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October 26, 2014

The Honorable Andrew Cuomo


Governor of New York
Albany, New York

Dear Governor Cuomo:

We write as professionals, activists, and public health researchers who have worked
to combat AIDS and other infectious diseases in New York and around the world for
over three decades. We have not forgotten how HIV/AIDS was at first largely
ignored while it appeared to affect only marginalized communities or the stigma
generated once fear of the virus took hold in the larger population. We have
watched with growing concern as Ebola virus disease (EVD) was ignored far too
long while confined to some of the poorest countries in the world, and how it has
now led to hysteria here in the United States, based on only a very small number of
cases. As you know, stigma remains our biggest enemy in fighting AIDS and could
quickly become the biggest barrier in combatting EVD. Therefore, we implore you
to withdraw the mandatory quarantine requirement for all people entering the
United States through Newark Liberty International Airport and John F. Kennedy
International Airport who have had direct contact with individuals with EVD in
Guinea, Liberia, and Sierra Leone.

This aspect of the procedural plan being put into place to minimize the risk of
outbreaks of EVD in the New York metropolitan area is not supported by scientific
evidence and will potentially have a profound effect on efforts to recruit U.S.-based
health care professionals who are desperately needed to help combat the
burgeoning EVD epidemic in West Africa while increasing stigma toward persons
who come from those countries. There is no evidence that indicates quarantines are
superior to active monitoring for symptoms with respect to preventing transmission
of EVD. We urge New Jersey and New York to instead require that all health care
workers and others with potential exposure to EVD returning to the U.S. through
Port Authority international airports engage in CDC-recommended active
monitoring for signs and symptoms of EVD and that they remain in close proximity
to a hospital with isolation facilities.

Port Authority-mandated quarantines for all arriving passengers who have had
direct contact with individuals with EVD may have consequences that are the
antithesis of effective public health policy. Should the New York metropolitan area
be the destination of individuals who have contact with people with EVD in West
Africa, but they instead travel through multiple hubs (thereby significantly
extending their transit time) or deny potential exposure to circumvent these
mandatory entry requirements, we will have undermined the most important
evidence-based components of breaking EVD transmission chains: prompt
diagnosis, isolation of those with bona fide symptoms and clear instructions for
those with possible exposure to Ebola. Unnecessary quarantines will also lead to
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stigma and discrimination directed toward people of West African origin, regardless
of their exposure to Ebola.

If we are to effectively prevent additional isolated cases of EVD diseaseand with
them, public fear and panicin the New York metropolitan area, and halt the spread
of the disease in other parts of the world, the only evidence-based solution is to
dedicate the resources required to break chains of transmission in countries where
the disease is prevalent. U.S.-based health care workers are critical to this response,
through volunteer and paid opportunities. We fear that mandatory quarantines will
greatly hinder current efforts to recruit skilled and experienced personnel. Groups
such as Mdecins Sans Frontires, Partners in Health, and the United Nations have
stressed in no uncertain terms that we desperately need more qualified health care
providers in Guinea, Liberia, and Sierra Leone to save the lives of those who have
been infected, to prevent the ongoing spread of the disease in those countries, and
to stem the risk of outbreaks in all other nations.

We urge you to end the mandatory quarantine policy and instead establish a
standard protocol, to be developed by the Port Authority in close collaboration with
the U.S. Centers for Disease Control, the State of New Jersey Department of Health,
the New York State Department of Health, and the New York City Department of
Health and Mental Hygiene, for active monitoring and required proximity to a
hospital with isolation facilities for all individuals who have had contact with
individuals with EVD.

When news of New York Citys first case of EVD broke on Thursday night we were
extremely proud of the measured response and high level of preparation described
by you and other New York City and State officials. We urge you to continue to
provide the leadership that has made New York the model for an evidence-based
response to HIV and other health crises.

Respectfully submitted,

ACT UP/NY
Adaora Adimora, MD, MPH, Chair, HIV Medicine Association
AIDS Treatment Activists Coalition
American Run to End AIDS, New York
Jeton Ademaj, ACT UP NY
Frederick L. Altice, MD, MA, Professor of Medicine, Epidemiology, and Public
Health; Director of Clinical and Community Research, Yale University School of
Medicine and School of Public Health
Wendy Armstrong, MD, Vice Chair, HIV Medicine Association
Ramin Asgary, MD, MPH, Assistant Professor, Department of Population Health,
New York University School of Medicine
Benjamin Bashein, Executive Director, ACRIA
Chris Beyrer, MD, MPH, President, The International AIDS Society; Professor, Johns
Hopkins Bloomberg School of Public Health
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Bernadette Boden-Albala, MPH, DrPH, Associate Dean of Program
Development; Director, Division of Social Epidemiology; Professor of Public Health,
Neurology and Dentistry, Global Institute of Public Health, New York University
Elizabeth H. Bradley, Professor of Public Health and Director of Yale Global Health
Initiative
Karen F. Brudney, MD, Assistant Professor of Medicine, Columbia University College
of Physicians and Surgeons
Anthony P. Cannella, MD, MSc, Assistant Professor of Medicine, Division of
Infectious Diseases and Global Medicine, Department of Medicine, University of
Florida College of Medicine
Arthur L. Caplan, PhD, Drs. William F. and Virginia Connolly Mitty Professor of
Bioethics; Director Division of Medical Ethics, Department of Population Health
(Med Ethics), New York University School of Medicine
Rea Carey, Executive Director, National LGBTQ Task Force
Guillermo Chacon, President, Latino Commission on AIDS
Eric Cioe, MD Columbia University International Emergency Medicine Fellow;
Instructor of Medicine & Attending Physician, New York-Presbyterian Hospital
Paul D. Cleary, PhD, Anna M. R. Lauder Professor of Public Health (Health Policy);
Dean, Yale School of Public Health; Director, Center for Interdisciplinary Research
on AIDS (CIRA)
Rachel M. Cohen, AIDS & Global Health Activist
Ted Cohen, MD, MPH, DPH, Associate Professor of Epidemiology (Microbial
Diseases), Yale School of Public Health
Jim Curran, MD, MPH, Director and PI of Emory Center for AIDS Research
Julie Davids, AIDS Activist
Dr. Sheila Davis, Chief Nursing Officer, Chief Ebola Response, Partners In Health
Patrick Dawson, MPH, Columbia University Department of Epidemiology
Haile T. Debas, MD, Director of the University of California Global Health Institute;
Distinguished Professor of Surgery, Emeritus
Carlos del Rio, MD, Chair-Elect, HIV Medicine Association
Hans N. Desnoyers, Director of Operations, Diaspora Community Services
Erin Drinkwater, Executive Director, Brooklyn Community Pride Center
Wafaa El-Sadr, MD, MPH, Director, International Center for AIDS Programs (ICAP)
End AIDS Now, New York
Joel D. Ernst, MD, Professor of Medicine, Pathology, and Microbiology; Acting
Director, Division of Infectious Diseases and Immunology, New York University
School of Medicine
Paul Farmer, MD, Kolokotrones University Professor, Harvard University; Co-
Founder, Partners in Health
Sally Findley, Professor of Population and Family Health, Mailman School of Public
Health, Columbia University
Jennifer Flynn, Executive Director, VOCAL-NY
Gerald Friedland, MD, Yale School of Medicine
Eric A. Friedman, JD, ONeill Institute for National and Global Heath Law,
Georgetown University Law Center
Gregg J. Fromell, MD, Vice President, Science Operations, NYU Langone Medical Center
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Kevin Frost, CEO, amfAR
Robert E. Fullilove, EdD, Cities Research Group, Columbia University
Jennifer Furin, MD, PhD, Assistant Professor of Medicine, Case Western Reserve University
Joel Gallant, MD, MPH, Immediate Past Chair, HIV Medicine Association
Tracie M. Gardner, Co-Director of Policy, Legal Action Center
Laurie Garrett, Senior Fellow for Global Health, Council on Foreign Relations
Robert F. Garry, PhD, Assistant Dean, Graduate Program in Biomedical Sciences,
Tulane University
Annette Gaudino, ACT UP NY & ACT UP NY Women's Caucus
Shelley Geballe, JD, MPH, Lecturer, Yale School of Public Health, Visiting Clinical
Lecturer, Yale Law School
Toorjo Ghose, Associate Professor, School of Social Policy & Practice, University of
Pennsylvania
GNP+ NA (The Global Network of People Living with HIV, North America)
Lewis Goldfrank, Chairman of Emergency Medicine, New York University and
Bellevue Hospital Center
Gregg Gonsalves, Global Health Justice Partnership, Yale Law School-Yale School of
Public Health
Lawrence O. Gostin, University Professor, Founding O'Neill Chair in Global Health Law,
Georgetown Law; Faculty Director, O'Neill Institute for National and Global Health Law;
Director, World Health Organization Collaborating Center on Public Health Law &
Human Rights
Karen Grepin, Assistant Professor of Global Health Policy, New York University
Sally Guttmacher, PhD, Professor of Public Health, New York University
Mark Harrington, Executive Director, Treatment Action Group
Tim Horn, HIV Project Director, Treatment Action Group
Virginia Kan, MD, FACP, Professor of Medicine, George Washington University
Sanjat Kanjilal, MD, Infectious Disease Fellow, Massachusetts General Hospital
William B. Karesh, DVM, Exec. Vice President, EcoHealth Alliance
Salmaan Keshavjee, MD, PhD, ScM, Director, Program In Infectious Disease and Social
Change, Department of Global Health and Social Medicine, Harvard Medical School
Gerald T. Keusch, MD, Professor of Medicine and International Health, Associate
Director, National Emerging Infectious Diseases Laboratory, Boston University
Kaveh Khoshnood, PhD, Associate Professor, Yale School of Public Health
Jacqui Kilmer, COO, Harlem United
Charles King, Chief Executive Officer, Housing Works, Inc.
Michael Kinzer, MD, MPH
Albert Icksang Ko, MD, Professor of Epidemiology (Microbial Diseases) and of
Medicine (Infectious Diseases); Department ChairEpidemiology of Microbial
Diseases, Yale School of Public Health
Thomas Krever, Chief Executive Officer, Hetrick-Martin Institute
Ann Kurth, PhD, CNM, MPH, Associate Dean for Research, NYU Global Institute of
Public Health
Tim Lahey, MD MMSc, Associate Professor, Infectious Diseases & International Health,
Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock Medical Center
Jay Laudato, Executive Director, Callen-Lorde Community Health Center
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Philip Lederer, MD, Infectious Disease Fellow, Massachusetts General Hospital
Jeffrey Levi, PhD, Executive Director, Trust for America's Health
Kelsey Louie, CEO, GMHC
Amanda Lugg, Director of Advocacy, African Services Committee
Hon. Keith Martin, MD, PC, Executive Director, Consortium of Universities for
Global Health
Susan L. F. McLellan, MD, MPH, Infectious Diseases and Tropical Medicine, Tulane
University
Robert McNamara, Managing Director, Friends In Deed
Peter Meacher, MD, Chief Medical Officer, Callen-Lorde Community Health Center
Suerie Moon, MPA, PhD, Research Director and Co-Chair, Forum on Global
Governance for Health, Harvard Global Health Institute, and Lecturer, Department of
Global Health and Population, Harvard School of Public Health
David Mushatt, MD, Chief, Infectious Diseases Section, Tulane University
Nancy Neveloff Dubler, LL.B, Adjunct Professor, NYU Langone Medical Center
New York Civil Liberties Union
Gbenga Ogedegbe, MD, MPH, Vice Dean & Chief Medical Officer, Global Institute of
Public Health, New York University
Cynthia ONeal, President, Friends In Deed
David Paltiel, PhD, Professor, Yale School of Public Health Yale School of Management
Melinda Mary Pettigrew, PhD, Associate Professor of Epidemiology (Microbial
Diseases); Associate Dean for Academic Affairs, Yale School of Public Health
Jonathan Platt, MPH, Columbia University Mailman School of Public Health
Positive Women's Network USA
J. L. Pottenger, Jr., Nathan Baker Clinical Professor of Law, Yale Law School
Gina Quattrochi, Esq., CEO, Bailey House
Miriam Rabkin, MD, MPH, Associate Professor Medicine and Epidemiology,
Columbia University Mailman School of Public Health
Asghar Rastegar, MD, Professor of Medicine; Director, Office of Global Health, Yale
University School of Medicine
Robert H. Remien, PhD, Clinical Psychologist (New York, NY)
Elena Rios, MD, MSPH, President & CEO, National Hispanic Medical Association
Joyce Rivera, Founder & Executive Director, St. Ann's Corner of Harm Reduction
Maria Said, Physician, Board Certified Internal Medicine and Infectious Diseases
Nathan Schaefer, Executive Director, Empire State Pride Agenda
John S. Schieffelin, MD, MSPH, Assistant Professor of Pediatrics and Internal
Medicine, Sections of Infectious Disease, Tulane University School of Medicine
Carl Siciliano, Executive Director, Ali Forney Center
Virginia Shubert, J.D., Shubert Botein Policy Associates
Michael Silverman, Executive Director, Transgender Legal Defense & Education Fund
Prabhjot Singh, MD, PhD, Director of Systems Design, Earth Institute; Assistant
Professor of International & Pubic Affairs, Columbia University
Barbara Smith, PhD, RN, FACSM, FAAN, Associate Dean for Research, Michigan
State University
Kimberleigh Smith, VP, Policy & Advocacy, Harlem United
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Samara Soghoian, MD, MA, Assistant Professor of Emergency Medicine, New York
University School of Medicine
Andrew Spieldenner, PhD, Assistant Professor, Hofstra University
Peter Staley, AIDS Activist
Sharon Stapel, Executive Director, New York City Anti-Violence Project
Rev. Moonhawk River Stone, MS, LMHC, RiverStone Consulting
Sean Strub, Executive Director, Sero Project
Dan Suarez, RN, MA, President, National Association of Hispanic Nurses (NAHN)
Glennda Testone, Executive Director, The NYC Lesbian, Gay, Bisexual and
Transgender Community Center
Melanie Thompson, MD, AIDS Research Consortium of Atlanta, HIVMA Board of
Directors
David Tiersten, MD, FCAP, Past President, New York State Society of Pathologists
Francesca Torriani, MD, FIDSA, Professor of Medicine and Director of UCSD
Infection Prevention and Clinical Epidemiology and TB Units, Division of Infectious
Diseases, Department of Medicine, UC San Diego
United States People Living With HIV Caucus
Tom Viola, Executive Director, BROADWAY CARES/EQUITY FIGHTS AIDS
Terri Wilder, AIDS Activist
Suzanne Willard, PHD, APN, FAAN
Brian Yablon, MD, Internal Medicine/Pediatric Physician, Anchorage, AK

cc:
Tom Frieden, CDC Director
Ron Klain, Ebola Response Coordinator, Executive Office of the President
Sylvia Burwell, United States Secretary of Health and Human Services
Douglas Brooks, Director of the Office of National AIDS Policy
Cecilia Munoz, Assistant to the President for Domestic Policy
Lisa Monaco, Assistant to the President for Homeland Security and Counterterrorism