Sierra Leone's Ebola quarantine: a questionable strategy

Sept. 16, 2014

The government of the West African nation of Sierra Leone has announced a controversial plan: this coming weekend—Friday, September 19, through Sunday, September 21—it is going to enforce a nationwide quarantine. Sierra Leone’s 5.5 million citizens will be confined to their homes for 72 hours, while some 7,000 teams of healthcare workers will go door-to-door in an effort to identify people who are suffering from Ebola hemorrhagic fever. Police and the military will be used to support the extraordinary strategy to contain the spreading epidemic. It is not entirely clear from early reports whether the government plans to transport ill patients who are discovered to a healthcare facility—in some cases, presumably, against their will—but that seems to be a reasonable inference.

In describing the rationale for the action, government officials are using language that seems more appropriate to a military campaign against a foreign enemy than a public health action on behalf of the nation’s citizens. “It’s clear that we have pockets of resistance” to calls for Ebola-stricken people to seek healthcare, one government spokesperson says. “People are still harboring loved ones at home.” “Public resistance”? “Harboring”?

Aside from the civil liberties issues that this raises, it should be noted that health organizations have generally questioned the efficacy of this kind of strategy in the past, no matter how pressing the threat to public health. Such an action adds an element of punishment to public health policy and creates or worsens an adversarial relationship between health officials and the public. In this case, some observers think, it may only increase public distrust of healthcare workers, which has been a stumbling block to effective control of the Ebola epidemic from the start.