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.

Public health authorities have adopted entry screening and other restrictions on travelers from Ebola-affected West African countries as a strategy to prevent importation of Ebola virus disease cases. The authors analyzed international, federal, and state policies to evaluate variations in policies; they found substantial differences among 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. Differences in policies likely resulted in part from different policy goals, and some state-level variation appears to be motivated by short-term political goals. The authors propose recommendations to improve future policies.