The economic impact of international travel measures used during the COVID-19 pandemic: a scoping review.

INTRODUCTION: Assessment of the use of travel measures during COVID-19 has focused on their effectiveness in achieving public health objectives. However, the prolonged use of highly varied and frequently changing measures by governments, and their unintended consequences caused, has been controversial. This has led to a call for coordinated decision-making focused on risk-based approaches, which requires better understanding of the broader impacts of international travel measures (ITMs) on individuals and societies. METHODS: Our scoping review investigates the literature on the economic impact of COVID-19 ITMs. We searched health, social science and COVID-19-specific databases for empirical studies preprinted or published between 1 January 2020 and 31 October 2023. Evidence was charted using a narrative approach and included jurisdiction of study, ITMs studied, study design, outcome categories, and main findings. RESULTS: Twenty-six studies met the inclusion criteria and were included for data extraction. Twelve of them focused on the international travel restrictions implemented in early 2020. Limited attention was given to measures such as entry/exit screening and vaccination requirements. Eight studies focused on high-income countries, 6 on low-income and middle-income countries and 10 studies were comparative although did not select countries by income. Economic outcomes assessed included financial markets (n=13), economic growth (n=4), economic activities (n=1), performance of industries central to international travel (n=9), household-level economic status (n=3) and consumer behaviour (n=1). Empirical methods employed included linear regression (n=17), mathematical modelling (n=3) and mixed strategies (n=6). CONCLUSION: Existing studies have begun to provide evidence of the wide-ranging economic impacts resulting from ITMs. However, the small body of research combined with difficulties in isolating the effects of such measures and limitations in available data mean that it is challenging to draw general and robust conclusions. Future research using rigorous empirical methods and high-quality data is needed on this topic.

An analysis of WHO's Temporary Recommendations on international travel and trade measures during Public Health Emergencies of International Concern.

During Public Health Emergencies of International Concern (PHEICs), The International Health Regulations (IHR) require the WHO to issue Temporary Recommendations on the use of international travel and trade measures. During the COVID-19 pandemic, WHO's initial recommendation against 'any travel or trade restriction' has been questioned, and virtually all countries subsequently used international travel measures. WHO's Recommendations to States Parties also changed over the course of the pandemic. There is a need to understand how WHO's treatment of this issue compared with other PHEICs and why States Parties' actions diverged from WHO's initial Recommendations. This first analysis of WHO's Temporary Recommendations on international travel and trade measures during all seven PHEICs compares the guidance for clarity and consistency in several areas of substance and process. We find that lack of clarity and inconsistency in WHO guidance makes it difficult to interpret and relate back to IHR obligations. Based on this analysis, we offer recommendations to increase consistency and clarity of WHO's guidance on this issue during global health emergencies.

The Unintended Consequences of Information Provision: The World Health Organization and Border Restrictions during COVID-19.

Why do some international agreements fail to achieve their goals? Rather than states' engaging in cheap talk, evasion, or shallow commitments, the World Health Organization's (WHO) International Health Regulations (IHR)-the agreement governing states' and WHO's response to global health emergencies-point to the unintended consequences of information provision. The IHR have a dual goal of providing public health protection from health threats while minimizing unnecessary interference in international traffic. As such, during major outbreaks WHO provides information about spread and severity, as well as guidance about how states should respond, primarily regarding border policies. During COVID-19, border restrictions such as entry restrictions, flight suspensions, and border closures have been commonplace even though WHO recommended against such policies when it declared the outbreak a public health emergency in January 2020. Building on findings from the 2014 Ebola outbreak, we argue that without raising the cost of disregarding (or the benefits of following) recommendations against border restrictions, information from WHO about outbreak spread and severity leads states to impose border restrictions inconsistent with WHO's guidance. Using new data from COVID-19, we show that WHO's public health emergency declaration and pandemic announcement are associated with increases in the number of states imposing border restrictions.

Resumen: ¿Por qué motivo algunos acuerdos internacionales no logran alcanzar sus objetivos? El Reglamento Sanitario Internacional (RSI) de la Organización Mundial de la Salud (OMS)­el acuerdo que rige la respuesta de los Estados y la OMS a las emergencias sanitarias mundiales­señala como motivo las consecuencias imprevistas del suministro de información, en lugar del discurso trivial, la evasión o los compromisos superficiales por parte de los Estados. El RSI tiene como doble objetivo proteger la salud pública de las amenazas sanitarias y minimizar las interferencias innecesarias en el tráfico internacional. Como tal, durante brotes importantes, la OMS proporciona información sobre la propagación y la gravedad, así como orientación sobre cómo deben responder los Estados, principalmente en lo que respecta a las políticas fronterizas. Sin embargo, durante la COVID-19, las restricciones fronterizas, tales como las restricciones de entrada, las suspensiones de vuelos y los cierres de fronteras, han sido habituales, a pesar de que la OMS recomendó no aplicar estas políticas cuando declaró el brote epidémico como emergencia de salud pública en enero de 2020. Basándonos en los resultados del brote de ébola de 2014, argumentamos que, sin aumentar el coste de ignorar (o los beneficios de seguir) las recomendaciones contra las restricciones fronterizas, la información de la OMS sobre la propagación y la gravedad del brote lleva a los Estados a imponer restricciones fronterizas que no son coherentes con las orientaciones de la OMS. Utilizando nuevos datos de la COVID-19, mostramos que la declaración de emergencia de salud pública de la OMS y el anuncio de pandemia están asociados con el aumento del número de estados que imponen restricciones fronterizas.

Résumé: Pourquoi certains accords internationaux n'atteignent-ils pas leurs objectifs? À l'inverse d'États se perdant dans des discussions superficielles, des pirouettes ou des engagements insignifiants, le Règlement sanitaire international (RSI) de l'Organisation mondiale de la santé (OMS), à savoir l'accord encadrant la réponse des États et de l'OMS aux situations d'urgence sanitaire internationales, évoque les conséquences imprévues de la transmission d'informations. Le RSI a un objectif double : protéger les populations contre les menaces pour la santé publique, tout en minimisant les interactions non nécessaires dans le trafic international. Par conséquent, lors des grandes épidémies, l'OMS fournit des informations relatives à la transmission et à la gravité des maladies, ainsi que des conseils quant aux mesures que les États doivent mettre en œuvre, principalement en ce qui concerne les politiques aux frontières. Pourtant, durant la pandémie de COVID-19, les restrictions aux frontières, telles que les limitations des entrées, les suspensions de vols et les fermetures, ont été monnaie courante, et ce bien que l'OMS ait déconseillé de telles pratiques lorsqu'elle a déclaré que l'épidémie constituait une urgence sanitaire, en janvier 2020. S'appuyant sur des travaux portant sur l'épidémie d'Ebola en 2014, nous soutenons, sans exagérer l'impact d'une non-conformité (ou les avantages d'une conformité) aux recommandations de l'OMS en matière de restrictions aux frontières, que les informations transmises par l'organisation en matière de transmission et de gravité de la maladie ont conduit les États à imposer des restrictions aux frontières non conformes auxdites recommandations. Grâce à de nouvelles données relatives au COVID-19, nous montrons que la déclaration d'urgence sanitaire et l'annonce de la pandémie par l'OMS se sont accompagnées d'une augmentation du nombre d'États imposant des restrictions aux frontières.

Evidence of the effectiveness of travel-related measures during the early phase of the COVID-19 pandemic: a rapid systematic review.

OBJECTIVE: To review the effectiveness of travel measures implemented during the early stages of the COVID-19 pandemic to inform changes on how evidence is incorporated in the International Health Regulations (2005) (IHR). DESIGN: We used an abbreviated Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols to identify studies that investigated the effectiveness of travel-related measures preprinted or published by 1 June 2020. RESULTS: We identified 29 studies, of which 26 were modelled. Thirteen studies investigated international measures, while 17 investigated domestic measures (one investigated both). There was a high level of agreement that the adoption of travel measures led to important changes in the dynamics of the early phases of the COVID-19 pandemic: the Wuhan measures reduced the number of cases exported internationally by 70%-80% and led to important reductions in transmission within Mainland China. Additional travel measures, including flight restrictions to and from China, may have led to additional reductions in the number of exported cases. Few studies investigated the effectiveness of measures implemented in other contexts. Early implementation was identified as a determinant of effectiveness. Most studies of international travel measures did not account for domestic travel measures thus likely leading to biased estimates. CONCLUSION: Travel measures played an important role in shaping the early transmission dynamics of the COVID-19 pandemic. There is an urgent need to address important evidence gaps and also a need to review how evidence is incorporated in the IHR in the early phases of a novel infectious disease outbreak.

The Disease Outbreak-Human Trafficking Connection: A Missed Opportunity.

This article examines the connection between disease outbreaks and human trafficking. A central challenge in combating trafficking is poor data on its nature and scope. One way to deal with these gaps in knowledge and still target resources effectively is to identify key "push and pull" factors that increase the likelihood of trafficking from origin countries and to destination countries. One under-examined push factor is the outbreak of disease. Outbreaks are associated with several well-documented trafficking risk factors, from the breakdown of rule of law and increase in criminal activity to competition for resources and diminished economic opportunity. Disease outbreaks can also disrupt family ties. For example, the 2014 Ebola outbreak in West Africa left thousands of orphans at increased risk of exploitation. The article outlines possible mechanisms through which outbreaks could increase trafficking risk and, using data on disease outbreaks and trafficking across states over the past 2 decades, provides evidence that countries that have recently experienced a disease outbreak are more likely to have trafficking outflows. The findings point to the importance of integrating trafficking prevention into outbreak response and call for a research agenda more fully examining the connection between trafficking and outbreaks (and potentially other types of natural disasters as well).

Concealing Disease: Trade and Travel Barriers and the Timeliness of Outbreak Reporting.

Slow outbreak reporting by states is a key challenge to effectively responding to global health emergencies like Zika, Ebola, and H1N1. Current policy focuses on improving domestic outbreak surveillance capacity globally in order to reduce reporting lags. However, governments also face economic and political incentives to conceal outbreaks, and these incentives largely are ignored in policy discussions. In spite of the policy implications for outbreak response, the "capacity" and "will" explanations have not been systematically examined. Analysis of a dataset coding the timeliness of outbreak reporting from 1996-2014 finds evidence that states' unwillingness to report-rather than just their inability-leads to delayed reporting. The findings suggest that though building surveillance capacity is critical, doing so may not be sufficient to reduce reporting lags. Policy aimed at encouraging rapid reporting must also mitigate the associated economic and political costs.

Resumen: La lentitud en la notificación de brotes por parte de los estados es un desafío clave que impide responder de manera efectiva a las emergencias de salud globales como el zika, el ébola y la gripe A H1N1. La política actual se centra en mejorar la capacidad de vigilancia nacional de los brotes a nivel mundial para reducir los retrasos en la notificación. Sin embargo, los Gobiernos también enfrentan incentivos económicos y políticos para ocultar los brotes que son, en gran medida, ignorados en las discusiones sobre políticas. A pesar de las implicaciones políticas que subyacen a la respuesta a los brotes, las explicaciones relativas a la «capacidad¼ y la «voluntad¼ no se han examinado sistemáticamente. El análisis de un conjunto de datos sobre la prontitud de la notificación de brotes correspondiente al período comprendido entre los años 1996­2014 arroja evidencia de que es la falta de voluntad de los estados para notificar, más que su incapacidad, lo que genera demoras en la notificación. Si bien el fortalecimiento de la capacidad de vigilancia es fundamental, las conclusiones de este análisis sugieren que una política dirigida a fomentar la celeridad de la notificación también debe mitigar los costos económicos y políticos asociados.

Extrait: Le signalement lent des épidémies par les États est un défi majeur pour intervenir efficacement en cas d'urgences sanitaires mondiales, telles que Zika, Ebola et H1N1. La politique actuelle est axée sur l'amélioration de la capacité de surveillance nationale des épidémies au niveau mondial afin de réduire les délais de signalement. Cependant, les gouvernements sont également confrontés à des motivations économiques et politiques pour dissimuler les épidémies, qui sont largement ignorées dans les discussions politiques. En dépit des implications politiques pour l'intervention en cas d'épidémie, les explications liées à la « capacité ¼ et à la « volonté ¼ n'ont pas été systématiquement examinées. L'analyse d'un ensemble de données sur la rapidité des signalements d'épidémie de 1996 à 2014 démontre que la réticence des États à signaler (et non leur incapacité) entraîne un retard dans le signalement. Bien que le renforcement des capacités de surveillance soit essentiel, les résultats suggèrent que la politique visant à encourager le signalement rapide doit également atténuer les coûts économiques et politiques associés.

Domestic politics and the WHO's International Health Regulations: Explaining the use of trade and travel barriers during disease outbreaks.

During the 2009 H1N1 pandemic, the World Health Organization (WHO), acting under the authority of the International Health Regulations (IHR), recommended against the imposition of trade or travel restrictions because, according to WHO, these barriers would not prevent disease spread. Why did 47 states impose barriers anyway? This article argues that states use barriers as political cover to prevent a loss of domestic political support. This logic suggests that governments anticipating high domestic political benefits for imposing barriers during an outbreak will be likely to do so. Logistic regression and duration analysis of an original dataset coding state behavior during H1N1 provide support for this argument: democracies with weak health infrastructure-those that stand to gain the most from imposing barriers during an outbreak because they are particularly vulnerable to a negative public reaction-are more likely than others to impose barriers and to do so quickly.