Andy Maybury, Director of Global Assistance at SPS
As outbreaks of infectious diseases such as Nipah and Ebola continue to shape the global health risk landscape, organisations are placing greater emphasis on protecting employees travelling and working overseas. From proactive intelligence gathering and medical evacuation capabilities to real-time crisis response, robust duty-of-care programmes have become an essential part of business continuity planning. Travel Daily Media speaks with Andy Maybury, Director of Global Assistance at SPS, about the realities of managing infectious disease threats, the challenges of evacuating high-risk patients, and what multinational organisations should be doing to strengthen their preparedness.
Travel Daily Media (TDM): How prepared are most corporate duty-of-care programs for a confirmed Nipah or Ebola case today?
Andy Maybury (AM): It varies enormously, and it usually comes down to whether a programme is built to respond or only to react. A lot of duty-of-care arrangements are essentially reactive: they manage the fallout once something has already happened to a member of staff. That is the wrong way round for a fast-moving infectious disease.
A programme needs to do two things at once. It needs to be proactive, with an early-warning capability that feeds ground-truth intelligence to programme directors so they can mitigate exposure before staff travel into an affected area. And it needs to be actively responsive, reaching people who are already on the ground with current information, guidance on reducing exposure and recognising symptoms early, and a direct line to a medical team who can take them through an incident if symptoms appear.
Programmes that have both are well placed. Those relying on a policy document and a phone number tend not to be.
TDM: How many operators globally can realistically evacuate a confirmed Category A infectious patient, and what happens when several outbreaks run at once?
AM: On paper, a fair number of air ambulance operators could carry an infectious patient. In practice the number that genuinely can, and will, is small, and it is the aircraft and the clearances rather than the patient that set the limit.
Operators have their own duty of care to crew and may decline to fly into a high-risk area.They need specialist insurance to operate in those environments, and many will not take on the cost or the exposure. And every flight needs clearances from the authorities where the outbreak is, and from the receiving country, which often will not allow an immediate repatriation. Patients, sometimes even a country's own nationals, may have to route through a third country for a stand-off period before being allowed home.
Put those together and you are left with a handful of operators able to move quickly: the ones willing to take it on, properly insured, and able to navigate the clearance process in time.
Numbers do not really ease the picture. Most air ambulances are configured for a single critical patient, and a larger aircraft fitted for more would need more medical staff, increasing the operator's own exposure and making the clearances more complex still, because they are issued against the aircraft and the clinical needs of each patient. In reality, each patient needs their own single-patient aircraft, so simultaneous outbreaks stretch a thin resource very quickly.
TDM: During the 2014 Ebola outbreak, evacuation systems faced major bottlenecks. What lessons were learned, and are organizations better prepared today than they were a decade ago?
AM: Three things stand out. First, early detection and diagnostics: front-line providers now have better tools to confirm cases quickly and shape their response in the critical opening days, though overall healthcare capacity in less developed settings is still thin and facilities are often overwhelmed at the peak.
Second, community education: sustained work on hygiene, safe care of the sick and early symptom recognition has measurably reduced community transmission, but a deep and historically rooted mistrust of health systems and foreign aid workers persists and continues to undermine response efforts.
Third, funding for front-line systems: supplies still take too long to reach the people who need them, and that gap remains the hardest to close. On balance, yes, organisations are better prepared than in 2014. The lessons of that outbreak and of COVID-19 have changed how both health systems and evacuation providers respond. The process is still complicated, but there is now a clear path through it and protocols to manage these cases properly.
TDM: At what point in an outbreak does the evacuation window begin to close?
AM: There is no single moment that applies to everyone. Each case is assessed on its own merits against medical, logistical and security factors: the patient's condition, the availability of evacuation resources, and whether the receiving facility has capacity. The window can narrow sharply once borders tighten or clearances slow, but the decision is always case by case, and it is only made well when the medical, operational and security teams advocating for that patient are working the problem together.
TDM: How should a multinational tell genuine medevac capability apart from a policy that just reimburses costs after the fact?
AM: Ask two questions, the same two from the start of this conversation. Is the programme proactive: am I actually receiving intelligence on emerging outbreaks before my people are exposed? And is it actively responsive: is my assistance provider in contact with my staff on the ground, giving them a direct line to the right specialists to help them reduce exposure, and will they guide each person through every step if an exposure occurs? A reimbursement clause does none of that. It pays an invoice after the event. Genuine capability is the intelligence, the people and the coordination that are in place before anything goes wrong, and that you can actually reach when it does.
TDM: With Nipah in Kerala and Ebola active in parts of Africa, what is your assessment of the current risk landscape?
AM: These viruses move fast and the picture changes daily, so the first rule is to stay current on exactly what is happening where.
The risk profile depends on what the traveller is doing and where they are going, and it is mostly about planning ahead to reduce exposure. Some travellers, health workers and NGO staff in particular, carry more risk but tend to be more aware of it. Business travellers and tourists often need that risk explained to them.
Areas with acute outbreaks are also more prone to wider instability, and the insecurity and community mistrust seen around treatment centres in the DRC is a real operational factor. Avoiding the higher-risk areas altogether is the ideal. Where that is not possible, you start with the basics: hand hygiene, food choices and preparation, drinking-water precautions and so on. SPS provides Health Risk Assessments and Medical Emergency Response Plans built around each traveller's actual itinerary and drawn from our teams' real-world experience in these regions.
