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How Much Freedom Should We Give Up To Avoid the Spread of Infectious Diseases?

The first patient to be diagnosed with Ebola outside of West Africa has been reported. He is now in the US, receiving treatment. He arrived from Liberia via Brussels before reporting symptoms, which were initially mis-diagnosed and treated with antibiotics.

If I were in West Africa and I had reason to fear I had been exposed to Ebola, do you know what I would do, if I had the resources? I would not wait to see if symptoms appeared or to be diagnosed, I would fly to the US or Europe, where, if symptoms developed, I would receive the very best health care in the world, including experimental treatments, in front of the world’s media.

If I could afford it, even selling everything, I would get on that plane to freedom, or at least a chance. A better chance to live.

But of course along the way, I would expose others to the risk of infection, and I would risk introducing the infection to areas of the world that are currently Ebola-free. It is unlikely, even so, that it would reach the levels seen in West Africa, as these countries have the resources and infrastructure to implement more effective containment strategies. Nevertheless, there is a chance that some people would die.

So how much freedom should people have? Should our freedom to travel be balanced against the risks it might pose to others?

We might think that Ebola as it currently stands does not warrant such limitations: it is infectious by sharing bodily fluids and is likely to be comparatively easily contained in a wealthy country with strong health infrastructures. But what if it mutates to a less deadly but more easily transmissible form, spreading as easily as perhaps flu? How much risk to others is too much? How many lives are worth the freedom and economic gains that we would have to give up?

Ebola is a terrifying disease, and I expect many readers are willing to give up this freedom and these economic gains to ensure greater protection against Ebola, especially if it mutated. It’s a trade-off.

But in fact, we reject this trade-off every day: flu is estimated by the CDC to have killed 48,614 people in the US in the 2003—04 season (the current Ebola outbreak has to date killed around 3,300 people). Yet adverts for flu remedies encourage us to dose up so we can get on with our lives, back into the work place: One famous Lemsip campaign had the strapline ’hard-working medicine.’ Of course, in doing so, we are infecting others, and some of those may die.

And we have for flu less intrusive measures than curfews and isolations available: I have argued that there is a case for mandatory flu vaccines for children . It would not necessarily protect those who are vaccinated: they would likely get over it anyway and suffer nothing more than a few days’ inconvenience, some may even get flu from the vaccine. But it would protect the immune suppressed, the elderly, and others vulnerable to death by flu.

We need to have an open and rational discussion about the price of freedom and the burden it places on others in relation to infectious diseases. We should not act from a place of panic for Ebola. But nor should we not act with flu from a place of complacency.

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3 Comment on this post

  1. Maybe one can make a Millian harm argument: I should have freedom of action as long as I do not harm others or their rights. Knowingly acting so that the risk of others becoming sick increases is unacceptable if their overall risk increases appreciably. I think it is the ‘appreciably’ part that will do actual work in judging what is unacceptable: it likely has to be above the noise level of normal pathogen encounters every day. Perhaps going to the office with a cold or a flu is unacceptable if you share it with other people, but if you keep to your room it is OK. Note that technology can change the equation: at least we research academics can do most of our work from home using the Internet, so we might want to stay home at a lower threshold of sniffles than others.

    The real challenge seems to be where moral obligation turns into legal obligation. This is presumably where the harm goes beyond mere inconvenience and actually starts having real effects on others lives. If we say that an action will statistically cause X deaths of other people, it seems reasonable to say that for some 0<X<1 we should ban the activity. We can even do calculations like R0 times mortality; for measles X=12*0.15=1.8, suggesting that getting measles is (on average) such a bad thing that we almost certainly ought to make vaccination compulsory. But for flu is X=2.5*0.001=0.0025 (for ordinary flu; pandemics can go up to 2 orders of magnitude higher) – if we think this is high enough to lead to obligatory vaccination, we may have to treat other diseases way more strictly if we want to be consistent.

  2. If you traveled before you were symptomatic, you would not expose anyone to Ebola. The disease is infectious only after symptoms appear. You might expose healthcare workers to the disease while you are receiving care, but that would happen whether you stayed in West Africa or traveled to the US or Europe. There’s a case to be made that you would endanger fewer people if you traveled to a country with the resources to effectively isolate and treat you. Healthcare workers in the US or Europe would be safer than those in under-resourced settings in West Africa, because they could be protected from infection and, if infected, be effectively treated. So, in terms of the consequences, it would be better to travel while asymptomatic, and seek healthcare in a country that has the resources to treat you and protect those who might be exposed to you. As health checks are being implemented in airports worldwide for passengers from West Africa, you probably wouldn’t succeed in getting on a plane while symptomatic.

    If Ebola mutates and becomes airborne, and transmitted as easily as flu, the situation changes. But it would be handled like SARS was, I suspect. Travel to and from affected areas would be severely restricted, as it was with SARS. Which is to say, your legal right to travel would be restricted on public health grounds, regardless of your preferences. I remember well the temperature checks in Hong Kong’s airport in the months following the SARS outbreak there.

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