Public health considerations while resuming international travel

Many countries halted some or all international travel since the onset of the COVID-19 pandemic but now have plans to re-open travel. Here are some key considerations for national health authorities when considering the gradual return to international travel operations.

The decision-making process should be multisectoral and ensure coordination of the measures implemented by national and international transport authorities and other relevant sectors and be aligned with the overall national strategies for adjusting public health and social measures.

The gradual lifting of travel measures or temporary restrictions should be based on a thorough risk assessment, taking into account country context, the local epidemiology and transmission patterns, the national health and social measures to control the outbreak, and the capacities of health systems in both departure and destination countries, including at points of entry.

The World Health Organisation (WHO) recommends that priority should be given to essential travel for emergencies, humanitarian actions (including emergency medical flights and medical evacuation), travel of essential personnel (including emergency responders and providers of public health technical support, critical personnel in transport sectors such as seafarers and diplomatic officers), and repatriation.

Cargo transport should also be prioritised for essential medical, food and energy supplies. Sick travellers and persons at risk including elderly travellers and people with chronic diseases or underlying health conditions, should delay or avoid travelling internationally to and from areas with community transmission.

There is no “zero risk” when considering the potential importation or exportation of cases in the context of international travel. Therefore, thorough and continuous risk assessment and management will help identify, reduce and mitigate those risks, while balancing the socio-economic consequences of travel measures (or temporary restrictions) against potential adverse public health consequences.

The decision process should include an analysis of the situation, taking into account the local context in countries of departure and destination. The following factors should be considered: local epidemiology and transmission patterns, the national public health and social measures for controlling the outbreaks in both departure and destination countries; public health and health service capacity at national and subnational levels to manage suspect and confirmed cases among travellers, including at points of entry (ports, airports, ground crossings) to mitigate and manage the risk of importation or exportation of the disease; and the evolving knowledge about COVID-19 transmission and its clinical features.

Because the COVID-19 epidemiological situation will vary among countries, international travel, carries different levels of risk of exportation/importation of SARS-CoV-2 virus, depending on the passenger’s country of departure and country of arrival. Four scenarios are considered:

• No cases: Countries/territories/areas with no reported cases

• Sporadic cases: Countries/territories/areas with one or more cases, imported or locally detected

• Clusters: Countries/territories/areas experiencing cases, clustered in time, geographic location and/or by common exposures

• Community transmission: Countries/area/territories experiencing larger outbreaks of local transmission defined through an assessment of factors including, but not limited to:

– Large numbers of cases not linkable to transmission chains

– Large numbers of cases from sentinel laboratory surveillance

– Multiple unrelated clusters in several areas of the country/territory/area.

In addition to the public health risk posed by the COVID-19 pandemic, countries should also take into account other economic, political and social considerations when deciding on resuming international travel. Such considerations should be assessed with relevant stakeholders and appropriate experts and authorities.

Working across sectors is essential for the proper implementation of public health measures. The transport sector is central to travel operations, but the involvement of other sectors such as trade, agriculture, tourism and security are essential to capture all the operational aspects associated with the gradual resumption of international travels.

Countries should regularly reiterate the risk assessment process and review the capacity of their public health and other relevant sectors while gradually resuming international travels.

Source: World Health Organisation