Revisiting the Role of COVID-19 Travel Restrictions in Light of Delta and Other Variants

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CHAPTERS 

[00:03:27]: IHR compliance and the evidence vacuum in early 2020 

[00:07:01]: WHO's initial stance on travel restrictions 

[00:09:44]: Countries that went early and hard: the COVID zero strategy 

[00:13:05]: How realistic is an elimination strategy for cross-border travel? 

[00:15:37]: The current patchwork: partial measures and Delta risks 

[00:18:34]: Exit strategy: vaccines, testing protocols, and travel volume 

[00:21:31]: Lessons for the next pandemic: interoperable systems and coordination

TRANSCRIPT 

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Hi, everyone.

[00:00:01.760] 

Welcome to Moving Beyond Pandemic, the podcast from the Migration Policy Institute that looks at how COVID-19 is reshaping all aspects of human movement, from tourism and business travel to labor migration and mobility. I'm Meghan Benton, I'm the Research Director for MPI's international work and also for our sister organization, MPI Europe. This podcast has been on hiatus while I've been on maternity leave, but I'm delighted to be back and digging into these issues once again. The effectiveness of pandemic travel restrictions has been hotly contested since countries first began limiting cross-border movements in early 2020. But perhaps no one expected that they'd last so long, or that we see such a dance of two steps forward, one two steps back in the process of easing restrictions. Right now, of course, there's a patchwork of different measures in place. This is difficult, it's often costly for travelers and migrants to navigate, and it's unclear whether many of these are serving their stated public health benefits. And then of course, the arrival of new variants, including the Delta variant, has questioned much of what we knew. Delta has led to outbreaks even in countries like Australia and Singapore that looked like they'd contain the virus.

[00:01:12.100] 

And it's raised doubts about whether vaccination requirements and other protocols are robust enough to stem the spread of troubling variants. I talked to Dr. Kelley Lee, who is professor and Tier 1 Canada Research Chair in Global Health Governance at Simon Fraser University in Canada. She leads the Pandemics and Borders Research Project which is trying to improve decision making on cross border measures to control pandemics. I asked her to reflect on what we've learned about the role of travel restrictions, but also what the future holds and what will happen when the next potential pandemic arrives. Hi, Kelley, how are you?

[00:01:51.070] 

Hi Meghan. I'm well, thank you.

[00:01:53.790] 

Well, thanks so much for agreeing to speak with me today. I was hoping you could just start by describing a little bit about your work and about the Pandemics and Borders Project.

[00:02:02.810] 

Yes, I'd be happy to. So our Pandemics and Borders Project is an international and an interdisciplinary team of researchers. So we're based in Canada, Hong Kong and the U.S. And we've been working together since March 2020 to try to understand how travel restrictions and generally cross border measures have been used by every country in the world during the COVID-19 pandemic. So it's quite a big project. We didn't think it would be such a large project when we started out. We conducting all sorts of analyzes. So systematic reviews, for example, of what studies have been done so far to try and look at the evidence around these measures. We're doing some case studies of how these measures have been used and why. So sort of decision-making about those measures. We're starting to look at genomic sequencing data to see if restrictions have actually influenced how specific strains of the virus have circulated around the world. And we're also going to be starting to look at mathematical modeling and using that to test, I guess, or model different testing and quarantine protocols. So we've got lots going on. We want to make sure we bring this all together and try and inform decision-makers, because it's been a very fraught area of policy.

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And the idea is to really help decision makers to make these tough decisions.

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Well, I want to hear more about what you found in terms of effectiveness and decision making in just a moment. But I wanted to start perhaps by kind of rolling us back in time to spring 2020. Your work looks at compliance with the international health regulations, and I thought it would be interesting to think about what actually happened, whether or not countries did comply. The international health regulations, of course, require countries to work together, but we actually saw this sort of unilateral action. What would an alternative scenario have looked like if countries had complied? Can you imagine a more orderly start to the pandemic?

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Yes, definitely. It should not have turned out the way it did. And we have something called the International Health Regulations. They were revised in 2005 to prevent this. This exact scenario of countries doing exactly what they think or doing things individually without coordinating with other countries. So we saw this early on with travel measures or border measures, and our team assumed that countries were non-compliant, that this was not what was set out in the IHR. And in fact, it's actually more complicated than that. The story of whether countries are compliant or not is not that clear cut. If you look at the IHR, there's various commitments by states to use what are called additional health measures. And that's under Article 43. And what it says is that you need to have a clear public health rationale for using travel measures. You have to have no other measure could be used. This would kind of like the last resort. They have to be supported by scientific principles and evidence. And you have to inform who within 48 hours if you're going to put into place restrictions on travel. And countries need to review these measures after three months.

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So a lot of this was not complied with. Absolutely. But I think the key thing here is that we have to look back and see what was the evidence that was supporting these measures. And that was the problematic part, is that we assumed that somehow travel restrictions would have some scientific basis or not. And when you look back, the previous outbreaks didn't really help us because they were very different pathogens. They're very different contexts. And so countries were actually facing a vacuum in evidence. And so they did go ahead and do what they thought was best, which was more precautionary approach. And so, you know, lawyers can debate whether that was compliant or not. They certainly, you know, if there's no scientific principles to either way, our states violating an international law. So putting that aside, I think what would have been better, absolutely, is a coordinated response. Countries should have at least informed each other through WHO of what it was doing. But it was all a mad scramble instead. And what we still have is quite a chaotic situation.

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Yeah, I mean, it's extremely difficult to make decisions in the context of such uncertainty. So you can kind of understand why national governments reacted in the way they did. But it's interesting how the World Health Organization at the beginning wasn't really supportive of travel restrictions. Have they shifted position? And what have we learned about the who's role as kind of this early response mechanism for calling out potential pandemics? Did it serve that role well?

[00:07:00.770] 

Well, yes. When WHO recommended against the use of travel and or trade restrictions on January 23, or was it January 30 when it declared a public health emergency of international concern? So that decision was based on previous outbreaks, as I mentioned, you know, Ebola, H1N1, and border measures for those outbreaks were not necessary, in fact, can be counterproductive and, you know, hinder people from being forthcoming about their health status. They can be incredibly impactful on economies, on people's lives, can be quite discriminatory. So all of the evidence showed that those kind of measures were not necessary. And WHO was calling on that evidence to make the decision about this particular pathogen. And as we know now, you know, we didn't know a lot about this particular virus. It turns out that it's actually very different from previous. The previous SARS virus, for example, there's asymptomatic transmission, it's more transmissible, it is mutating very quickly. All sorts of things that make it actually, you know, unprecedented in terms of the rule book around travel restrictions. So now we've learned since January 2020 that this novel virus would actually have been slowed down, at least potentially stopped in its tracks, had we put into place border restrictions.

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Quickly, all countries, you know, coordinated that. We didn't have to do it forever, but we could have made it, you know, less of a pandemic, at least, and more of a localized outbreak. And so evidence really shows that there are two public health interventions that were the most effective at reducing SARS-CoV2 transmission during this pandemic. One was social distancing, and the other was travel restrictions. And so, you know, reviews of evidence are, are indicating this. It's not the end all be all travel restrictions. You know, you don't just put them in place and put your feet up on your desk and say, okay, I've done my job. Obviously that's... It was only a temporary measure or one that would slow down and give you time to put into place other measures, but certainly throwing it out the window and saying, no, no, no, travel restrictions, you know, don't work at all, and we should never use them unless we're, you know, faced with an absolute necessity that that was actually now the wrong call. And I think WHO recognizes that they've issued some new guidelines on risk assessment related to travel. And that's what we're working towards now is understanding when you use travel restrictions and when you don't, because now we know that you do need to use them in some situations.

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So, I mean, it feels like the world was as locked down as it could be possibly have been. But you're saying that if it had been coordinated and perhaps a little earlier, there could have been more of a short, sharp closure of international mobility entirely. That might have been shorter lived as well.

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That's right. Countries didn't do the same thing as we were discussing. And some countries went very quickly. They were the early adopters and they went hard. I mean, they really shut down and restricted almost all travel. No countries actually closed their borders in a strict sense or banned travel. But they really made it very narrow who could travel and under what conditions. They would be tested and quarantined very, very closely. But other countries were slow to respond, but also only put in partial measures, so they would allow some travelers but not others. The testing wasn't really introduced in many countries or quarantine quite late. And so you had variation in not only the measures that were adopted, but how they were implemented. So that makes it hard to compare cases. But what we do know is that countries that went early and went hard and adopted, I guess, you know, an elimination strategy, the COVID zero kind of strategy, really fared much better. They had few, far fewer cases of imported virus and far fewer onward transmission. And that was, you know, that's been throughout the pandemic. You see this strategy, those countries that have not followed that approach, more of a mitigation or suppression strategy, have been those that have had the highest number of cases, number of deaths.

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And so travel was part of that. Travel measures are part of that story. And this is why we need to I guess learn lessons from countries who have done relatively well compared to others.

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And how realistic, I mean you pointed a little bit to the exceptions that were introduced early on and the fact that this kind of made travel restrictions quite leaky in a number of countries. How realistic is it to sort of have in place a COVID elimination strategy in the way that you are managing your travel and borders, in that you need to provide options for your returning nationals, returning residents to be able to come in? And you know, as we saw increasingly over the course of the pandemic, also provide mechanisms for essential workers and other, you know, people who really needed to get into the country to be able to cross borders?

[00:12:17.330] 

Yes, it's you know, politically and economically very challenging. And this is why we talk about border management, not border closures. Travel needs to continue. There is this category that countries use of essential travelers and the category, you know, who gets to be called an essential traveler varies politically. But the idea is that there are some people that will need to travel regardless of any restrictions. The idea is that you would put into place measures that allow travel, but you need to test people as they come in and you need to quarantine people as they come in based on risk. So it doesn't mean you just don't allow anyone in. It means you allow them in safely. And it's of course about volume as well. So you do need to think about who cannot travel, you know, people going on holiday, people who are I guess considered non essential to travel. They, they need to, to wait. But, but you do raise an important point. You know how I guess politically feasible it would have been. And early on it would have been very difficult because it's, it was such an unprecedented thing to do to secure borders around the world for a prolonged period of time.

[00:13:24.750] 

We've just never done it before and it was a high risk policy if you went that route. And most countries didn't have historical experience of serious outbreaks. So you see the countries that went early were the countries that had previous exposure to MERs, SARS1 being just in the region of Asia, east and Southeast Asia, where routinely primed to expect emerging infections and so had measures in place that could be implemented, there was less hesitation. So you go to Europe and North America. We just are so used to having people mobile, having a globalized world, it was just unthinkable. So that's, of course, January 2020. We, we thought this was unthinkable to do. But a year later and variants come on the scene, we've learned a year that this virus is being circulated by people who are traveling around the world. And the variants sort of gave a new opportunity, almost like a new pandemic. And travel measures could have been effectively used then to prevent or at least slow down the spread of variants. And again, you see a lot of variation. And because countries, I guess, were committed to either mitigation or elimination, they had gone one way or the, the other, they felt they couldn't go back.

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And so we see the same mistakes being made again. And the variants, of course, spread globally repeatedly.

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Yeah, it goes back to that point about how you do decision making in a context of deep uncertainty. I mean, if we had known back then in spring 2020, what the costs would have been of the global pandemic, perhaps countries would be made of different calculation, but it was all, you know, just conjecture at that point. So it's very difficult to make that cost benefit analysis when you don't know you're working with. So you started talking about what we have right now and how countries have used travel restrictions to good effect or not to manage the spread of variants. What do you think about the current picture? Is it serving public health objectives? Well, what is the current situation?

[00:15:37.650] 

Well, the current situation has changed because of the rollout of vaccination in some countries and not others, of course. So, you know, it's not a global picture. But I would say that, you know, from a public health perspective, the way that travel is being managed is certainly not positive. We have sort of like the worst of both worlds. We have partial measures that, you know, there's a kind of, oh, we need to be performative, we need to do something. We look like we're managing the borders and the risks of imported infections, but there's no, you know, in many countries, there's a limited commitment to this, There's a kind of let's do something, but we're not willing to go all out and go hard. So you have now an easing of restrictions with fully vaccinated people, particularly allowed to travel without or with very limited testing and often no quarantine, no isolation. And that's, of course, very worrying. We have the Delta variant, of course, and we have others waiting in the wings. And this is going to be a problem when we get this anticipated vaccine escape variant which is widely predicted to happen. So we're kind of seeing decision-makers really try to balance political and economic policy goals and public health goals.

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And what I think we're learning is that you need to prioritize the public health goals really at certain points. You can't really do everything at once because then everything sort of goes out the window. A little bit of this, a little bit of that, which is kind of how governments in, you know, Western democracies tend to work. They tend to try and do a little bit of enough of everything so that people are, you know, feeling like you're, you've got bases covered. But you can't really do that in the case of this pandemic because if as soon as you allow variants to come in and seed in a domestic situation, you're actually impacting on the economic and the political anyway, it's better to actually stop with the chronic lockdowns and the up and down, you know, open and closed systems and really go for a consistency. And this is what we're seeing, for example, in Taiwan, in New Zealand and Australia where they're, you know, they've had their moments for sure, they've had their outbreaks, but they've jumped on them very, very quickly and strong. And once they get them under control, the society within the borders goes back to relative normality.

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Whereas what we have is this chronic lockdowns or restrictions that actually aren't good for anyone, aren't good for public health, for the economy, for society.

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And what's the exit strategy then from this kind of worst of all world scenario? I mean, we have, as you said, the prospect of potentially a vaccine resistant variant emerging. We have this very different picture with places like Taiwan and Australia that are still trying to manage their domestic outbreaks and maintain quite stringent external measures. What does the next six months look like? And you know, how do we get out of this picture, this patchwork?

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Yeah, it's a very dynamic situation. So what worked six months ago may not work now. And it comes down to what variants are circulating, what the vaccination picture is looking like. But I guess I would land on a few things. First of all, we absolutely need to address the inequities in global vaccine access. Nobody can travel safely and worldwide until we get as many people as possible vaccinated. And we know that's a really inequitable situation. The second thing is that there's this temptation to ease up on the testing and the contact tracing. And we're seeing that there's an assumption if you're fully vaccinated, you don't pose a risk, you can get infected or pass it on to others. There's certainly a reduced risk and that's very good. And we should encourage people to be vaccinated for sure. But we need to also match the protocols of fully vaccinated travelers with the evolving science. We just still don't know fully how this virus behaves and particularly the variants. So how susceptible are you to infection and serious illness, how transmissible you are even though you're fully vaccinated? So those things need to be aligned. The protocols at the borders and the evolving science.

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And I guess a third thing is the volume of travel, which I mentioned before. So there's many countries like the UK are wanting to open up travel again and allow as many people as possible to be green countries or get rid of the traffic light system. We saw this in the US to open up travel again to Europe and to other parts of the world. And the thing is that the volume of travelers goes up and your capacity at the border is the same, then you're going to get bottlenecks, you're going to get pressured not to test as, as, you know, as, as carefully, which is what we're seeing. Everybody has a test now pre departure, but not upon arrival and that sort of thing. So you're compromising the public health safety risk protocols because you have too many travelers to deal with. And so that has to be managed very carefully. But I guess in the beyond this pandemic and trying to figure out that we shouldn't do this again in a problematic way, I think we need to begin, I think with finding a way to distinguish or to assess the risks from travel depending on the pathogen we're dealing with.

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The next time we have a report of an unusual respiratory infection that's moving about human to human transmission, we need some way to assess with limited knowledge, you know, because novel pathogens are by definition, you know, not known very well, but that we need to apply some sort of evidence, informed, risk based approach to border management. We haven't got that. We just have very poor methodology to kind of inform policymakers. The second thing we need to do after we get out of this pandemic is create some interoperable systems to put into place. So borders are, you know, I guess we're used to trying to ease border management in the era of globalization, but actually borders still matter and so we need to put into place systems that are interoperable, which, I mean, you know, they're compatible across countries.

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We don't.

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We shouldn't have different systems of vaccine recognition, different ways of screening people. We should be able to get together and establish a coordinated system. And if you think of air traffic control as a good example, you know, we have thousands of aircraft in the air at one time navigating around each other. They are all constant contact with the air traffic control system around the world. And how they do that is there's an international treaty that says everybody, all pilots and all air traffic controllers need to speak English. Then there's agreed protocol. And so, you know, we figured that out. I think we could figure out the other requirements for public health risks as well. So just generally, you know, committing to that collaborative approach and I guess finally then thinking about borders, you know, capacity at borders, we didn't invest in borders very much. Amid globalization, we've actually undermined capacity thinking we want to get rid of borders. You know, we're in a globalized world, but actually when this event happens, we want to be able not to be policing, but really to make sure that people can keep moving, but they can do so safely.

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And that requires increased capacity.

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So this coordinated system, what does that look like? If we have another viral outbreak that looks like it could be a pandemic in a few years, it would certainly

[00:23:51.290] 

have to go back to the international health regulations and to look at that legal framework and to, I guess, get countries to recognize that committing to the IHR in a fuller way is actually in their interests. And that's going to be the political challenge in the next few months and the next few years is how to strengthen and revise the IHR once again to ensure that countries, their first response is to coordinate and not to do their own thing. We also have to fill the gaps so that this evidence is there, there's a decision tree or a model that will allow policymakers who don't have all the information to follow so that it leads to a coordinated system, not a national individual response. I think having regular updates and meetings on coordinating border management would be important. That extends beyond health, that there's, you know, there's the other parts of travel, you know, could be the trade side, it could be the security, migration, immigration, and so on. It goes well beyond health, the policy issues, and that an intersectoral approach would be very important. And technology, we have the opportunity to apply technology and to make sure that it's interoperable, that we have consistent systems across the world and that's going to require some investment for sure if we're going to have a global system.

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And once again, we can't isolate different parts of the world in a bubble. If we're going to have a globalized world, we need to make sure that all the countries are on board and have the capacity to participate in a coordinated system. So it's a tall order, but I think my sense is people don't want to go back to a world of the 18th century or go back in time where people stayed in their own countries. I don't think that is a viable option. So if we're going to go back to a world where we can live on this planet and share this planet and move about in the planet in different ways, it's no option. We do need to figure this out.

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Thank you so much, Kelley, for your time.

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Oh, you're most welcome. Thanks Meghan.

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That was Dr. Kelley Lee from Simon Fraser University and the Pandemics and Borders Project. Speaking with Kelley, I was struck by the picture she paints of countries and the World Health Organization being on the back foot in the way they made decisions about COVID and cross border mobility in early 2020. The position taken by many actors at this point was shaped by what had come before. So the WHO was concerned to avoid experiences in the past when border measures turned out to be costly and unnecessary. Countries with experience of managing SARS1 or MERS defaulted to the strategies they learned when managing these outbreaks. It's interesting to think about what the rational response is for governments faced with an unknown pathogen. Is it to learn from the past to be highly risk averse and plan for the worst? These kinds of choices are always difficult in the context of uncertainty. But I think we need to reflect on the lessons from the COVID pandemic to create a framework for decision making next time. I also thought it was interesting that she casts new public health protocols and technology and expansions in border capacity as necessary steps to preserve the future of global mobility itself, and that she cast these as largely permanent shifts.

[00:27:26.320] 

Governments are clearly beginning to let go of the fantasy that they might be able to go back to how things were before the pandemic. But we are seeing a bit of a split between governments that want any new tools, any new infrastructure, for instance digital health certificates, to be temporary, to be just for emergency kind of burn after use approach. And then there's those that are thinking about these investments as the pillars of future mobility management. Kelley talks about the global coordination challenge facing us as a bit like air traffic control. Everyone's safety depends on people working together. But I do wonder whether this analogy, or perhaps some of Kelley's vision, goes a step too far. Air traffic control requires constant vigilance forever. But for COVID, we hope at least, there's a point in the future when the risk will be low, at which point perhaps the greater threat might be being left with protocols and requirements that we no longer need. So as we think about designing the future mobility system, I think we need to be realistic that what we build will stay. It will stick. But that means that we need to keep in mind a principle of risk proportionality being streamlined, minimalist, having a strategy for abandoning measures that we no longer need, or where we can turn off measures if we fall below a certain risk threshold.

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For those of you interested in what the future might hold and choices facing us as we design mobility systems, I'd like to make a little plug for my report Future Scenarios for Global Mobility in the Shadow of Pandemic, which you can find on our website migrationpolicy.org. If you want to hear more, please subscribe to this podcast, Moving Beyond Pandemic, wherever you find your podcasts, or you can access it as well through our website migrationpolicy.org/podcasts. I'd like to thank my colleagues Lisa Dixon, Michelle Mittelstadt and Yoseph Hamid for producing this podcast. The music you heard today was Juno in the Space Maze by LooPop. I'm Meghan Benton and I'll see you next time.