Emerging diseases NIMBY?
The current U.S. administration is clearly taking a NIMBY (not in my backyard) approach to emerging disease, manifest in responding to the Bundibugyo ebolavirus outbreak in the DRC with travel and entry bans and plans for the offshore quarantine & treatment of exposed U.S. citizens in Kenya, all while dismantling USAID, which had in the past been instrumental in outbreak containment & management, ending participation in the World Health Organization’s interventions on the ground, and crippling the CDC’s National Center for Emerging and Zoonotic Infectious Diseases.
Once again, the travel and entry ban and the plans for offshore quarantine and isolation represent the Politician’s Syllogism:
Something must be done.
This is “something.”
Therefore, this must be done.
All the better if it suits the Nationalist, isolationist “America First” agenda, which apparently trumps (pardon me) the need for effectiveness and benefit.
At first glance, it may appear intuitive that keeping cases of contagious disease off of U.S. soil might reduce the chance for a local epidemic, but the reality is far more complex.
Travel bans do not stop the spread of infectious disease
Although international travel controls may temporarily delay the first epidemic peak of cases in a pandemic, in today’s global economy they are not effective in preventing the importation of communicable diseases. Exemptions always exist, and people of privilege who know how to get around travel bans will step around these precautions. Pathogens are often transmitted before the reactive imposition of entry restrictions. Isolationist responses result in failure to address distant outbreaks, which allows pathogens to proliferate and evolve.
Ebola and Andes hantavirus do not currently present a risk for epidemic transmission in the U.S.
The principal drivers of Ebola transmission are patient care without adequate barrier precautions and burial practices. Transmission of Ebolaviruses requires close physical contact, and can be contained by isolating patients and utilizing strict barrier nursing and infection control procedures. Since the 2014 West African outbreak, which involved the repatriation of 10 exposed and 9 symptomatic U.S. aid workers, over $1 billion in public health resources has been invested in 56 U.S. hospitals designated as Ebola containment and treatment centers, with the CDC’s Maximum Containment Unit at the Emory University Hospital in Atlanta and the National Biocontainment Unit at the University of Nebraska Medical Center in Omaha best experienced and equipped to manage symptomatic cases. The U.S. possesses sufficient resources to effectively manage exposed and symptomatic individuals without risking transmission.
In Sub-Saharan Africa, Ebola viral disease is only maintained in the human population in temporally limited outbreaks; its recurring presence in Sub-Saharan Africa is dependent on periodic reintroduction in zoonotic spillover events from its reservoir in fruit bats, with no comparable potential reservoir existing in North America. Human-human transmission is only seen in short transmission chains. The “what if it becomes airborne?” question comes up, but is an unrealistic concern in the short term that would require substantial viral evolution in adaptation to replication in human respiratory epithelial cells.
What about Hanta?
The Andes hantavirus is only poorly transmissible person-person, requiring symptomatic respiratory disease and close contact in confined environments. Other hantaviruses are incapable of human-human transmission. Most nations are permitting self-quarantine at home of asymptomatic exposures in MV Hondius passengers, as it is highly unlikely that the virus would be communicable under normal circumstances. The decision to enforce confinement of U.S. passengers at the National Quarantine Unit at the University of Nebraska Medical Center in Omaha is based on political optics and fear-mongering rather than medical reality.
Isolationist approaches contribute to the emergence of diseases
The conditions that might result in improved viral adaptation to the human host and facilitated human-human transmission are dependent on widespread infection in human populations, providing the opportunity for mutation, recombination, and selection. The best way to thwart this is to focus efforts on outbreak containment, monitoring, & management. The U.S. CDC and USAID, and their cooperation with the WHO, have been major resources in the past, prior to their mindless/malicious dismantling by the current U.S. administration. An isolationist approach can only contribute to the emergence of concerning human pathogens, increasing the risk to the world at large. Abandoning the U.S.’s leading role in virological research under the conspiratorial belief that it has contributed to the emergence of disease (including by acting CDC Director Jay Bhattacharya and HHS director RFK Jr.) is a reckless and incompetent move. Offshoring quarantine and isolation of Ebola exposures to a hastily constructed field hospital in Kenya, much more poorly equipped to manage containment than U.S. facilities in which we’ve already invested over a billion taxpayer dollars and extensive training in development, only risks expanding the range of the current outbreak in Africa, which this administration clearly considers an expendable population. Not in my backyard, but bringing exposed individuals to Kenya, not yet involved in the outbreak, is apparently fine.
The emergence of new pathogens is not limited to “other places” (or what this administration rudely refers to as “shithole countries”).
The 2009 H1N1 “swine” ‘flu was first identified in Veracruz, Mexico, but the virus, a triple recombinant of human, bird, and pig influenza viruses, appears to have been introduced to Mexico by U.S. students who had travelled to Mexico over the 2009 spring break. Unsustained zoonotic spillovers of the H5N1 Avian influenza virus have been ongoing in the U.S. since March 2024. Sin Nombre hantavirus emerged as a human pathogen in the U.S. Southwest in 1993. The 1918 pandemic “Spanish” ‘flu (named “Spanish” because only the uncensored Spanish press reported its early spread) emerged in rural Kansas, spreading to Camp Funston at Fort Riley in eastern Kansas, with thousands of soldiers subsequently departing to military bases across the United States and Europe. Isolationism does not distance the U.S. from emerging disease.
Our current Department of Health and Human Services has purged our public health agencies of competent individuals and gutted our pandemic preparedness. It would not be uncharitable to describe these moves as exercises in stupidity.
A coalition of infectious disease specialists has petitioned the U.S. President, the Secretary of State, and the Secretary of the Department of Health and Human Services to reexamine and modify U.S. policy regarding the proposed relocation of US citizens with Ebola exposure to Kenya, offering assistance in formulating a strategy that prioritizes national security, upholds the law, and respects human dignity. I’m not holding my breath.
