Travel restrictions and infectious disease outbreaks

Abstract

Background A key purpose of the International Health Regulations (IHR) is to prevent unwarranted interruptions to trade and travel during large and/or transnational infectious disease outbreaks. Nevertheless, such outbreaks continue to disrupt the travel industry. This aspect of the IHR has received little attention in the academic literature despite its considerable impact on affected States and commercial activity. This article outlines the challenges and gaps in knowledge regarding the relationship between outbreaks and the travel sector and discusses the opportunities for further research and policy work to overcome these challenges. Methodology We conducted a literature review on the relationship between outbreaks and travel restrictions, with a particular focus on the 2014–16 Ebola epidemic in West Africa. This review was complemented by an expert roundtable at Chatham House and further supported by case studies and qualitative interviews. Results Numerous travel stakeholders are affected by, and affect, large-scale infectious disease outbreaks. These stakeholders react in different ways: peer pressure plays an important role for both governments and the travel sector, and the reactions of the media and public influence and are influenced by these stakeholders. While various data sources on travel are available, and World Health Organization is mandated to work with States, there is no recognized coordinating body to disseminate timely, consistent, reliable and authoritative information and best practices to all stakeholders. Conclusion This article highlights the interdependent relationship between various travel stakeholders. The reasons for interruption of travel during the 2014–16 Ebola outbreak were complex, with decisions by States only partly contributing to the cessation. Decisions by non-state actors, particularly the travel industry itself, contributed significantly and were based on a variety of factors. Further research, analysis and policy development are required to mitigate the health and economic consequences of infectious disease outbreaks. Any further research will also need to take account of COVID-19 travel-related issues.

Public health emergencies of international concern: a historic overview

“…The disproportionate decline in travel and trade was particularly obvious during the Ebola outbreak. 74 The reasons for interruption of travel during the 2014–2016 Ebola outbreak were complex, with decisions by States only partly contributing to the cessation. Decisions by non-state actors, particularly the travel industry itself, contributed significantly and were based on a variety of factors.…”

“… 73 However, often disproportionate to a declaration and in contrast to the intention and spirit of IHR, outbreaks lead to travel warnings, and loss in tourism and air travel. 74 …”

Health diplomacy across borders: the case of yellow fever and COVID-19

“…As a legally binding agreement between 196 UN states the IHR has two aims—to strengthen the reporting of infectious disease outbreaks as well as to deter states from imposing unwarranted travel restrictions. 13 The WHO has not typically been in favour of travel bans and restrictions, seeing them as a disincentive for early outbreak reporting, disruptive for travel and trade with economic and social impacts, and as not always an effective health measure during an emergency, interrupting or diverting resources. 13 During the COVID-19 pandemic, the WHO has sought to achieve a balance between restricting travel or trade and appropriate protection when physical distancing is not feasible.…”

“… 13 The WHO has not typically been in favour of travel bans and restrictions, seeing them as a disincentive for early outbreak reporting, disruptive for travel and trade with economic and social impacts, and as not always an effective health measure during an emergency, interrupting or diverting resources. 13 During the COVID-19 pandemic, the WHO has sought to achieve a balance between restricting travel or trade and appropriate protection when physical distancing is not feasible. Balancing health with travel, trade, and diplomatic considerations will continue to be an inherent part of disease control measures imposed on borders.…”

COVID-19’s impact on travel medicine surpasses that of all other emerging viral diseases

“…Ebola was declared a public health emergency in 2014 in West Africa and again in 2018 in the Democratic Republic of Congo. 12 About 14 000 Ebola deaths were recorded, which now in hindsight pales against the 1.4 million deaths due to COVID-19, although at the time, it led to widespread panic and undue travel warnings. 12 Spread of Ebola via air travel has only rarely occurred, 13 the main reason being that connectivity between the worst-affected Ebola countries is relative low and the fact that Ebola patients are too symptomatic to board a plane or are picked up at entry screening, whereas a large proportion of COVID-19 are asymptomatic.…”