Robert Meyer and Lawrence Gostin on Managing the Risks of Ebola

The U.S. move to screen travelers from three West African countries at five airports for signs of Ebola has drawn the usual share of controversy. Is it sufficient as a preventive measure? Or is it an overreaction? Some see it as a PR tactic aimed at preempting criticism that the Obama Administration did not do enough should the epidemic worsen. Others see it as the best the government could have done under the circumstances.

The decision to screen air travelers was announced in the wake of other significant news: Liberian national Thomas Eric Duncan died of Ebola last Wednesday at a Texas hospital, three weeks after landing in the U.S. “To a large degree, this is a public relations issue. If you look at the … actuarial risk associated with this, it is not really that high,”said Wharton marketing professor Robert Meyer, who is also co-director of Wharton’s Risk Management and Decision Processes Center.

“It certainly is a Band-Aid fix. President Obama is under enormous and intense political pressure to do something,” added Lawrence Gostin, professor of global health law at Georgetown University Law Center. Gostin is also faculty director of the university’s O’Neill Institute for National & Global Health Law.

Gostin and Meyer shared their perspectives on the wisdom of the U.S. government’s decision regarding airport screenings on the Knowledge at Wharton show on Wharton Business Radio on SiriusXM channel 111. (Listen to the podcast at the top of this page.)

Last Saturday, the Centers for Disease Control and Prevention (CDC) began screening passengers arriving from Guinea, Liberia and Sierra Leone with temperature checks, detailed interviews and questionnaires. The five airports selected for the screenings are John F. Kennedy International Airport in New York, Washington Dulles International, Newark Liberty International, O’Hare International in Chicago and Hartsfield-Jackson International in Atlanta. These airports account for 94% of travelers to the U.S. from the three West African nations grappling with the Ebola outbreak. Nigeria and Senegal have not reported any new cases since September 5 and August 29, respectively, the CDC said. The latest outbreak of the Ebola disease has claimed 3,742 lives in West Africa, the agency reported in its latest update.

“I can’t anticipate any relief [from Ebola] until 2015, if we are lucky.” –Lawrence Gostin

The airport screening of travelers “may not be reliable,” since Ebola has a 21-day incubation period, said Gostin. The tests will not raise red flags about a lot of people because they will not be symptomatic of Ebola. On the other hand, it could generate a lot of “false positives” showing the virus to be present when it may not be so, he noted. Further, this also happens to be the peak season for flu, malaria and tuberculosis, all of which could mask symptoms of Ebola, he pointed out.

However, all things considered, the airport screenings were the best option for the Obama Administration, as it is “under enormous and intense political pressure to do something,” said Gostin. In fact, some are calling for more extreme measures, he added. Prominent senators have called for travel bans and mass fever screenings of all passengers from sub-Saharan Africa.

Meyer agreed with Gostin, and said the decision to conduct airport screenings is “a fairly appropriate and measured response…. The key thing in all risk management is controlling the objective risk by putting in all the resources, but also to manage the psychological risk. In a lot of cases, the psychological risk is greater.”

Call for Action

Decisive action of some sort in battling Ebola has become all the more important because no drugs are currently available to be shipped to the affected West African countries, said Gostin. ZMapp, the experimental drug developed by Mapp Biopharmaceutical of San Diego, Calif., that successfully treated two American aid workers who contracted the disease in Liberia, is not available. The U.S. Department of Health and Human Services has contracted with the company to make a small amount of the drug for early stage clinical safety studies and nonclinical studies.

There are some encouraging developments, however, on the treatment front, Gostin noted. At least two promising vaccines are in development, and “there are a number of antibody and antiviral treatments that we hope we could get out fairly soon,” he said. The National Institutes of Health is working on an investigational vaccine to prevent Ebola and is collaborating with a company to develop an antiviral drug, while the U.S. Department of Defense is working with three companies that are developing Ebola treatments. All the same, “I can’t anticipate any relief until 2015, if we are lucky,” said Gostin.

Gostin noted that President Obama has not yielded to pressure to impose travel bans to and from the affected West African countries. A travel ban would be “a disastrous policy,” he said, explaining that it could have a “potentially devastating economic, commercial, trade and humanitarian impact on the region.” It could cause a collapse of the already fragile health systems in those countries and food shortages, and prevent aid workers from operating freely, he added. “In this modern globalized world, you really can’t put cellophane wrap around three countries and expect to keep a highly pathogenic novel virus [contained]. It just doesn’t work that way.”

Overreaction to Fears?

Meyer felt that even the airport screening move may be an overreaction, considering that the virus is not airborne. He compared the fears over Ebola to those concerning possible terrorist attacks. “People have very high degrees of latent fear associated with it,” he said, “even the fear doesn’t seem to have that much of a rational basis in terms of what the real risk is.”

“In this modern globalized world, you really can’t put cellophane wrap around three countries and expect to keep a highly pathogenic novel virus [contained]. It just doesn’t work that way.” –Lawrence Gostin

Meyer said the move to conduct airport screenings is a “PR game” where the actions are guided by motivations “to lower people’s fear [and] make sure that the government seems to be doing something.” However, he agreed that most Americans will understand that the screenings are not the perfect solution, and that the move could backfire.

Meyer explained that although the government could have used the money spent on the screenings more efficiently by funding research to develop Ebola treatments, people need “a tangible sign” to reassure themselves that the government is indeed acting decisively. As an example, he cited the terrorist plots involving an “underwear bomber” and a “shoe bomber” that resulted in the U.S. investing in 1,800 body scanners at airports across the country and requiring travelers to remove their shoes at security checks.

“Why this extreme overreaction to … an event which would never occur again?” Meyer asked. The screenings are very visible, reduce fears and “give the sense that the government is actually doing something as opposed to working behind the scenes in a ‘Trust us, we’re taking care of it’ mode,” he noted.

In that context, Meyer concluded that the latest set of airport screenings were to ensure that the Ebola scare in the U.S. does not become “a wholesale panic.” The worst thing that could happen is for people to decide to drive to relatives’ houses instead of flying during the Thanksgiving holidays, he said. “That could result in a far higher death toll by putting so many people on highways.”

Ground Realities

Will the screenings actually work? Gostin doesn’t think Duncan, the Liberian national who died of Ebola last week, could have been saved if the airport screening measures had been in place on September 20, when he entered the U.S. Duncan wouldn’t have shown symptoms of the disease at that time, Gostin pointed out.

“What would you do if you or your five-year-old daughter was exposed to Ebola and you wanted to get to the United States for treatment?” Gostin asked. “Would you disclose it? You would have to not tell them because they wouldn’t let you in the country. Your instinct would be to try to evade it and get to a hospital.”

“We have to catch it before fear gets out of control; and certainly there is a very real risk associated with the disease itself. It is not an illusion.” –Robert Meyer

Gostin said that during the SARS epidemic of 2002-2003, Canada and some Asian countries screened thousands of passengers. “But they never picked up one confirmed case and [generated] a lot of false positives,” he added. He recalled that on a trip to Beijing at that time, the airline he used handed out Tylenol tablets to first-class passengers to avoid the fever screenings. The SARS (or severe acute respiratory syndrome) outbreak originated in Hong Kong, spread to 37 countries and claimed 775 lives.

In the face of such obstacles, what can health care workers realistically do to contain Ebola? People who have been exposed to Ebola victims should be given rapid diagnosis, rapid treatment, isolation and careful monitoring, said Gostin. At the first signs of fever or other symptoms, they should be quarantined, he added.

“But you need to have a plan in place for safe, effective, humane quarantine. We saw how that really broke down in Dallas,” Gostin said. “It was very concerning to see the lack of capacity and preparedness in a large American city.” Duncan had sought care for fever and abdominal pain at the Texas Health Presbyterian Hospital in Dallas two weeks before he died but was initially sent home; he didn’t show signs of Ebola at the time. He returned to the hospital when his condition worsened, and he died on October 8.

Fears of Alien Diseases

Meyer said Americans’ fears about Ebola are “wildly out of proportion to the actual risk” and offered an explanation: “It speaks to some fundamental fears we have had for generation — the notion of incurable disease that comes from alien countries, for which there is a lot of dread … and there is no control.”

Even as some of the fears about Ebola may be overstated, more needs to be done in developing vaccines to fight it, said Meyer. “We have to catch it before fear gets out of control. Certainly, there is a very real risk associated with the disease itself. It is not an illusion.”