Travel Restrictions & Other Cross-Border Pandemic Control Measures Need More Coordination  
World Health Assembly side event – COVID-19 and Cross-Border Health Measures, left to right – Apakrishnanarna Ananth, Lisa Forman, Karen Grepin, Catherine Worsnop, Roonjin Habibi, Diego Silva, Barbara von Tigerstrom, James Wiltshire

Controlling a disease outbreak requires cooperation both behind borders and between countries, experts said at a Wednesday event co-organised by the Geneva Graduate Institute’s Global Health Centre.  And one key, neglected area of international cooperation has been travel restrictions, where countries worldwide have created a cacophony of different measures to control COVID.  

“Travel measures are potentially necessary, but they’re not sufficient to control an outbreak. It’s not sufficient to just have strong travel measures in place,” said Karen Grepin, University of Hong Kong associate professor, during the World Health Assembly side event. “We also need a strong national response, a public health response to the pandemic. It can’t just be one or the other.” 

Panelists discussed the impacts of cross-border measures implemented in response to COVID-19. They also considered lessons learned regarding the strengths and weaknesses of the existing International Health Regulations (IHR), which govern country responses, as well as the broader global health ecosystem. 

Travel Measures Must Be Implemented at a Granular Level

Travel measures must take into account local capacity, economic and social circumstance, and legal obligations of countries

These measures need implementation at a granular level, taking into account the “incredible diversity of local capacity, economic and social circumstances, and other legal obligations among member states,” said Barbara von Tigerstrom, Professor at the University of Saskatchewan.

She said experts are making efforts to adapt to a single uniform set of recommendations “when member states are so varied, and especially when things are moving quickly and we need to make quick decisions.” 

Regarding the IHR, von Tigerstrom suggested that evaluating a centralized recommendation or a single set of regulations is not necessary to evaluate what is legitimate or lawful: “If we’re going to use travel restrictions and have them be useful, [then] the more quickly the better.”

Grepin said travel measures also should be rethought in terms of effectiveness: “In the case of COVID, I can say without a doubt that travel measures have been effective in various contexts.” 

Karen Grepin, University of Hong Kong

These measures have been a critical component of national infectious disease response,  Grepin said, and many countries have effective border measures in place they are reluctant to discontinue. 

However, Grepin pointed out, “The reality is that we don’t need to respond like we have in this pandemic to all future threats. Context matters an enormous amount. Some places are more likely to benefit from [these measures] than others, so blanket measures that apply to all state parties are likely to be limited in what they can really [do].” 

James Wiltshire, International Air Transport Association assistant director, also called for a context-based approach for travel measure exit strategies: “There’s not a joined-up approach between measures at the border and measures behind the border.”  

Almost every country in the world has travel measures in place, but those measures are highly inconsistent.  And the IHR rules, which have few provisions about travel in the first place, provide even less guidance on how such measures should be relaxed or removed as the  pandemic is beaten back.

Said Wiltshire each country also faces different contexts, not in terms of disease transmission as well as social and economic pressures: This is a “complex pandemic, with many different countries in different states, so almost certainly a phased removal or relaxation of measures is needed. It is not realistic to expect something that’s prescriptive of the IHR to be followed to the letter of the law, given the range of different circumstances that countries have.” 

High-Income Countries Have ‘Moral Obligation’ Regarding Travel Regulations

Diego Silva, University of Sydney

University of Sydney health ethics lecturer Diego Silva said, “If we’re truly interested in global health, if we’re truly interested in taking seriously the ‘pan’ part of a pandemic, then we need to think through how we interact with each other.”

Silva discussed reciprocity between countries with different income levels. He said travel restrictions and border closures must be understood not just in the context in which they occurred, but also in relation to broader politics and policies. 

Using Australia as an example, Silva said its government is very hesitant on immigration from certain Asian countries, and that “[this] geopolitical reality shapes [Australia’s] border responses.” He said this idea of “state sovereignty used in a protectionist manner” may be “morally problematic, because of the global nature of the virus.” 

He advised that countries need to work on a regional level, at the very least, when it comes to border closures. High-income countries also have a “moral obligation” to work with LMICs on  international travel issues: “It’s not enough to act again in a unilateral manner.”

Potential Gap in IHR Compliance and Policy Implementation   

Catherine Worsnop, University of Maryland

Looking beyond potential IHR revisions and a potential pandemic treaty, University of Maryland Assistant Professor Catherine Worsnop said it’s critical to understand compliance behavior during an outbreak, as well as the potential drivers of variant spread. 

Worsnop found a potential gap between legally compliant behavior and implemented policy when evaluating country compliance in regards to Article 43 of the IHR. 

“Compliance and non-compliance does not capture the full extent of variation and policies that states were actually adopting at the border,” said Worsnop. Implemented policies were not necessarily aligned with the dual purposes of the IHR: to protect health and minimize interference with international traffic.

“We need better clarity on what the IHR are actually aiming to achieve when it comes to cross-border measures, and what counts as compliance really needs to be aligned with that aim going forward,” Worsnop said. 

Roojin Habibi of York University addressed legal considerations in the interpretation of Article 43. The precautionary principle has come up often, notably in reviews conducted by the Independent Panel for Pandemic Preparedness and Response (IPPR), the IHR Review Committee’s report, and the Independent Oversight and Advisory Committee’s report. Yet this “is nowhere written in the text of the IHR,” Habibi said. 

The principle asserts that positive actions, such as a ban on certain activities, may be implemented in order to protect the environment or public health before a risk is scientifically proven. “I would caution us, and would strongly urge us to think carefully about the precautionary principle,” Habibi said. “Doesn’t scientific evidence do the job well enough for us?” 


Image Credits: Sanshiro Kubota/Flikr, Global Health Centre/Twitter, Graduate Institute Geneva.

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