Can nations protect themselves from emerging infections?
In our globalised interdependent world more people are crossing borders than ever before. But is there anything that a country can do to prevent the import of communicable diseases from foreign countries?
During the SARS outbreak Singapore installed thermal imaging scanners at airports, seaports and land entry points to check passengers for signs of fever. In 2014 the UK government announced plans to take the temperature of passengers arriving from Ebola-stricken countries at UK airports. However, because Ebola has a long incubation period (up to three weeks), under this system someone only just infected would not be stopped from entering the country. For example, the first man to die from Ebola in the USA did not develop symptoms – and therefore was not infectious – until he had already been in the USA for a week.
In the UK and elsewhere there have also been calls for the compulsory screening of all immigrants for tuberculosis (TB) and HIV. While this is an issue that makes headline news, there is little evidence to support such a policy on the grounds of protecting public health, and doing so could easily feed anti-immigration sentiments.
Introducing such a policy would also raise several practical and ethical questions. For a start, which groups of immigrants would be screened? Only asylum seekers? Foreign students? What about people from the expanded EU?
The big ethical issues include the possibility of discrimination, loss of conﬁdentiality, and stigmatisation. In short, communicable disease control is not the same as immigration control. History also tells us that ‘public health’ has often been used as a smokescreen for politically motivated actions. Australia, for example, has historically had strong border controls, partly for medical reasons. Yet in the 19th century, these controls were shot through with class and race prejudice.
In the Sydney smallpox epidemic of 1881, for example, a quarantine station was divided into the Hospital Ground (for the infected) and the Healthy Ground (for suspected carriers). The Healthy Ground was deliberately segregated by class, the Hospital Ground by race. And eight Chinese men, although healthy, were forcibly separated in tents and not allowed to mix with Caucasians.Lead image:
sameerhalai/Flickr CC BY NC