ABSTRACT
The limited and coordinated use of travel measures to control the international spread of disease, based on scientific evidence and respect for human rights, are core tenets of the World Health Organization's (WHO) International Health Regulations (IHR). Yet, during the COVID-19 pandemic, there has been near universal and largely uncoordinated use of travel measures by national governments, characterized by wide variation in what measures have been used, when and how they have been applied, and whom they have been applicable to. Given the significant social and economic impacts caused by travel measures, analyses to date have sought to understand the effectiveness of specific measures, in reducing importation and onward spread of SARS-CoV-2, or needed efforts to strengthen compliance with the IHR. There has been limited study of the role of national-level policy making to explain these widely varying practices. Applying path dependency theory to Canadian policies on travel measures, this paper analyses the interaction between science and politics during four key periods of the pandemic response. Bringing together systematic reviews of the scientific literature with parliamentary records, we argue that the evidentiary gap on travel measures during the initial pandemic wave was filled by political and economic influences that shaped when, how and for whom testing and quarantine measures for travelers were applied. These influences then created a degree of path dependency that limited the capacity of government officials to change policy during subsequent waves of the pandemic. This was accompanied by frequent government claims of reliance on science and evidence but limited transparency about what and how scientific evidence informed policy decisions. We argue that, over time, this further politicized the issue of travel measures and undermined public trust. We conclude that fuller understanding of the interaction between science and politics in national decision-making about border management during the COVID-19 pandemic is essential to future efforts to strengthen international coordination under the IHR. Copyright © 2022 Piper, Gomis and Lee.
ABSTRACT
BACKGROUND: The near universal adoption of cross-border health measures during the COVID-19 pandemic worldwide has prompted significant debate about their effectiveness and compliance with international law. The number of measures used, and the range of measures applied, have far exceeded previous public health emergencies of international concern. However, efforts to advance research, policy and practice to support their effective use has been hindered by a lack of clear and consistent definition. RESULTS: Based on a review of existing datasets for cross-border health measures, such as the Oxford Coronavirus Government Response Tracker and World Health Organization Public Health and Social Measures, along with analysis of secondary and grey literature, we propose six categories to define measures more clearly and consistently - policy goal, type of movement (travel and trade), adopted by public or private sector, level of jurisdiction applied, stage of journey, and degree of restrictiveness. These categories are then brought together into a proposed typology that can support research with generalizable findings and comparative analyses across jurisdictions. Addressing the current gaps in evidence about travel measures, including how different jurisdictions apply such measures with varying effects, in turn, enhances the potential for evidence-informed decision-making based on fuller understanding of policy trade-offs and externalities. Finally, through the adoption of standardized terminology and creation of an agreed evidentiary base recognized across jurisdictions, the typology can support efforts to strengthen coordinated global responses to outbreaks and inform future efforts to revise the WHO International Health Regulations (2005). CONCLUSIONS: The widespread use of cross-border health measures during the COVID-19 pandemic has prompted significant reflection on available evidence, previous practice and existing legal frameworks. The typology put forth in this paper aims to provide a starting point for strengthening research, policy and practice.