Analyzing Variability in Ebola-Related Controls Applied to Returned Travelers in the United States

Abstract

Public health authorities have adopted entry screening and subsequent restrictions on travelers from Ebola-affected West African countries as a strategy to prevent importation of Ebola virus disease (EVD) cases. We analyzed international, federal, and state policies-principally based on the policy documents themselves and media reports-to evaluate policy variability. We employed means-ends fit analysis to elucidate policy objectives. We found substantial variation in the specific approaches favored by WHO, CDC, and various American states. Several US states impose compulsory quarantine on a broader range of travelers or require more extensive monitoring than recommended by CDC or WHO.Observed differences likely partially resulted from different actors having different policy goals-particularly the federal government having to balance foreign policy objectives less salient to states. Further, some state-level variation appears to be motivated by short-term political goals. We propose recommendations to improve future policies, which include the following: (1) actors should explicitly clarify their objectives, (2) legal authority should be modernized and clarified, and (3) the federal government should consider preempting state approaches that imperil its goals.

Local Decision Making for Implementing Social Distancing in Response to Outbreaks

“…Some states and territories did enact policies in line with guidance from CDC and the World Health Organization, other states and territories instituted more aggressive policies than recommended by CDC, and still others issued no policies at all. 7,8 Given the prominent role of health departments in responding to communicable disease outbreaks in the United States and the documented variation in policies and use of social distancing measures, we sought to identify key features of preparedness (eg, facilities, budget, legal authority) as well as the primary concerns affecting state and local public health officials' decision to implement social distancing measures. We also aimed to determine whether any particular factor, including population size, political leaning, and history of implementing social distancing measures, could explain the widespread variation among localities in response to outbreaks and, specifically, whether the locality weighs nonhealth concerns as important as, or as more important than, public health or clinical concerns.…”

US State-Level Policy Responses to the Ebola Outbreak, 2014-2015

“…19 The emergence of cases of Ebola in the United States occurred shortly before Election Day in 2014, when several gubernatorial seats were being contested. For example, the governor of New York, a state that announced a more aggressive quarantine policy, was up for reelection.…”

Raising the Yellow Flag: State Variation in Quarantine Laws

“…Jurisdictions and institutions around the country instituted vastly different rules, resulting in several high-profile cases that questioned not only the utility of quarantine, but the legality of the tool. viviiviii Even though there were only a handful of cases in the U.S., the spread of Ebola from West Africa resulted in widespread panic amongst concerned citizens and highlighted serious gaps within the U.S. federal and state level protocols for handling highly infectious diseases, educating the public on the use of scientific evidence, and protecting civil liberties.…”