Who Pays for Medical Expenses During a Major Infectious Disease Outbreak?

When an infectious disease outbreak becomes a WHO notification event (e.g. 2026 Hantavirus cluster onboard MV Hondius) or a Public Health Emergency of International Concern or PHEIC (e.g. 2026 Ebola outbreak), the WHO and governments take the lead in managing the response.

But does this mean they also assume financial responsibility for the affected travellers?
Not necessarily.

The responsibility for coordinating the emergency response and responsibility for paying the resulting expenses are two different matters.

Who pays for what?
Financial responsibility generally depends on the nature of the expense, WHO International Health Regulations (2005) Article 40, national legislation, insurance coverage and arrangements between the parties involved.

- Public health investigations, contact tracing and disease surveillance: Generally funded by governments and public health authorities.
- Mandatory screening, isolation and quarantine: The International Health Regulations generally restrict governments from charging travellers for specified public health measures. However, certain costs may be recoverable from applicable insurance sources.
- Hospital treatment (including intensive care): Travel insurers may remain financially responsible where treatment is covered under the policy. Public healthcare systems or patients may bear the costs in other circumstances.
- Medical evacuation: Financial responsibility may rest with travel insurers, governments or other parties, depending on insurance coverage and the circumstances of the evacuation.
- Repatriation and additional travel arrangements: Costs may fall upon insurers or travellers, depending on applicable obligations and policy provisions.
- Crew medical care and repatriation: Shipowners and employers may have contractual and maritime-law obligations, supported by their insurance arrangements.

Impact on travel insurers?
A WHO notification event or a PHEIC does not automatically transfer financial responsibility for individual medical claims to governments.
Insurers may continue to face substantial medical and travel-related claims, even when government authorities control the timing and conditions of treatment, evacuation, quarantine and repatriation.

This creates an unusual challenge: insurers may retain financial exposure while having limited operational control over the decisions that determine the duration and cost of a claim.

For medical assistance teams, the priority becomes supporting government-led operations, maintaining medical oversight of insured patients and coordinating treatment or repatriation within the restrictions imposed by public health authorities.