Dodging Disease Prevention

The American couple in front of me in line at Taca Airlines was turned away because they did not have proof of a yellow fever vaccine. The security agent was adamant - anyone flying from Ecuador to Brazil must have a yellow fever vaccination.

“What?” They both said, incredulously. The man turned to me and said - “it’s the craziest thing - they are asking for proof of vaccination. For yellow fever.”

The Taca security agent pleaded with them to go see the travel agent in the airport to arrange for a vaccination, but they wouldn’t budge. “We have hotel reservations”, the male traveler declared firmly, “we are getting on this flight. And there is no way we are getting a vaccination in Ecuador.” His companion chimed in, “If they don’t require yellow fever vaccines in the United States, why would we need to get it here? That’s just crazy”.

Ultimately the line progressed around them, so I was surprised when I later saw the man while I was standing on the tarmac waiting for security guards to inspect my luggage. “We had to bribe the travel agent in the airport $35 each to get documentation”, he explained, red-faced. “This country is COMPLETELY CORRUPT”. He shouted his last few words in the direction of the security guards.

I don’t think it ever occurred to him that his health might be endangered without the vaccine. I’m sure it never occurred to the couple - who I last saw sitting in first class drinking vodka tonics - that their own actions in dodging the public health requirements might endanger others. I am positive they never considered that their own actions - purchasing a false document and using it to evade public health authorities - were in any way corrupt.

If they had done a quick search on the Internet, here’s what they would have discovered.

The Center for Disease Control (CDC) has issued a health alert for travelers to Brazil in response to a recent outbreak in that country, where 15 have recently died from yellow fever and an additional 33 have been recently infected. Vaccinations are strongly recommended for US-based travelers; Brazil requires vaccinations for travelers from a specific list of countries, including Ecuador. Now the health emergency seems to have spread to Paraguay, where last week more than 4000 people blocked a major highway to protest the lack of available yellow fever vaccine in the country. Today Paraguay declared a state of emergency related to an outbreak of yellow fever.

In Brazil, “jungle yellow fever” has a mortality rate of about 50%. There is no cure, only prevention efforts will curb the disease. Other high-risk countries like Honduras are taking precautionary vaccination measures, including restricting entry to the country to those who have been vaccinated.

The experts at the Harvard School of Public Health predicted the response of these American travelers during a course I took last year. Harvard experts warned that when facing health emergencies, traditional alerts and quarantines can be undermined by two major factors. First, we can expect resistance among those who haven’t been reached or convinced with the right messages. Secondly, an inadequate international supply chain for vaccines and other treatments will make infectious disease containment difficult across borders.

Yellow fever doesn’t usually rank among the most feared infectious diseases today; that is largely due to vaccinations and public health monitoring. Two hundred years ago yellow fever was the most feared disease in the United States. In fact human volunteers working on the Panama Canal - who allowed themselves to be infected with the virus and then died of it - were an important part of groundbreaking public health research that confirmed a connection between mosquitoes and yellow fever.

Other mosquito-borne diseases, such as malaria, have not yet been curbed with vaccines. A rigorous international effort is underway to identify a malaria vaccination, which could prevent up to 3 million malaria-related deaths per year. Along with scientists and public health authorities, communications experts need to plan for effective public health communications. Science, medicine and public relations must interlock for public health programs to work.