Lentis/International Air Travel as a Disease Vector

Introduction
The volume of international air travelers has increased rapidly in recent decades. In the early 1990s, about 500 million people crossed international borders annually on commercial flights. In 2013 alone, more than 3 billion passengers traveled via domestic and international flights worldwide. These changes in the accessibility, speed, and volume of air travelers suggests an increasingly connected global culture which has broad implications for disease spread.

History of Travel and Disease
Human travel and disease spread have rich and connected origins. Following the five week voyage of Christopher Columbus to the New World in 1492, disease spread was rampant. Europeans brought diseases such as smallpox, measles, and typhus to which the Native Americans had no immunity. It is estimated that 80 to 90 percent of Native Americans were killed from exposure to these diseases within 150 years of Columbus' voyage. Technological changes that facilitate flexibility of movement, such as boats, trains, and airplanes, have become a potent force for disease emergence and spread. New forms of travel carry humans around the globe at volumes and speeds unprecedented in history. This mixing of human populations has led to the geographic dispersion of infectious diseases.

International and historic disease outbreaks, such as during the Columbian Exchange, occurred when long distance transportation was laborious, expensive and relatively slow. Thus, geographic mobility of large scale populations was rare. Springing forward, over the last two centuries exponential increases in spatial mobility have occurred. Alongside these changes in movement, issues of disease prevention, spread, and treatment on an international scale have been brought to the forefront.

Ebola Outbreak
The Ebola virus was first discovered following international outbreaks in the Democratic Republic of the Congo and Sudan in the late 1970s. Human transmission of the virus typically occurs via direct contact with blood or bodily fluids from an infected individual. Nearly 40 years later, in May of 2014, the most widespread and deadliest Ebola outbreak in West Africa was reported. By late November of 2014, the reported death toll totaled nearly 5,700 individuals spanning six countries: Liberia, Guinea, Sierra Leone, Nigeria, the United States and Mali. The recent Ebola outbreak has sparked conversations about banning international flights from Ebola infected countries with the hopes of reducing disease spread. This case has brought about two distinct sides: those who support air travel ban and those who oppose air travel ban.

Opposition to Air Travel Ban
Opponents to the air travel ban are health experts and professionals who provide rational arguments and alternatives to stop the spread of Ebola to the U.S. Participants in this group often are more specialized in the field of infectious disease and capable of implementing technical solutions.

Center for Disease Control and Prevention
Center for Disease Control and Prevention (CDC), the national public health institute of the United States, supports better monitoring and screening passengers at the airport, but opposes an air travel ban. The director of the CDC, Tom Frieden, stated "We don't want to isolate parts of the world, or people who aren't sick, because that's going to drive patients with Ebola underground, making it infinitely more difficult to address the outbreak."

World Health Organization
The World Health Organization (WHO), similar to the CDC, opposes bans on international travel or trade, but advised countries to be prepared to detect, investigate, and manage Ebola cases. WHO states that the risk of Ebola transmission during air travel is low.

President Obama
President Obama has voiced his concerns about banning flights from West Africa. In his weekly address on October 18th of 2014, Obama stated that "Trying to seal off an entire region of the world, if that were even possible, could actually make the situation worse." President Obama agrees with the CDC and opposes an air travel ban. He thinks the best way to contain the spread of Ebola is at its source with the support of medical professionals. Blocking air travel would impede the transport of these professionals and supplies. While he is concerned about the spread of Ebola to the U.S., he must also consider foreign relations with Ebola infected nations. He reminds the public that if we are guided by science, facts, and not fear, then we can prevent a serious Ebola outbreak in the U.S.

International Airline Companies
Many international airline companies are opposed to a flight ban because they are financial stakeholders. The founder of The Aviation Law Firm outside of Washington D.C., Greg Winton, stated that mass flight restrictions "will have a huge impact financially, certainly on the whole economy, not just the aviation sector." However, international airline companies are not only concerned about their business, but also stopping the spread of the Ebola. A spokesman for Airlines for America stated that they "agree with the White House that discussions of flight bans are not necessary and actually impede efforts to stop the disease in its tracks in West Africa."

Support for Air Travel Ban
Many supporters of the air travel ban are individuals who are acting based on fear and/or their own personal beliefs.

Government Officials
Fred Upton, a Republican from Michigan, believes air travel bans from West Africa are the best solution to stop the international spread of Ebola. Upton believes that airport screening of passengers is insufficient to stop the spread of Ebola to the U.S., due to the 21 day symptomless incubation period of the virus. Passengers can also evade screenings by taking ibuprofen to reduce their fever.

Non-Specialist Individuals
Non-specialist individuals, such as protesters in Washington D.C., have voiced their support for an air travel ban. Donald Trump, an active participant on social media, has voiced his fiery opinions on Twitter. Examples of Trump's tweets are: "Stop the EBOLA patients from entering the U.S. Treat them, at the highest level, over there. THE UNITED STATES HAS ENOUGH PROBLEMS!", "The U.S. must immediately stop all flights from EBOLA infected countries or the plague will start and spread inside our 'borders.' Act fast!", and "Stop flights into the U.S. from West Africa immediately!". Trump's arguments are emotionally-based and fear-driven.

Media
The media indirectly supports the air travel ban by creating a sense of danger, fear, and panic in the public. Sensationalized reports can lure the public into supporting the flight ban. The media's influence on public perceptions is aided through widespread accessibility and dramatized news accounts. Individuals who lack technical knowledge are especially susceptible to the media's influence.

Germ Panic
Germ panic is a psychological phenomenon characterized by general anxiety, uncertainty, and the potential for irrational behavior due to the fear of an unknown disease. In the Ebola flight banning case, mass media plays a major role in shaping the public’s response and promoting germ panic. The media is capable of challenging the authority of health professionals with scare statistics, sensationalist titles, and “it-could-happen-to-anyone” scenarios. Examples include headlines like “Ebola: ‘The ISIS of Biological Agents?'” and “Ebola in the air? A nightmare that could really happen” from CNN and “Nurses in safety gear got Ebola, why wouldn’t you?” from the Associated Press. These actions by the media are not driven by malevolence but rather an understanding that the idea of a pandemic sells. In a competitive consumer culture, media uses fear to capture the public’s interest and sell their news, which indirectly promotes germ panic.

Parallels to the Red Scare
Senator Joseph McCarthy was an influential political figure during the 1950s. McCarthy was notorious for his use and exploitation of fear to gain popularity and support as a politician and promote his own self-interests. The rise of the terms Red Scare and McCarthyism were a direct result of his tactics. When investigating the rise and fall of McCarthy, one historian claimed that McCarthy was so effective because he had “access to the dark places of the American mind”. He understood that Americans were most afraid of a communist invasion or infiltration of the United States government. Equipped with this fear, McCarthy was able to lead anti-communist crusades. Even though these crusades were not fact-based, he was still able to ruin the careers of some of his opponents in the process. Much like with germ panic, fear trumped reason in the case of McCarthy and the Red Scare.

Parallels to Homeland Security and 9/11
The United States Department of Homeland Security (DHS) was formed in 2002 in response to the terrorist attacks on September 11, 2001. Since then, DHS funding has risen dramatically, increasing from $19.5 to $66 billion between 2002 and 2009. Funding increased partly because of pressures from the American public. In a July 2007 Gallup poll, 47 percent of the public was worried that they or someone they knew would become a victim of terrorism. Government agencies, like the DHS, control both the creation and the interpretation of terrorist threat information. This information monopoly creates an excessive level of fear in the public, but it protects the mission of the DHS. Policymakers generate and employ fear of terrorism to sell their policy to voters.

The Power of Fear
Fear gives power to the improbable and a platform to the minority. Although the chances of an Ebola pandemic, terrorist attack, or communist invasion are minute, we are forced to consider these improbable scenarios because the implications are so large. The fear associated with these events allowed McCarthy to mark his place in American history with his communist witch-hunts, and it enabled the large funding increases for the Department of Homeland Security. This same fear provides the platform for media to sell their products to consumers.

Future research for expanding this chapter could investigate stigmatization of certain groups as a result of germ panic. Future research for creating a new chapter could investigate the role of media and advertising in transmitting public health messages.