whole populations.