After decades of experience in dealing with global disease outbreaks as deadly as Aids and Ebola, the World Health Organisation has forged a series of guidelines on how to deal with epidemics. Most countries are now ignoring them in the face of the coronavirus pandemic.
It has specifically advised against imposing travel bans on countries with Covid-19 outbreaks and warned that international restrictions can be “ineffective” during public health emergencies.
Experts say such actions can discourage countries from timely reporting of outbreaks if the result is economic and social disruption, while the WHO has warned the measures can delay aid and detract from other control measures.
“Why we’re concerned about these outbreaks is the direct and immediate loss to human life and making sure that is limited. But it is also about the functioning and stability of societies and their abilities to have a long-term response to both health and economic needs,” said Thomas Bollyky, director of the global health programme at the non-partisan US-based Council on Foreign Relations.
Bollyky also said that these targeted travel bans could distract governments from making the necessary preparations for the arrival of disease.
“Clearly some countries relied on this without taking all the domestic measures that needed to be done to prepare for the outbreak, and that’s tragic.”
An unprecedented number of travel constraints are now in place around the world as countries scramble to deal with the spread of Covid-19, after failing to prepare for its arrival after it broke out in China almost three months ago.
As of last week, more than 80 countries had imposed some form of travel restrictions against mainland China, according to a report by the Think Global Health initiative from the Council of Foreign Relations.
More curbs are being announced daily, mostly now focused on and within Europe, which has become the centre of the epidemic.
On Tuesday the European Union was poised to close its borders for 30 days for all non-essential travel.
A number of European countries have already implemented their own restrictions, with Germany, Spain and Denmark among those to either restrict foreigners or close land borders.
“The less travel, the more we can contain the virus,” European Commission President Ursula von der Leyen said on Monday discussing the EU plan, which covers the passport-free Schengen zone.
The WHO has said travel measures that “significantly interfere with international traffic” may be justified at the beginning of an outbreak, as “they may allow countries to gain time … to rapidly implement effective preparedness measures”.
But a number of governments, including the United States, have been criticised for failing to prepare their public health systems to confront the disease.
On January 31, the White House did declare a public health emergency in response to the outbreak, and banned entry to foreign nationals who had recently been in China.
While President Donald Trump played down the risks to Americans, the US Centres for Disease Control and Prevention found in February that kits it had prepared and sent out across the country to test for Covid-19 were flawed, setting back efforts to track infections.
Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, last week said systemic issues were still slowing testing down compared with other countries.
With so many countries ignoring the WHO guidance against travel bans, the foundations of the international health regulations are at risk, Bollyky said.
“I’ve never seen anything like this before, and it is hard to see how international health regulations survive in their current form after what has happened during this pandemic,” he said.
The WHO’s regulations were designed to guide the international response to outbreaks of disease, while avoiding “unnecessary interference with international trade and traffic”.
According to those regulations, the 196 signatory countries need to provide the body with scientific and public health reasons for travel or trade restrictions that exceed WHO’s own recommendations. As of March 9, only 45 states had given such notice, the WHO said.
It is hard to see how international health regulations survive in their current form
The restrictions in force vary widely around the world.
In the Middle East, Kuwait, Jordan and Saudi Arabia have halted all international flights, while Israel is restricting all foreigners unless they can prove they are able to self-quarantine for 14 days upon their arrival.
“Limiting population movement has some public health rationale. However many scientists have clearly shown in past examples that restriction of air travel is not effective when it is implemented, because it is far too late to expect [it to slow down] the process,” said Antoine Flahault, director of the Institute of Global Health at the University of Geneva. “In past pandemics travel restrictions have never proved useful.
“When countries like Germany close borders, they violate explicitly the International Health Regulation, an international treaty Germany has signed as well as all WHO member states.”
The WHO declared an international public health emergency on January 30 but has not recommended travel and trade restrictions.
In an updated note on February 29, the organisation said such measures were “ineffective in most situations”.
Significant disruptions “may only be justified at the beginning of an outbreak” to gain time to implement preparedness measures, the organisation said in a repeat of previous comments.
The quarantine in Wuhan, the city at the centre of the outbreak in China, may have slowed the spread of the disease inside the country by three to five days, according to a study published in the journal Science last week by an international group of researchers.
But the study also said that “a large number” of infected people travelled internationally without being detected despite international travel bans on China, and said the evidence suggested that further restrictions on affected areas would have “modest effects”.
Other approaches are also possible. For example, South Korea focused on testing hundreds of thousands of people for the disease.
This meant the number of infections recorded were second only to China in Asia, but the country was able to gain a clearer picture about where infections were occurring and focus its public health resources on quarantining the infected to contain the epidemic.
Alex Oliver, director of research at the Sydney-based think tank, the Lowy Institute, said domestic and global political trends – such as an increasing shift towards nationalism and protectionism – were also a factor in how governments responded.
“We have an increasingly disrupted international system, with a focus on nationalism and protectionism over the global public good … Governments are becoming increasingly protectionist and isolationist. This is playing to all those base instincts of government to ‘protect ourselves even if it does harm to you’,” she said.
These measures have the potential to shake up the way that the world deals with such crises in the future and recovers from this one.
Is this going to be the moment for globalism or is this going to be the moment that globalism died?
The CFR’s Bollyky said international health regulations represented a “bargain” between signatory countries.
“In exchange for countries preparing to detect outbreaks and report them as early as possible, countries commit not to impose unscientific and unnecessary travel and trade restrictions – that’s the deal … that deal has fundamentally broken down in this outbreak.”
Oliver said the implications are likely to spill over beyond public health issues as countries grapple with the longer-term economic consequences of the pandemic.
“That’s where we will need the sort of international action that we saw during the financial crisis and query whether that can be done with the way that governments are behaving now, without the global leadership of the United States, which was critical to the responses 10 years ago,” she said.
“Is this going to be the moment for globalism or is this going to be the moment that globalism died? This is the moment where we find out.”
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