Monday, December 29, 2014

Ebola: Modern Air Travel the Game Changer for Pandemic Disease



Ebola Virus Photo: CDC
Today, 12, December, 2014, Scotland reported its first case of Ebola. A report in the Guardian suggests that the patient became symptomatic following a flight from Sierra Leone to Heathrow. The Guardian notes: "Urgent steps were being taken by officials with Health Protection Scotland and Public Health England to trace scores of passengers on the nurse’s Royal Air Maroc flight into the UK from Casablanca in Morocco, and the 71 passengers on her internal British Airways connection – BA 1478 – from Heathrow to Glasgow on Sunday night. Nicola Sturgeon, the Scottish first minister and previously Scottish health secretary, said on Monday evening the search for passengers “was very much a precautionary measure”. The nurse, who is believed to be at the early stages of the infection, had been cleared by screening in Sierra Leone and at Heathrow.“The risk to other people as a result of this Ebola case is deemed to be extremely low,” Sturgeon told a press conference." Source: http://www.theguardian.com/world/2014/dec/29/ebola-case-confirmed-glasgow-healthcare-worker
As the viral load is usually very low at the beginning of the disease and Ebola is thus far not airborn, it is highly unlikely other passengers were exposed, however this case serves to highlight how modern air travel has changed public health security and increases the risk of pandemic disease. Current measure to screen travelers from West African countries, in my personal view, are pointless and in place only to assure the general public. While nations with sophisticated public health infrastures can contain highly pathogenic diseases rather swiftly and the Glasgow case does not pose any threat of epidemic or pandemic, travelers from capital regions in West Africa and transportation to other nations with little or no public health infrastructure poses a more urgent risk. Having sat through years of WHO communicable disease surveillance discussions it is the 'pace not the space' as they say when it comes to disease transmission. In numerous table top exercises and scenario based pandemics which I've developed and run over the years, air travel remains one of the major factors in the how fast disease is spread. Not only are airplanes an ideal inclosed incubator for several hours but the transiting of potentially infected passengers through major airport hubs offer viruses global reach. 
In considering realistic containment strategies, screening passenger for fever would not be one that immediately springs to mind as it is entirely reactionary with little scientific evidence to support this method. Halting air travel or imposing restrictions is often not usually an option and can have devastating impacts on nations which are essentially embargoed. Ideally, when an outbreak of a disease like Ebola or other highly pathogenic diseases emerge as an epidemic, nations with resources such as mobile labs, field hospitals and medical staff must immediately be put in place in country. It may be wise to limit passenger air travel out of endemic regions for defined periods of time and to require all health care workers undergo, in the case of Ebola, a 21 day quarantine in country. This too must be looked after by the international community and resources provided to efficiently manage the transiting of health care workers from paid quarantine in country back to home countries with health certificates clearing them. This would be far more valuable and cost effective than even one case arriving into non-endemic countries. However, in order to actually do this the international community would need to set up a  state of the art treatment center where all health care workers could receive the same treatment they would receive upon evacuation their countries of origin or Europe. Regardless of if the most recent Ebola outbreak continues we need massive investment for West Africa in public health care. To limit transmission through travel, requires not only a state of the art high containment clinic, but more general investment across the board in public health infrastructures. Superficial measures which waste resources should be re-considered. 
If we want to end Ebola we need to keep it from travelling and eradicate it at the first signaling of outbreak, anything less advantages this virus. A total commitment must be made by the international community to develop and maintain public health security in states which can not provide their own. Investment is a global issue and an international responsibility. 

Dr.Jill Bellamy is an internationally recognized expert on biological warfare and defence. She has formerly advised NATO and for the past seventeen years has represented a number of bio-pharmaceutical and government clients working on procurement strategy between NATO MS and Washington DC. Her private government relations consultancy Warfare Technology Analytics is based in the Netherlands. Dr. Bellamy's articles have appeared in the National Review, The Wall Street Journal, The Washington Post, The Sunday Times of London, Le Temps, Le Monde and the Jerusalem Post among other publications. She is a CBRN SME with the U.S. Department of Defence, Chemical, Biological, Radiological and Nuclear Defence Information Analysis Center and CEO of Warfare Technology Analytics.

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