Can South Africa rely on airport screening to detect Ebola disease?
Airport and point-of-entry (PoE) screening became a major part of the international response to Ebola outbreaks in West Africa between 2014 and 2016 and in the Democratic Republic of the Congo (DRC) between 2018 and 2020. Although millions of travellers were screened, few confirmed cases were identified directly through screening. Infected travellers may be asymptomatic, while early symptoms can resemble other illnesses.
The 2026 Bundibugyo virus disease outbreak in the DRC and Uganda has renewed questions about how countries should prepare for potential imported cases. For South Africa, the challenge is to strengthen preparedness without relying on screening as the sole means of preventing international transmission.
This article examines lessons from previous Ebola outbreaks and identifies opportunities to strengthen South Africa’s surveillance, referral and response systems.
Historical experience with Ebola PoE screening
During the 2014–2016 epidemic, the United States screened approximately 38,000 travellers without identifying a confirmed case solely through airport screening. Sierra Leone screened more than 166,000 travellers, with none of the five people denied boarding subsequently testing positive. During the 2018–2020 DRC outbreak, screening generated alerts that led to further investigation, including laboratory-confirmed cases. These experiences highlight the importance of linking screening to broader surveillance systems.
What screening can and cannot achieve
The incubation period and non-specific early symptoms limit symptom-based screening. Infected travellers may be asymptomatic at departure or arrival, meaning temperature checks cannot reliably identify all infections.
However, screening can support traveller education, risk communication, referral, contact tracing and monitoring. Its value should be assessed through its contribution to the wider public health response, not confirmed cases detected at borders alone.
Expenditure and operational burden
Large-scale screening requires substantial staffing, equipment and logistical support. False-positive alerts can lead to unnecessary assessments, while prolonged screening may divert resources from laboratory investigations, contact tracing and healthcare preparedness. Measures should therefore be proportionate to epidemiological risk and expected public health benefits.
International travel risk: What the evidence shows
Confirmed Ebola cases exported outside Africa have been rare, with sustained transmission outside Africa even rarer. Although the risk is not zero, evidence supports proportionate preparedness rather than indiscriminate border measures. South Africa must nevertheless maintain the capacity to recognise and respond rapidly to imported cases.
Implications for South Africa and recommendations
A layered approach should combine risk-based PoE measures with airline notification, event-based and healthcare surveillance, laboratory capacity, rapid referral and contact tracing. Training airport personnel, emergency responders and clinicians is essential for early recognition and appropriate infection prevention and control.
Discussion
The value of airport screening depends on its integration with surveillance and response systems. For South Africa, strengthening these connections can support timely detection and management of imported cases while avoiding unnecessary disruption, expenditure and stigmatisation.
For a more in-depth look into this report, download the full PDF below
