The Canadian government and the World Health Organization have met to discuss travel restrictions Canada imposed on residents of countries with widespread Ebola transmission, both parties confirmed Friday.
International health law experts say Canada's move to stop issuing visas to people from the affected countries contravenes the International Health Regulations (IHR), a treaty Canada helped revise after the 2003 SARS outbreak. Earlier this week the WHO asked Canada for the scientific and public health rationale underpinning the decision.
In this unprecedented Ebola outbreak, the WHO has repeatedly urged countries not to close their doors to people from Guinea, Sierra Leone and Liberia, saying to do so would be counterproductive and could increase the risk of international spread of the disease.
After the meeting, however, both parties appeared to have agreed to an accepted line on Canada's visa restrictions. And while that message seems to imply that the World Health Organization has no problem with Canada restricting travel from the three countries, no one from the WHO would explicitly confirm that on Friday.
"The WHO is satisfied that these measures do not represent a general travel ban and will not impact on the movement of Canadians who wish to participate in the humanitarian response in West Africa," Citizenship and Immigration Canada said in an email.
WHO spokesperson Tarik Jasarevic also said via email that "we understand it is not a general travel ban because Canadian health workers (and other citizens who want) can continue to go to the countries if they wish."
But the restrictions had not been cast as a general travel ban when they were announced. In fact, when the government revealed the new policy — on Oct. 31 in the Canada Gazette — it stipulated it did not apply to Canadians health-care workers returning from the affected countries.
An international health law expert said Canada isn't off the hook simply because it implemented selective travel restrictions. And David Fidler suggested that if the WHO condones Canada's action, it would be sending a signal to other countries that they too can bar entry to people from Ebola-affected countries.
"WHO and Canada did not need to meet to conclude that Canada's ban is not a 'general ban.' Just reading what Canada announced would produce that conclusion," noted Fidler, who teaches international health law at Indiana University.
"WHO asked for Canada's justification of the measure it put in place, as the IHR require."
Citizenship and Immigration Canada said the visa decision "represents the best option at this stage to balance the need to protect the health and safety of Canadians while causing minimal disruption to travel and trade — and in doing so, helping to prevent Ebola from coming to Canada."
When pushed about what scientific evidence it presented to the WHO, the department replied: "We have nothing to add to our response."
The International Health Regulations are designed to strengthen global health security by requiring countries with infectious disease outbreaks that could spread internationally to report them to the WHO. In return, other countries agree not to penalize affected countries by imposing trade or travel restrictions beyond what the WHO recommends.
Fidler said the implication of the post-meeting comments is that because Canada is allowing Canadian medical workers to return home, it hasn't contravened the International Health Regulations. But the goal of the treaty isn't to ensure foreign nationals can get home from an outbreak-affected country — it's to protect the people in the outbreak-affected country.
"The IHR is not just concerned about Canadians travelling to and from West Africa," he said. "The WHO has been critical of the type of measures Canada has put in place because it stigmatizes, without justification, travellers from these West African countries."
Under the health treaty, the WHO can recommend actions to protect states during a public health emergency of international concern. (The Ebola outbreak has been declared one.) Countries must justify any actions they take over and above the WHO recommendations.
The WHO guidance for this outbreak does say there should be no "general travel ban." But it does not say partial bans are permissible.
"WHO doesn't recommend general travel bans, but many measures, including partial bans, are still subject to the rules of the IHR. It is simply not credible that the IHR stop being applicable if the measure in question is not a 'general ban,' a concept not found in the text of the IHR," Fidler said.
In fact, the only restrictions the WHO guidance expressly endorses relate to people who have Ebola or have had unprotected exposure to an Ebola case. They should not travel internationally unless that travel is a medical evacuation, the WHO has said. That restriction does not apply to health-care workers who treat patients wearing the appropriate protective equipment.
Fidler was critical of the WHO for appearing to approve the Canadian visa restrictions, saying it will give a green light to other countries to follow suit.
"Apparently, any country can now ban any travellers from West Africa from entering their territories, without explaining the rationale for such a ban, as long as the country does not prohibit its nationals from travelling to and from West Africa," he said.
And Dr. Ross Upshur, an ethicist and global health expert, suggested the situation undermines the credibility of the International Health Regulations.
"How does this foster global transparency and reporting? It doesn't. It actually works against it. Because everybody looking at this will see that anything shy of a general travel ban — whatever that may be — is permissible even if you report," said Upshur, who is head of the division of clinical public health at the University of Toronto's Dalla Lana School of Public Health.
"Why would anybody want to disclose anything if you can get these ... selective restrictions on people from your nation being able to travel?"