TRAVEL AND TRADE RESTRICTIONS DURING OUTBREAKS Meetings Seminars and Workshops... · – Increase awareness, preposition equipment's and supplies, contingency planning, and technical

International Health Regulations1 |

TRAVEL AND TRADERESTRICTIONS DURING

OUTBREAKS

TRAVEL AND TRADERESTRICTIONS DURING

OUTBREAKSBUILDING THE EVIDENCE BASE ON THEIR EFFECTIVENESS, IMPACT AND

PUBLIC HEALTH RELEVANCE

Dr Carmen DoleaTeam Leader, IHR Emergency Committees, Travel and Trade

Country Health Emergencies Preparedness and IHRWHO Health Emergencies Programme


Additional health measures under the InternationalHealth Regulations (2005)

Additional health measures under the InternationalHealth Regulations (2005)

κ Unjustified restrictions of travel or trade during outbreaks can have a massiveeconomic impact on affected countries.

κ Article 43 of the IHR: if States Parties implement health measures that restrictinternational traffic, they are obliged to report to WHO the rationale and publichealth justification within 48h.

κ WHO is required to share such information with other States and may askStates to reconsider the measures.

κ If measures are unjustified, WHO may escalate to national authorities, butthere is no enforcement mechanism under the IHR to ensure compliance withrequirements related to unjustified measures, only peer pressure/moralobligation.


Travel measures during public health events under IHR(2005)

Travel measures during public health events under IHR(2005)

Closing bordersTravel/trade ban

Visa refusal for passengersoriginating from affected countriesRefusal of entry or departure*

or their delay for more than 24 hours

Entry screeningExit screening

Information checkInvasive/non-invasive medical examination

Avoid unnecessary travel to affected countryVaccination recommendationsPersonal protective measures

* of international travellers, baggage, cargo, containers, conveyances, goods, and the like

Additional health measuressignificantly interfering with travel

(Article 43)

Health measures

Advisory

Allowed for publichealth purposes(Articles 23, 31)WHO monitors

State Party required to send toWHO public health rationale and

scientific evidence within 48h.WHO required to share measureand rationale with other States

Parties (on the EIS)WHO monitors and escalates


SP reconsidersadditional health

measures within 3months

INFORMATION DISSEMINATIONEvent

WHO DG actions:ƒ Public health advices , orƒ Temporary recommendations if PHEIC

Significant interference with international traffic(>24h delay)

Within 48h of implementation the State Partyinforms WHO and provides the public healthrationale, (Art.43.5)

IHR Event Information Siteƒ Additional measuresƒ Public health rationale

WHO public websiteAdditional measures

Measures stopped, no furtheraction

Yes

Additional measures continue

No

WHO escalates to higher nationalauthorities

WHO reports annually at WHAon health measures

Overall summary of:ƒ Additional measuresƒ Public health rationale

WHO assesses information provided: Additionalmeasures considered justified?

State Party implements additional healthmeasures (based on scientific principles etc.)

Measures continue despite lackof justification

WHO monitoring of additional health measures underthe IHR

WHO monitoring of additional health measures underthe IHR


Impact of additional health measuresImpact of additional health measures

κ Harm national economies of affected countries

κ Discourage countries from openly reporting outbreaks

κ Do not delay much the international spread

κ Create barriers for the response

κ Impact travellers at personal level


Modelling the impact of flight restrictionsModelling the impact of flight restrictions

Flight stops donot actually delay

much theinternational

spread

Source: Poleto C et al, Eurosurveillance 2014;19(42):20936


Preventing international spread and protectingeconomies – plague outbreak, Madagascar, 2017 (1)


κ WHO advice for international travellers:– Published on 3 October - aligned with ECDC

and CDC advisories– Risk of international spread considered very

low– WHO does not recommend any restrictions to

travel and trade

κ Emergency Committee (EC) under the IHR:– EC not called: based on the Secretariat's

assessment, the event did not constitute a"public health emergency of internationalconcern"

κ Exit screening protocol at internationalairport in Madagascar

– Early October by national authorities– WHO and GOARN partners (CDC, INVS)

further strengthened the protocol

κ WHO provided support for preparednessand readiness for neighbouring countriesand territories




κ WHO actively tracking health measures related to international traffic– Media signals– Regular communication with ICAO, IATA, IMO (International Maritime Organization)– Information included in sitreps for transparency and peer-pressure

κ Preparedness in neighbouring countries– Draft Guidance note on IHR provisions related to international traffics shared with neighbouring countries– Increase awareness, preposition equipment's and supplies, contingency planning, and technical assistance

κ AirSeyechelles, stopped the flights to Madagascar, at the request of Public Health Authority,as of 8 October:

– Rationale sent to WHO 3 weeks after the implementation of the measure• only suspension of travel considered (protection of the population and limited capacity of response)• other measures including isolation of passengers coming from Madagascar not addressed

– WHO provided technical support to Seychelles for epidemiological surveillance and risk communication


Guidelines on effectiveness and impact of travel andtrade restrictions

Guidelines on effectiveness and impact of travel andtrade restrictions

κ Following WHO guidelines review process

κ Internal Steering group

κ External guidelines development group

κ Develop PICO questions, identify or commission systematic review

κ Formulate recommendations, taking into account benefits and harms,values and preferences


Elements of the PICO questionsElements of the PICO questions

κ Target population for the intervention: international travellers, local population (in bothaffected and receiving countries)

κ Interventions: exit screening, entry screening, quarantine, closure of borders (visarefusal, denial of entry for more than 24h), trade bans

κ Comparison: absence of the intervention

κ Outcomes: detection of cases at border/prevention of international spread/ delay ofinternational spread; economic impact, impact on tourism and trade.

κ Events: contaminated goods, Cholera, Ebola (and other viral haemorrhagic fevers), Food-borne diseases, Influenza, Meningitis, MERS, Pneumonic Plague, Rift Valley Fever, SARS,Yellow fever, Zika.

κ Out of scope for these guidelines: interventions governed by OIE standards


Draft analytical frameworkDraft analytical framework


Guidelines development group meeting9-10 May 2019, Tunis, Tunisia

Guidelines development group meeting9-10 May 2019, Tunis, Tunisia

Objectives

κ to review the effectiveness of travel or traderestrictions on the prevention of internationalspread of diseases.

κ to develop specific recommendations on therelevance and justification of public healthmeasures for:

– preventing the exportation/importation ofdiseases via movement of people, vectors orgoods

– managing the risk perception of populationsin non-affected areas, preventing thuseconomic losses and political concerns.

Deliverablesκ repository of evidence-base on the

effectiveness of travel and trade restrictions onthe prevention of international spread ofdiseases and their economic and trade impact(focus on VHFs, selected air-borne and food-borne diseases)

κ evidence-based guidance on the relevance andjustification of public health measures atborders during outbreaks

κ research agenda on the benefits and harms oftravel and trade restrictions during outbreaks(including the role of modelling to informdecision-making on travel and traderestrictions)

Documents

TRAVEL AND TRADE RESTRICTIONS DURING OUTBREAKS Meetings Seminars and Workshops... · – Increase awareness, preposition equipment's and supplies, contingency planning, and technical