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Omicron wave: How to do travel restrictions right this time

President Joe Biden is mulling new travel restrictions to slow the spread of Omicron in the U.S., as a new Morning Consult poll shows nearly 80 percent of U.S. adults back a ban on arrivals from eight southern African countries that went into effect Monday.

The latest ban was imposed on the region where the heavily mutated coronavirus variant Omicron was originally identified, though experts have not established where the variant started.

The first U.S. case of Omicron was identified in California, the Centers for Disease Control and Prevention confirmed on Wednesday.

Possible forthcoming measures identified by the White House include more aggressive pre-arrival testing and a self-quarantine system for international arrivals. These are tools that could help make travel restrictions more effective in potentially slowing down the spread of the virus from international arrival, health experts say. They also argue that blanket national bans are a blunt tool, and that wider distribution of vaccines in low-income countries and observance of mask wearing and social distancing remain more effective in responding to the virus.

Travel bans can work to contain viruses such as Ebola, where infected people show symptoms of sickness, but not for coronavirus, which commonly has asymptomatic carriers, said Ingrid Katz, an infectious disease physician and associate faculty director at Harvard Global Health Institute.

Katz called Biden’s travel ban “theater” because it allows U.S. citizens and residents, and others from countries where Omicron is present, into the country without the need to quarantine upon arrival, which could allow for the variant’s spread.

But the proposal the White House is expected to announce soon should make restrictions more serious — and more in line with the science.

The White House now wants anyone arriving into the country to get tested one day before travel, instead of three days under current rules. The CDC recommends all passengers get tested 3-5 days following travel and unvaccinated travelers should quarantine.

The CDC is already expanding a testing program for “specific international arrivals” at four of the busiest international airports in the U.S. — JFK, San Francisco, Newark and Atlanta — its director Rochelle Walensky told reporters Tuesday.

Those measures are light in comparison to the arrival caps and hotel quarantine measures put in place by many countries during the pandemic.

Countries including Taiwan, Hong Kong and New Zealand continue to maintain strict hotel quarantine rules, ranging from seven to 21 days, applied to all arrivals. The purpose is to isolate any positive cases before carriers can spread them into the community, without completely shutting a border.

From the early weeks of the pandemic, health experts have warned that the key to slowing the spread of Covid-19 is universally practicing safe behaviors, such as social distancing and mask-wearing in public. The Trump administration — and many other governments — were nevertheless tempted to turn to bans on travelers from China and Europe to show they were taking decisive action.

While the restrictions helped some countries to minimize, and at times eliminate the virus, those successes were only possible when strict quarantine regimes were in place: an option the United States never pursued.

Since Covid vaccines became available from December 2020, the advice from pandemic experts was clear: No one is safe until everyone is safe.

Governments of rich countries mostly ignored the specialists. They prioritized buying vaccines for their national populations — admittedly, a responsibility of any government — but also bought up most of the vaccines available in 2021. That denied the 55 members of the African Union the chance to buy their own doses, the head of the African Vaccine Acquisition Task Team, Strive Masiyiwa told POLITICO. The U.N.-backed COVAX vaccine facility also failed to meet its delivery targets.

Though experts warned new variants would continue to emerge, governments continued to lean on travel restrictions as a method for containing the spread of the virus across borders — from outright bans on certain travelers, to severe arrivals caps and mandatory hotel quarantine systems — rather than dealing with the root issue: lack of vaccinated people.

Africa remains the most under-vaccinated region of the world, with some 7 percent of its 1.3 billion people fully immunized, while North America has vaccinated about 55 percent of its population, according to Our World in Data.

With more than 50 countries banning travelers from southern Africa, pandemic specialists have immediately pushed back. They point out there is no definitive answer on the source country of Omicron, and that given travel bans usually come with exceptions for citizens of a given country, those loopholes are enough to ensure a variant will make it into any country operating such a system.

South African President Cyril Ramaphosa added to this chorus of complaints, calling restrictions “scientifically unjustified” and suggesting his country is being blamed for doing what China didn’t do: quickly and transparently sharing new information about the virus.

Previous blanket restrictions have torn families and relationships apart, and shut down entire industries linked to tourism and education.

In the U.S. that included travelers from 26 European countries being locked out for 18 months. In April, the United Nations Human Rights Committee ruled that Australia’s strict cap on overall arrival numbers — at times as low as 1,500 people per week — effectively prevented thousands of its citizens from returning home, which it said is illegal under international law.

The travel bans established in recent days by more than 50 countries, applied against arrivals from southern Africa, may in fact make it harder to respond to the Omicron-driven outbreak in the region, say health experts.

Testing materials, medicines, vaccines and personal protective equipment are usually brought on passenger flights, which are now drastically reduced. “If commercial airplanes [are] not flying 75% of our cargo is lost,” tweeted Tulio de Oliveira, the director of the Centre for Epidemic Response & Innovation in South Africa and one of the top experts working on variants.

There are ways to make travel restrictions more effective in trying to slow the spread of Omicron.

The World Health Organization backed mitigation measures — including strict screening of passengers — Tuesday, but insisted that “blanket travel bans will not prevent the international spread” while noting “they place a heavy burden on lives and livelihoods.”

Any screening should be proportional to the risk, temporary “and applied with respect to travellers’ dignity, human rights and fundamental freedoms,” WHO said in its statement.

Airport owners agree, of course. Luis Felipe de Oliveira, head of Airports Council International, said that “full travel bans and border closures are not an ongoing solution as variants emerge,” and said that governments need to instead coordinate to implement “pragmatic and risk-based measures based on science.”

While the tourism industry is focused on its direct commercial interest in remaining open, health experts take a broader view. Travel restrictions should be embedded in a comprehensive public health approach, which includes scaled up testing and quarantine, said Jennifer Kates, senior vice president and director of global health and HIV policy at the Kaiser Family Foundation.

The U.K. for example is now requiring everyone to take a PCR test within two days after their arrival in country and to self-isolate until they get a negative result.

Belgium — which has seen a dramatic recent spike in Covid cases and evidence of community spread of the Omicron variant — now requires tests on arrival for citizens and visitors from designated hot spots. The aim is to minimize cases where a person catches or incubates the virus between their test and their flight, and to enable contact tracing of any cases that do initially slip through their net.

Any future U.S. restrictions should apply to everybody, including U.S. citizens and residents allowed back into the country. If those are not in place, bans will give people a false sense of security, Kates said. “These are hard measures to do, of course,” she acknowledged.

The U.S. has struggled with both restrictions and mitigation efforts. It never imposed strict quarantines like many other countries, and it has struggled to ramp up rapid testing.

Regulatory challenges and lack of early federal investment, as well as demand unpredictability and mixed messaging have all been a part of why the U.S. still doesn’t have cheap rapid testing available such as the U.K. and Germany, according to a KFF report. The Biden administration this fall committed at least $3 billion to increase rapid testing supply, but the surge has not come in time for the arrival of Omicron.

Travel bans should be used very sparingly, given their potential to disincentivize data sharing and cooperation, if testing protocols before and after travel and mask wearing during travel are implemented, said Charles B. Holmes, the director of the Georgetown Center for Innovation in Global Health and former chief medical officer in the State Department during the Obama-Biden administration.

“Globally, we need to be able to build in these protocols into our lives and societies. It’s not just for travel, but it may be for events and other areas,” he said.

“This is sort of a cost of doing business in society in 2021.”

In the end, the most effective policy for minimizing the effects of new variants will remain widespread vaccination. “New variants will continue to menace the globe if we keep failing to invest in last-mile vaccine delivery” in low-income countries, said Ritu Sharma, vice president at CARE.

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