Front page stories in many newspapers today reported the death of Thomas E. Duncan, the USA’s first Ebola virus victim. Mr. Duncan lived in Liberia and had recently come to Texas to rekindle an old love interest. Unfortunately for Mr. Duncan, he became infected with Ebola a few days before getting on the plane to fly to the USA. The episode triggered panic in Texas and hysteria among fellow passengers on his United Airlines flights. It also showed the USA health care system is not ready to deal with Ebola since the first time Mr. Duncan went to the hospital he was sent home, even after telling staff he was from Liberia, the center of the epidemic. How can we stop, or at least slow down, infectious viruses from spreading around the world?
The answer is to change airline policies when a potential pandemic arises. Mr. Duncan helped carry a neighbor suffering from Ebola from a car into her home a few days before getting on his flight to the USA. Before boarding the flight, he signed a screening card which stated he felt fine and had not had any contact with someone sick with Ebola. Had Mr. Duncan lived, both Liberian and US authorities stated they would prosecute him for lying on this screening form.
Screening forms are not new. Concerns over air travelers spreading SARS, bird flu, and H1N1, have periodically caused many countries to use these forms to screen passengers. I have filled in these forms and then marched past temperature checkpoints before being allowed into a number of different countries. A few of the times I was concerned about not being healthy enough to enter the country.
The problem facing most air-travelers is that they purchase non-refundable tickets well before they know their flight-time health status. These tickets have either no value if not used on the date stated, or have exceptionally high fees to change the travel date. If you are feeling the least bit sick and decide to skip your flight there is an exceptionally large financial penalty. Non-refundable tickets mean that passengers have a large economic incentive to get on their flight; healthy or not. It also means that passengers who are feverish before boarding a flight typically take aspirin or another fever reducer while flying so that they are not stopped at the temperature checkpoint.
Fever monitors and screening forms are not very effective at stopping viruses from spreading when people have an incentive to evade them. A simple method to convince people not to fly is to allow anyone who is sick to rebook their flights at no charge. Airlines will balk at implementing this suggestion since change fees and no-show passengers boost their profits. To make this a workable solution for airlines two caveats need to be included. First, a policy of free rebooking is only implemented in places and during times when an international agency, like the World Health Organization, has declared an international health threat exists. For example, to contain the Ebola virus this policy only allows passengers leaving from West African airports to rebook their flights for free. Second, any person who rebooks under the sickness clause is not allowed to travel on any airline during the incubation period or until they present proof they are disease free. For Ebola this means if you are feeling sick and don’t get on your flight, you cannot fly until 21 days have passed or until a blood test comes back confirming you are Ebola free.
As an economist, I recommend that any time an airline implements this policy, the airline be given a relatively small cash payment (say $1 or $2) for every passenger flying from the affected area, whether or not passengers avail themselves of free sickness rebooking policy. This small cash payment will cover the airlines reduced profits and likely result in airlines voluntarily implementing the policy, instead of having it mandated by governments. Most passengers today are charged an airport screening fee. Some of this fee could be diverted to a fund to pay airlines for the sickness policy, since having people voluntarily not fly when sick, lowers screening costs.
Pandemics have resulted in millions of deaths. World War I killed roughly 10 million people. However, the Spanish Influenza, which followed on World War I’s heels, killed roughly 20 million, double the death caused by the war. Allowing sick passengers to rebook their tickets will not eliminate pandemics but it will slow the spread from one country to another, and potentially give us time to develop effective prevention and treatments.