Why Are Travel Restrictions Imposed and What Is The Evidence Behind Them During This COVID-19 Crisis?
This is a fundamental question and requires an evidence based answer, particularly when trade is vital to our economy.
An article by Kelly Leigh and others in The Lancet May 14 looked at the evidence.
January 30, 2020, a date which I am sure will become enshrined in history, was the day the WHO declared the COVID-19 outbreak a public health emergency of international concern.
Under the provisions of the International Health Regulations 2005, IHR, it recommended against “any travel or trade restriction” – this recommendation was base on data that was available at the time. They used evidence from previous outbreaks. This formed an important part of the WHO’s message about how states and countries could effectively respond in a coordinated way.
In spite of this, according to the WHO, 194 countries adopted some form of cross border control including travel restrictions, visa restrictions and border closures. The WHO did little to stop these.
Interestingly, this response was a sharp increase from the number of member states that imposed trade and travel restrictions during the 2009 H1N1 influenza pandemic and the 2013-2016 outbreak of Ebola virus in West Africa.
The WHO’s recommendation against measures such as travel restriction and border closure became a point of criticism of the organisation at the very early stages of COVID-19 pandemic.
These cross border measures raise fundamental questions about what coordination actually means during a pandemic and whether the WHO has a role in facilitating this. It is argued that coordinated action amongst states in an interconnected global world underpins the effective prevention, detection and control of disease outbreaks across countries.
Governments of the countries party to the IHR agree that coordination is an important tool to ensure that measures do not unnecessarily disrupt international trade and travel. Surely, part of the WHO’s role is to provide evidence informed guidance on cross border measures during major disease outbreaks?
More extensive cross border measures have been adopted by countries during this COVID-19 pandemic than in any past disease outbreak, but one asks why?
What Measures Have Been Adopted by Commercial Companies Such As Airlines and Cruise Ships? And Why?
Companies do not fall under the remits of the IHR, but their actions have very clear consequences. Clearly countries have adopted different measures during this pandemic and some of these are inconsistent with the IHR.
The measures include international travel.
- Travel advisory – suspend transportation, land, air and sea.
- Visa requirement or refusal.
- Expedite entry of selected foreign nationals e.g. farm labourers, health workers.
- Restrict entry of selected foreign nationals on the basis of nationality, travel history or health status.
- Close national borders in part or whole.
International trade – restrict import of specific goods from selected country
- Expedite import of selected goods (e.g. ventilators, active ingredients for drug manufacturing, personal protective equipment)
- Restrict export of personal protective equipment.
- Impose technical requirements for imported goods (e.g. labelling certification)
Entry and exit control at national borders
- Compulsory temperature management.
- Compulsory questionnaire (e.g. symptoms, travel history, contract tracing).
- Voluntary or compulsory quarantine upon entry.
- Voluntary or compulsory testing upon entry.
- Distribution of public health information at ports of entry.
- Mandatory certification (e.g. vaccination, disease free status).
- Vector control and surveillance (e.g. spraying at borders or on aeroplanes).
However, the impact of these cross-border measures is not known. From a public heath perspective, there is limited research that exists on cross border measurements. However, research that exists during COVID-19 has focussed on the impact of travel restrictions on the prevention of disease transmission and this evidence is mixed.
Some studies suggest such restrictions can delay the disease spread whereas other research suggests that there are negligible effects on the overall number of cases.
Further studies suggest certain cross-border measures are counterproductive because they discourage the disclosure of potentially relevant information by individuals during screening and by governments seeking to avoid being the target of restrictions. Forced quarantine, visa restrictions and flight cancellations have possibly hindered the movement of health workers and essential supplies.
These cross border measures have significant economic, social, legal and ethical impacts that are inequitably experienced in different countries if there is insufficient attention to viewing the impact.
Protectionist trade and travel restrictions inevitably maintain public and investor confidence in some affected countries but will contribute to economic strain and poorer health outcomes in other affected countries which in itself will hinder response efforts. To this current date, the extent to which these effects have varied in terms of a public health effect and the context in which they occur has not been studied. These cross-border measures need to be evaluated urgently in the stages of the pandemic as they will be with us for some time.
Governments may adopt travel restrictions as a result of political pressure to do something and these travel restrictions are largely limited to economic interests. However, the decision making behind these cross-border measures requires a fuller explanation.
The authors argue that complex considerations could be at play – evolving knowledge about COVID-19 – uncertainty about the source of outbreak or biases about the origin – insufficient clarity from the WHO and their recommendations – timing of the public health emergency of international concern declaration – unknown efficacy of specific measures – lack of trust in public health officials – geopolitical dynamics – epidemiological trends over time.
The question of why, when and how governments decide to lift these cross-border measures is also largely unexplored and has not been researched. During the COVID-19 pandemic most policy attention has been on domestic restrictions and their lifting. But easing cross border measures – and possibly reintroducing them if there are any subsequent waves of new cases – will pose a similar challenge for decision makers. An example of this is the Australia/New Zealand travel bubble.
A fundamental core principal of the IHR has been protecting public health whilst minimising unnecessary interference with travel and trade. The authors argue that this longstanding goal should not be abandoned lightly.
A comprehensive evaluation is required of measures have been adopted during the COVID-19 and past outbreaks. A review of how these measures have impacted on public health and what factors have influenced their decision making is required. This information is required to enable evidence based, real time decisions on adopting and lifting cross-border measures in order to mitigate the harm during this COVID-19 pandemic and for any future outbreaks.
The London Global Practice, the international arm of LGP has welcomed and treated patients from around the world. In order to facilitate this during this time of travel restriction, we have perfected video consultations and have sourced medical partners throughout the world in order to help our patients.
Wherever you are, please feel free to ring for a video consultation.
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