Transcript
Sustaining the Response: Pandemics, Border Controls and International Travel
Professor David Heymann CBE
Distinguished Fellow, Global Health Programme, Chatham House, Executive Director, Communicable Diseases Cluster, World Health Organization (1998-2003)
Professor Kelley Lee
Professor, Canada Research Chair Tier I, Simon Fraser University
Alexandre de Juniac
Director-General and CEO, International Air Transport Association (IATA)
Chair: Emma Ross
Senior Consulting Fellow, Global Health Programme, Chatham House
Event date: 26 February 2021
The views expressed in this document are the sole responsibility of the speaker(s) and participants, and do not necessarily reflect the view of Chatham House, its staff, associates or Council. Chatham House is independent and owes no allegiance to any government or to any political body. It does not take institutional positions on policy issues. This document is issued on the understanding that if any extract is used, the author(s)/speaker(s) and Chatham House should be credited, preferably with the date of the publication or details of the event. Where this document refers to or reports statements made by speakers at an event, every effort has been made to provide a fair representation of their views and opinions. The published text of speeches and presentations may differ from delivery. © The Royal Institute of International Affairs, 2021.
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Emma Ross
Good afternoon and thanks for joining us again for the Chatham House COVID-19 webinar series with our distinguished Fellow, Professor David Heymann. Today we’re going to be talking about what’s going on across the world with border controls and travel restrictions and with getting everyone back to international travel and how the new variants and the vaccines are likely to influence how we travel, for the foreseeable future.
With us to discuss this are Kelley Lee and Alexandre de Juniac. Kelley is an expert in international relations and global health governance at Simon Fraser University in Canada. A big focus of her research at the moment is her leadership of the Pandemics and Borders Project, which is tracking the use of travel restrictions and other cross-border measures during the pandemic. Alexandre is the Director General and CEO of IATA, which is the International Air Transport Association, the body that represents the global aviation industry. He has almost three decades of experience in both the private and public sectors, including senior positions in the airline and aerospace industry and the French Government. And of course, IATA is in the thick of what’s going on at the global level, in terms of trying to work out how to get everyone flying again in the COVID era and beyond, but there’s still a lot to be done in the COVID era. So, I think also on hand with Alexandre is David Powell, IATA’s medical advisor, in case there are any more technical questions that he might need to respond to, but I’m not sure that that’s still the case, but anyway, welcome to you all, and thank you for joining us.
Before we dive in, the usual housekeeping and the event’s on the record, and to ask a question, please write them at any time in the ‘Q&A’ function on Zoom. Upvoted questions are more likely to be selected, so, please use that if you like a question. So, we will start now.
A lot of hope is being pinned on vaccination as the way through this, as we know, and of course, the emergence of the new variants has shown that it may not be that simple, as well as the different perceptions of the different vaccines. Similar issues with the prospect of mutual recognition of the various test results. As if that wasn’t complicated enough, you’ve also got fake test result documents being bought on the internet, the prospect of vaccination certification fraud, even fake vaccines. Anyway, it’s a bit of a nightmare, so there’s lots to sort out on this.
I’m going to start, David, with you, if I may? The issue of border closures or border measures, travel restrictions, is a bit controversial, especially as it’s so economically damaging, but disease does spread through international travel, doesn’t it? I mean, before we get into the discussion of what’s been going on with border controls and travel restrictions, David, can you kick us off by outlining, purely from an infectious disease control point of view, what the evidence says about whether and how taking measures at points of entry affects the spread at any stage of an outbreak. I mean, what’s actually effective in this area?
Professor David Heymann CBE
Well, thanks, Emma, and thanks to our colleagues who have joined today. Clearly, borders are the focus of attention because they’re where passengers travel internationally. But history has shown that border controls are not a permanent solution to stopping the spread of infectious diseases internationally. In SARS it clearly showed that disease could spread in the incubation period, while people were infected yet show up in another country. And so, generally, infectious diseases, the most important way of dealing with diseases that come in from outside, is to have good disease detection and response networks around the country, to rapidly detect and respond.
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However, with this current pandemic there are many new tools that may make it even more possible to do some type of examination at borders, if countries decide to do that, in order to make sure that people are, at least at the time they cross the border, not showing that they have infection. And these include new diagnostic tests, which can rapidly, within 15 minutes, show if someone is positive, but not all positives will be picked up by this method. There’s also been attempts to try heat and temperature scanning. This shows if people are sick, but it, itself, has not been shown to stop disease from spreading across borders, because again, it can spread in people in who are not showing a fever symptom.
Though, there are many new tools that are available. There are vaccines now coming online as well, and all of these will play a role, certainly in getting us back to safe travel, but we have to remember that vaccines need to have equitable distribution, that there are human rights issues about quarantining at border posts, and a whole series of things that need to be worked out, and that are being tried for the first time during this pandemic.
So right now, we’re learning a lot that’s new. We’ve seen that borders do not stop disease from entering countries, but that possibly you can decrease the entry of disease and make travel safer by some of the new tools and new mechanisms that are being used during the COVID pandemic.
Emma Ross
Okay, thank you, David, that’s a great start. Kelley, I’m going to move to you, if I may. What do you think is notable about how the border controls issue has been playing out during the pandemic, and could it have been any different?
Professor Kelley Lee
Yes, well, thanks, first of all, for inviting me to join you all. It’s a really complicated area and more complicated than I ever imagined. So, we’re one year into the project, Pandemics and Borders Project, and what we’ve noticed most strikingly is the diversity of practices that have been going on across different countries. So, what we’ve done is, we’ve been analysing this large dataset of every country’s use of cross-border measures during COVID-19. And there’s a couple of key variations in how people or how governments have responded during the pandemic.
Firstly, there’s very big differences in who is permitted to travel. There’s all sorts of conditions of – which really gives you eligibility to travel. It might be based on citizenship, residence, purpose of your travel, often we hear the term ‘essential travel’, it could be your occupation, for example, and of course, infection status. So, these permissions are sometimes based on some sort of risk analysis. It might be, you know, because you’re from a high-risk country, or it’s largely often because of political and economic factors. If you needed, for example, migrant workers to come and pick agricultural crops. So that’s a sort of economic factor. So, there’s wide, wide variation in how countries have dealt with who’s permitted to travel. You think about Australia putting a cap on the number of people that can arrive internationally and it has to be, you know, usually Australian citizens or residents. And then you think about the UK, which has more of a risk-based approach, with its red list of countries, and so, that’s the first thing.
And the second variation really is about the conditions under which travel is permitted. So again, large variation, this involves health screening, testing, quarantine isolation and contact tracing. All of these measures that are used in different ways and different combinations, different points of a traveller’s journey, and also, with different levels of stringency. So, all of this, you know, creates a really complicated
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picture about who’s doing what and really about how we understand which is the most effective, which isn’t effective, which is not necessary and so on, and that’s what we’re trying to figure out in our project.
Emma Ross
But does it – is – does it matter that there’s so much variation? Is it saying that we must make an effort to reduce the variation and get more countries doing more of the same, or do we accept that, you know, the world is pluralistic and there’ll be variation and that’s no big deal? Is it a problem that there’s this variation?
Professor Kelley Lee
It is a problem. But we’re trying to figure out, you know, in what way it is a problem. So, you know, in theory or in principle, we should not have had this happen. We should have had, under the International Health Regulations, particularly Article 43, is the use of what are called ‘additional health measures’ in a co-ordinated globally sort of legal way. So, states’ parties commit to using these sorts of measures only when it’s proportionate to the risk, when, you know, there are not alternatives to using these measures, that they respect human rights, and that they’re based on scientific principles. Now all of this seems to have gone out the window, because virtually, universally, governments have adopted these measures, and the received wisdom was previously based on what David said, SARS and influenza, that they weren’t generally necessary, but also, they probably can be counterproductive to the international spread of disease, to control and prevent that international spread.
So, all of this is really very different. It may be something to do with this particular pathogen and this particular pandemic, or it may be something to do with the, you know, the inherent weaknesses in the IHR. So, ideally, of course, we want to have a co-ordinated system, because by definition if you’re travelling internationally, at least there are two jurisdictions involved. If you have every country doing different things, this may be a problem. On the other hand, there may not be universal principles about, you know, when you should or not use these cross-border measures, and in fact, we’re moving away from a sort of binary, do they work or not, to when do they work, under what conditions, you know, what context? I think that’s where the complexity lies.
Emma Ross
Okay, thank you. Alexandre, this seems like a good time to bring you in on, does the variation across countries cause problems for international travel, from your point of view, or is that not a big deal?
Alexandre du Juniac
It’s an enormous problem, because when I stopped air travel, it’s mainly the measures taken by states to limit travel, to restrict travel, whether it’s through border closures or quarantines. We have measured that when there is a risk of quarantine, the impact on booking is -100%. So, it’s clear that travel restrictions, it’s a blocking factor, a complete blocking factor for travel and air travel particularly, just all. Secondly, when you have different measures, it complexify the system, so – and travel begins to be so complex and difficult, either for airlines or for passengers, that it also block everything. So, for us, different measures is a blocking factor.
So, what we did in September, before it was very difficult, but in September, it was to ask government to implement systematic testing for all passenger [audio cuts out – 12:56] arrive at an airport, using PCR
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tests or using antigen tests. So, the idea was to say the air traveller will arrive everywhere, without being infected or with a risk of being infected, below a certain threshold. Frankly, we have not been successful, and in January, just one month ago, with the surge of the pandemic in many countries, plus the existence of variants, governments came back in the – or came backwards, and they have closed again their borders or installed quarantines or systematic testing, cumulating in antigen and PCR, quarantine and testing. So, it has slowed down air travel and for travel and air travel, particularly. [Audio cuts out – 14:05] please can you setup a plan for reopening, now that you have the vaccine, plus the testing, and [audio cuts out – 14:21] government to implement a quick and effective restart of air travel. And – well, the only government that has successfully done that, after some, how could I say, a bit hectic, you know, period, is the UK Government. And we say bravo to the UK Government, you are the number one to have issued a consistent plan for reopening your country, and we will partner with you to reopen air travel. So, this is what we are doing.
Emma Ross
Okay, thank you. Kelley, I just want to come back to you, when you were saying about the basis for no – there being very little basis for doing it. What went on in this pandemic with the border measures? Were they scientifically justi – were they justified? I mean, I know you’re trying to work out what’s effective, what’s not, but you know, obviously it didn’t go through this International Health Regulations thing, and we could argue whether that whole system needs to be looked at and reformed, but were you saying that countries were just doing stuff with no basis for doing it at all? Or what were you saying there? Oh, you’re on mute, please unmute.
Professor Kelley Lee
I thought I got over that, after a year of using Zoom. Sorry about that. I think in part that it is a – it’s – you know, it’s driven a lot by political and economic factors. I mean, when we looked at the use of cross- border measures, it is in – when we were thinking about scientific principles, we’re thinking about public health evidence, and when we don’t have that evidence, which is what we’ve realised, because this is a very different public health emergency, then what do countries do? And so, they’ve fallen back, I’m not saying that it’s, you know, random, but governments have done what they think is right. Now they have juggled a very different – and multiple policy goals in managing their borders.
So, this is the complexity, each country has approached this in a different way, and this has caused this chaotic situation, which is an untenable, if we’re going to have a globalised world where, you know, we want to travel from one country to another and we have travellers trying to navigate. I would hate to be a travel agent at this moment, or even just a traveller trying to get from one continent to another. The measures are changing all the time. I mean, in my own country, there’s been 50, five zero, policy changes, since last year, and you know, just keeping up with those kinds of different slight changes, domestic restrictions, international changes, is really impossible.
So, I agree it’s not workable, and how we got here, I think is just that every country has seen that – I guess the IHR wasn’t relevant to what the immediate risk was, that was the perception, and that countries really believed they were doing the right thing for their own constituencies, and this is how we’ve ended up with a kind of national approach rather than a global approach.
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Emma Ross
Okay, thank you, that’s a great segue, Kelley. Back to Alexandre, and IATA has been working with other players at the international level to beat a path forward for international travel. So, what I wanted to ask you firstly, is what do you think is going to be crucial to sort out of this chaos and then, can you give us an idea of what action is being taken or what discussions are being had at the global level and among whom? And is there any effort to bring some overarching co-ordination to this, some globally agreed setup?
Alexandre de Juniac
First of all, just to come back to what Professor Lee was saying before, the number of national adjustment of the entry conditions all around the world, the number, the daily number of changes, is something like around 200 to 300 per day, currently. So, you know, when you say, Professor, that passenger are lost, it’s an understatement. They are not only lost; you have no more passengers, so that’s, in a way, the direct consequence, sorry for that. But that’s the reality we live in.
So, what we are – what we think will be the good – the roadmap to restart travel and air travel is to do two things. First of all, again, we are asking governments to adopt a reopening plan, to have a consistent strategy of reopening, consistent with their vaccination policy. They have vaccine, they have testing, now we have, I think, I’m not a specialist, but what I really – that we have a more precise idea of the effectiveness and efficiency of the vaccine against the virus and the variants, it’s what I understand, so setting a plan is possible, we think. And, I mean, a plan, which includes a significant risk reduction of reinfecting your population or your country, first of all.
Secondly, there are some international organisation within which you can discuss this plan, harmonise the plan and have, how could I say? A consistent approach among countries. That’s WHO or you have for us, the aviation, the ICAO, International Civil Aviation Organization, in which we are going to discuss, you know, a common approach for restart. We have tried once, it had been successful, and the measures you have seen implemented everywhere in the aircraft, you know, the obligation to wear a mask, and the fact that we disinfect or that we clean the cabin with a [audio cuts out – 20:51] method, it is approximately implemented everywhere. We have been unsuccessful in implementing a common testing system, so that’s – it has not worked.
The countries have decided to have a global guidelines, nobody has implemented them, no? And we are now working to have something like a restart plan that would be consistent and common among countries, that should be issued by the end of March. We hope it will work. I’m not entirely optimistic, but perhaps it’s the last period. [Audio cuts out – 21:35] things start to flow, we hope, by other states in the world. We could have something consistent, a common approach that would be applicable everywhere, that would – and that would minimise complexity, and of course, help to restart air travel. That’s what we are working, and we are pushing, you know, 33 states directly to adopt a plan and to have the consistent approach. I can tell you, it’s hard work, and it’s not a done deal yet.
Emma Ross
Yeah, yeah, totally, and at 33 countries is not the majority of countries, I have to say.
Alexandre de Juniac
No, we have chosen the biggest aviation market, that was our criteria.
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Emma Ross
Well, it’ll deal with a big chunk of it, and then, I guess, maybe the hope is that others would follow. How realistic do you think that is, feasible? I mean, has – in civil aviation, has there ever been a kind of globally agreed anything? Is it reasonable to believe that you could come together globally instead of a patchwork and that the whole sovereignty, that countries will do what they do, why do you have hope that something can be done globally? Is it the pandemic or do you have a precedent?
Alexandre de Juniac
We have hope for two reasons. First of all, the ICAO is the forum and the UN agency in charge of doing these type of things, and it has done that in the past. If there is a safe air travel all around the world, and if we are probably the safest industry, it’s not by chance, it’s because we have implemented common [audio cuts out – 23:18] all over the world. [Audio cuts out – 23:22] we are wrong, but we bet on, how could I say? Human rationality and political rationality, we could be right.
Emma Ross
So, what specific things, Alexandre, are being discussed at the global level that have to be harmonised? Like what? Have all airports got to have the same layout in the gate, or have airlines got to space out their passengers the same way, or what specific aspects are being discussed for harmonisation?
Alexandre de Juniac
No, what has been discussed first, it was in May, it was you know, what we have called the biosafety measures applicable to air transport. So, the mandatory wear of masks, the fact that we have demonstrated that it was not useful to neutralise the seat, because the risk to catch the virus, when you have a mask in a cabin, considering the way the air condition is moving through the cabin, minimise the risk to a level, which is really, really minimal. We have also introduced some cleaning and disinfection measures that are now applicable everywhere. So, it has been successful.
What we should target is to have, what we think, a systematic testing system, plus vaccination control, of certification that would be applicable everywhere. And the reason why we are developing an IT app, an app that we will be able to download on your smartphone, to certify that you have been either tested or vaccinated, you know, according to all national requirements applicable to your travel. If you go from one country A to one country B, or to country B, you have travel requirements that we have collected in our database, and the point is, these travel requirements [audio cuts out – 25:33] vaccination or testing and in certain conditions. But if you want to control that between two states [audio cuts out – 25:45] to guarantee that everything has been done properly, you must have a kind of tool to certify, and also, a tool that is not, at least [audio cuts out – 25:56].
Emma Ross
We’re not hearing you clearly.
Alexandre de Juniac
[Audio cuts out – 26:09]. Can you hear me?
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Emma Ross
I think you said you must have a tool that – I think you were talking about that can’t be falsified. Are we talking about…
Alexandre de Juniac
Yeah.
Emma Ross
…blocking technology to…?
Alexandre de Juniac
Yes, [audio cuts out – 26:24].
Emma Ross
You’re frozen again.
Alexandre de Juniac
That will be able [audio cuts out – 26:31].
Emma Ross
We’ll keep trying, don’t worry.
Alexandre de Juniac
Do you hear me, because…?
Emma Ross
Yes, I can hear you.
Alexandre de Juniac
Is it okay?
Emma Ross
We can hear you, but your picture’s frozen, but let’s try a little bit, for a moment.
Alexandre de Juniac
I’m sorry. So, what we are aiming at is developing a digital tool to certify that everything has been done, according to the travel requirements imposed by states. So, it’s called IATA Travel Pass and it will be a
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certification tool that will – an app that will give the guarantee and the comfort to states really effectively received. So, that’s what we are doing.
Emma Ross
Okay, so I understand there’s actually a few apps. There’s yours and then the International Chamber of Commerce…
Alexandre de Juniac
Yes.
Emma Ross
…got there, all okay, and there’s others. Are we going to have several and each country will pick which one they respect, or is there an effort to settle on one, get behind one?
Alexandre de Juniac
Yeah, what we are trying to do is to have a single standard that is not one app, but a single standard that impose to all apps to be interoperable, and then you can choose the app you want. It will be usually linked with the reserve – and the booking system for airlines, interoperable and applicable everywhere, so that you will be able [audio cuts out – 28:02] application, but one interoperable standard between them, and interoperable with different administrations, so that’s what we are aiming at. We are not claiming for any monopoly situation of course, by definition.
Emma Ross
Thank you. So, Kelley and David, I wanted to ask you, that sounds like interesting and it’s not – you know, we’ve heard this, that’s there’s – where there are moves afoot to get these. Can you tell me about, kind of, governance-wise, global health diplomacy-wise and scientifically, what your thoughts are on that? I mean, for instance, what I mentioned before is, that are we going to have to pick one testing system? What if one country doesn’t like – doesn’t recognise the testing methodology or they think one vaccine is not acceptable or not as good as another, they’ll only take people who’ve had vaccine X versus vaccine Y? Is that a possibility that we could be getting into that or am I catastrophising here?
Professor Kelley Lee
So…
Professor David Heymann CBE
Oh, go ahead.
Professor Kelley Lee
…I’ll go ahead, David, quickly. If it does go that way, I think it’s concerning that we have a, kind of, fragmented system where certain people get access to travel and others don’t and, you know, it gets into the issue of exclusion and inequities and so on. So, I’m a little bit concerned about that. I understand
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why, you know, people were chomping at the bit to get travel moving again, but from a public health point of view, I think it’s really important to get the risks down first, and, you know, I think that when you see countries that try and do both, they try and do the public health side and the economic side at the same time, they actually are less successful in, you know, controlling the virus and so on. So, you have these different strategies where you have a, you know, kind of, suppression strategy that you’ve had in the UK, for example, where you’re trying to balance everything at once and get people to travel for holidays, but also to control the virus, and it didn’t go very well. You know, there was a lot of importation of the virus into the UK because of these travel corridors. They went too soon. They didn’t focus on really getting the risks down first.
So, I mean, I see this very much as a gradual strategy, where you may have countries that are already vaccinating much quicker than other countries, so they are going to be out of the block first, but they’re going to be dressed up and nowhere to go, because other countries haven’t caught up with them yet. So, those countries will have an advantage in that their citizens will be able to move about more domestically, but until we get the whole world, or at least more countries have a high level of vaccination, and we have the scientific evidence that people aren’t still infectious and so on, and the length of immunity, then we can’t really have a, you know, an effective global system.
So, it really comes down to getting that vaccine out as far and wide as possible, as equitably as possible, otherwise we’re going to be having this, kind of, fragmented – you know, we’re always chasing the risk, aren’t we? We’re always behind, in terms of chasing the virus. We never know exactly where the real risk are, because we’re testing and sequencing too late, and so we know what happened last week, but we don’t know what’s happening this week. And so, we really do need to kind of get the risk down first and then go from there.
Emma Ross
David, what’s your take on this and the, kind of, complications in the system that Alexandre has described, the vision?
Professor David Heymann CBE
Yeah, no, I just follow on with what Kelley said. What will also be helpful in getting people back to travelling internationally is their own confidence that they can travel in safety. And it was a very interesting observation that I made during the SARS break back in 2003, when countries were using thermal detectors, as people walked in through airports, to pick up people who were sick. I mean, that study that was done in Hong Kong and various other countries, they actually picked up very few people who had the SARS coronavirus. They were picking up people who had other infections, which, in itself, is something laudable. But when these countries were asked, “Why do you continue to use that as a means of getting people – getting travel safer?” They said, “Because it increases the confidence of the passengers.” And I think that’s very important, that passengers must also be confident that they’re travelling in a safe environment.
Of course, we’ll have vaccines, hopefully. We’ll have diagnostic tests, hopefully, that can contribute to safe travel. But safe travel also depends in what’s on the other end. And if safe travel – all these arrangements are made to make safe travel, which is very important, when people get to the other side, if they go to a nightclub or places where transmission is occurring, then they’ll just be either infected because they had a negative test, but not a vaccine, or they’ll be infected because they haven’t paid attention, or their vaccine hasn’t functioned. So, hopefully, all of these things will work together. There can be passenger
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confidence, there can be, as Kelley said, equitable distribution of diagnostic tests that might be necessary, as well as vaccines that might be necessary. But it will be very difficult to have a global recommendation from WHO on vaccinate before travel, when there’s an inequitable distribution of vaccines. So, what Alexandre said, I think, is very important. 33 countries are piloting a way that they see might ensure safe travel in getting back to travel, and that will be a pilot study that other countries can apply or not apply. But I don’t think we should be looking for global recommendations from WHO because of the difficulty in equitable distribution of vaccines and diagnostic tests that may be useful in this, moving forward.
Emma Ross
Okay, thank you. Before I go – oh, he’s dropped off. I was going to ask Alexandre to walk us through the vision of what the passenger journey would be from end-to-end, before we go to questions, but I’ll come back on that. I’m going to go to questions. The first question, the most upvoted anyway, is probably better for you, David or Kelley. For the countries – this is from Tom Hodson, and it’s the most upvoted question. “For the countries that have essentially shut their borders, like New Zealand and increasingly the UK,” that seems a bit of an editorial comment, “what do you think the exit strategy is for these policies, or rather should be, as I’m sure you don’t know what it is, but what do you think the exit strategy should be for the countries that have shut completely?” I mean, obviously, it can’t continue forever.
Professor David Heymann CBE
Maybe I’ll start, because a group that I Chair at WHO, which advises the emergencies programme has talked about the way to get travel back to a reasonable level of normal is to understand that countries have an equal risk, when they’re going from one to another, an equal risk of infection, but also, that in those countries there are equal measures to deal with infections, such as good contact tracing and good, wise shutdown of places where transmission might be occurring. So, all of these things will play into this, and I know WHO is trying to develop a framework for countries to use to do a risk analysis, to see if they want to open up. And I think that was first used by Hong Kong and Singapore when they tried to create a travel bubble last year. They were all set to equalise travel between the two countries, because they had equal risk, and then, all of a sudden, in one of the countries, there was an outbreak, and they put their travel bubble on hold, and they’re waiting again.
So, it’s very difficult for countries to do their own risk assessments and to assess the risk in other countries, but I expect that will be one of the tools that will be used, going forward. But I’d be interested in hearing what Kelley has to say about those issues as well, Kelley?
Emma Ross
Yeah, and also what you think of the ‘air bridge’ idea, ‘cause, you know, have they worked?
Professor Kelley Lee
Yes, I mean, I’ll follow on with – David’s exactly right in identifying those efforts about, you know, countries that have comparable policies and comparable levels of virus. So, you know, countries have taken two strategies. They’ve had this COVID zero strategy or suppression strategy, and countries like Australia and New Zealand, with the COVID zero strategies, are very reticent to, you know, open up again. I should say, we should stop using probably the words, you know, ‘travel bans’ and ‘border closures’, ‘cause people are still moving, it’s just really, they’re very restricted, and it’s just a question of who gets to travel and under what conditions.
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So, in the case of Australia and New Zealand, which have done extremely well at suppressing completely, so COVID zero, they could possibly partner with other countries that have had the same strategy and therefore, the same comparable measures. The problem though is that again, you know, we’re always, as I say, measuring the risk from last week or a few weeks ago. It’s very difficult for us to know what the risk is going forward, so it just takes a plane to arrive with a passenger with a new variant to, kind of, throw everything off kilter, and then these air bubbles or these corridors slam shut, and it’s hard for travellers who are caught, you know, on one side or another. So, I think, you know – but that would probably be what Australia and New Zealand and other countries like Taiwan, Thailand, there are many countries out there doing these COVID zero strategy, and they probably would be an interesting maybe initiative that they could take on, in terms of a, kind of, sub-regional or a cross-regional strategy, like the 33 countries we heard before, maybe those COVID zero countries could try and do the same.
Professor David Heymann CBE
Emma, let me just come in on that and say that I think that these countries that have suppressed the virus have been very interesting in how they’ve done it, but at the same time, this disease appears to become endemic, it’s becoming endemic. And if it does, then those countries will have to be considering, in their strategies moving forward, not only the fact that they’ve suppressed the virus and they don’t have an immune level within the country, but also, if they haven’t been successful in vaccinating their entire populations or whatever strategy they want to be using moving forward, will they accept that this virus does come in and become endemic? Because many countries have seen that it appears to be becoming endemic and will remain in human populations for quite a time yet before us.
Emma Ross
Okay, thanks, so onto Alexandre, you’re back.
Alexandre de Juniac
If I may – yeah, I’m sorry, sorry for that.
Emma Ross
Do come in.
Alexandre de Juniac
May I just react on that point? You know, again, I’m not a medical specialist, but – or I am the, as everybody, I have become an Epidemiologist in the last year. Just for us, and it’s not only a problem of airlines I think that targeting a zero COVID situation is unrealistic. I think it’s unrealistic. So, we have to learn to live with that virus, and to maintain this pandemic under control, which we think, perhaps we’re wrong, that with the vaccination and the testing, it is possible to maintain that under control, meaning with the risk, and sorry to pronounce the word, but with casualties that are limited to something that is comparable to, you know, flu or measles or, you know, the disease with which we live, we have been living now for decades. So, we are not zero COVID believer. We think that we will have to learn to live with that virus and that the vaccination allows many states to cope with that successfully. But perhaps I’m wrong in saying that.
13 Sustaining the Response: Pandemics, Border Controls and International Travel
Emma Ross
No, that sounds what David’s been saying for quite a while. Just while we still have you with a good connection, Alexandre, before you dropped off, obviously there are still some things to sort out with vaccination, one being, you know, does it prevent transmission, and two being, you know, has everyone had a chance to get it, before you start demanding certification or anything, like that, and then, the issues with the test besides that, and obviously, you know, well hopefully, we’re not going to wait until all that is sorted out before we get people travelling again. Could you show us your vision? So, could you describe a passenger journey, and I know, I’ve seen from one of the questioners that there’s a lot of discussion on air travel and, you know, what about other types of travel, but for the moment let’s just stick with an airline passenger, an end-to-end journey, what that might look like in the meantime. I’m not talking about going back to pre-COVID where nobody has to – where we go back to the way it was, but that may be a while and, you know, I’m not going to ask anybody for a date from that because, you know, that’s – there are so many scenarios that are variations on that there’s, you know, not much point in asking about that. But, in the meantime, safe international travel, could you plot out the vision for what the passenger end-to-end journey might look like? So, take me to – arrive at an airport, what happens ‘til you get off, you know, after you get off the plane the other side? What’s it going to look like?
Alexandre de Juniac
Perhaps one remark before I answer your question. We are not recommending mandatory vaccination. We are not recommending that, because we know that, for a medical reason, some people cannot be vaccinated, and there are also many people who don’t want to be vaccinated, for whatever reason, no judgement in that. But – so we do not recommend a mandatory vaccination, first of all. So, what could be the passenger journey? I think that we will arrive at the airport. Do you hear me? Sorry for that. Yeah?
Emma Ross
Yes, okay.
Alexandre de Juniac
We will arrive at the airport, and probably, we will ask either to be tested or to be vaccinated or both. That will depend on your country of destination and perhaps your country of departure, but mainly your country of destination. And then you will show your app or if you don’t have a smartphone, it will be a paper or a kind of paper process, you will show your paper with the stamps and all that stuff. And then you will have a normal journey, but we will continue probably for a while to impose the mandatory wearing of masks. You will have probably a light service, in terms of catering, but not so different from what it was before and then, at the arrival, you will be perhaps tested again. Some countries will impose a systematic testing at the arrival, and you will be asked to show that you have been tested at the departure and that you are vaccinated or not, depending on states.
So, it will not be significantly different from what we are experiencing, that we have experienced in the past, but only the health condition could be stricter. That will be the, I think, the future of air travel.
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Emma Ross
Okay, what about social distancing? I mean, any chance we might get a bit more space on a plane, with not somebody, you know, right on top of us, or not be penned in at the gate like a farm animal? Any chance?
Alexandre de Juniac
You know, our position is not to have – to neutralise seats, because, you know, the economics are not in that area. If we neutralise seats, it means that we will have to multiply the fares by something around two, one-and-a-half or two. So, it means that air travel will come back to the previous situation in the 50s or the 60s or the beginning of the 70s, in which it was a travel for the rich. You know, it has been, and we have fought for 50 years, you know, to democratise this transportation system, and successfully, it has been a fantastic success, you know, to allow almost everyone to take a plane and my personal conviction is that we shouldn’t accept to go backwards. I will not accept that.
Emma Ross
Okay, that sounds pretty clear. I’m going to go back to questions now, and this one is from Martin O’Neil, and it’s probably for Kelley. “There’s a great deal of domestic air travel going on in the US, where each state has its own quarantine rules and other control measures. Are there any lessons, positive or negative, that could be drawn for international travel?” So, Kelley, I’ll give you that one, and I’m going to give each of you one, I’m not going to have all three of you answer every single one.
Professor Kelley Lee
Okay, a great question from Martin. I think this is something – I was just typing an answer to him, actually – that this is one of the features of this pandemic that is quite different. We have a lot of countries applying in, you know, domestic measures, and it’s really a microcosm of the chaotic situation at the international level. You can imagine one state, you know, doing one thing or one province in another state, or province doing another, and that can create risks for other parts of a country, because you allow one thing and another, and the issue here then is that you need a co-ordinated approach if you’re dealing with a public health risk, but also, if you’re trying to get people moving, you know, across boundaries. Any jurisdiction, you’re going to need a co-ordinated approach.
So, this is something I think we need to look ahead in future, is to deal with that. A lot of our countries don’t have, I guess, national public health legislation or national public health strategies, and this was the problem, that everything got fragmented. So, we’re going to have to learn from that, in terms of institution building, but also, that it really is an undermining of public health efforts if you have one part of the country cutting itself off from another and others, you know, having a lot of travel. So, a big problem.
Emma Ross
Okay, great, I’m going to bunch a lot of the questions on vaccine – vaccination certificates together. Picking a few of them, there are one, two, three, four, at least five. But the most upvoted one, so N S Damir, “What do you think about vaccine passports, will it work?” Michael Harvey, “To what” – and this definitely – and let’s see if we can get this answered, “To what extent do you think that individual countries or groups of countries, such as the European Union, might refuse to accept certain vaccinations,
15 Sustaining the Response: Pandemics, Border Controls and International Travel
such as AstraZeneca, even though they may appear on a vaccination passport?” And there’s one here, I think specifically for Kelley, from Louis Lillywhite, “What is the legal position in respect of vaccination certificates? I have heard they are not legal under Article 35 of the International Health Regulations.” And then there’s a bit of blah, blah, blah, technical stuff here, “Except Article 35 does not apply to temporary residents, whilst Article 1 defines temporary.” Basically, if you could address that, Kelley, about is there a legal issue with vaccine certificates, under the International Health Regulations? Could they be defeated on legal grounds? And then, other than that, could – would it work if countries said, “We don’t accept this vaccine or that vaccine,” and I’ve brought that up before. And in general, what do we think about vaccine passports? So, who would like to go first on that? Kelley, do you want to ask the, first of all, are they going to be legal?
Professor Kelley Lee
Yeah, that’s a great question. I’m not an International Lawyer. I think, probably, I wouldn’t want to venture. I think that there is an issue about, you know, going back to the equity issue, if some people have the vaccine certificate and others don’t, there is an issue there. There’s also costs and there’s, you know, who bears the cost of all of this? But there – you know, the International Health Regulations have to respect human rights, and there are travellers that need to travel on the basis of need. It’s not just because they want to go on holiday. So, we have to take that into consideration and, you know, whether it is actually against international law to prevent people, because they don’t have a vaccine certificate, from travelling for humanitarian purposes.
Emma Ross
Well, David, with yellow fever countries that require a yellow fever certification, are they – if you don’t have it, are they allowed to say, “Well, you can’t come in,” or are they – you can come in without a yellow fever vacc certificate?
Professor David Heymann CBE
Well, under the International Health Regulations, the yellow fever vaccine and vaccination is something that countries can adopt, it’s a maximum procedure that they can adopt. So, if they feel that someone is coming from a country that has yellow fever, they can in fact require that that person be vaccinated. They can do it at the airport if they wish, or they can ask for a certificate. That’s the maximum that they can do, if WHO has said that yellow fever is occurring in their country. That was in the previous regulations. That remains as a possibility.
But, you know, all of this, Emma, what’s most important is not to set up false security by using interventions that aren’t understood by policymakers or by people in general, and that includes vaccinations. There’s a lot we don’t yet know, as most people know about vaccinations. We don’t know, for example, if they stop transmission completely, and we don’t know how long that might last, if they do stop transmission. So, if we’re using vaccines to stop transmission and make it safer on airlines, we don’t yet have the evidence for that, and we don’t even either have the evidence for how long a vaccination certificate would be valid, before a booster dose might be required. We just don’t have that information yet.
So, talking about vaccine certificates is maybe a way that countries would want to express that they’re trying to protect people from people coming in with disease, but until we understand completely the potential of these vaccines, vaccination certificates will be a false security. So, what we need to do is make
16 Sustaining the Response: Pandemics, Border Controls and International Travel
sure that whatever countries do, they understand that they have to be ready to detect and respond to infections, including contact tracing, as Kelley said, if they do enter their countries. But a vaccine passport or an immunity passport is a possibility, at some point in the future, when we more understand about the length of antibody and protection from either natural infection or from a vaccine. So, all of these are things that are in question, but the most important, Emma, is that countries don’t set up false security and then let down their guard by not making sure that they have detection and response systems.
Emma Ross
Sure, but is it a possibility in your experience, David and Kelley, that countries might adopt the immunity passports or whatever these apps for – or you know, proof of vaccination before we know that it transmits? I mean, can we stop them doing that? Is it a possibility that that might be prematurely adopted? As you say, confidence is so important and Alexandre’s efforts might provide the platform for the recordkeeping and the assurance of credibility, that they’re not, you know, falsified evidence. Is it possible that we might see this before we have a lot of those questions, so that there is a bit of a false sense of security? Or do you think nobody’s going to act on it until we have those questions answered? What’s your experience or your suspicion of how this might playout?
Professor David Heymann CBE
Emma, I’ll say a word and then I’ll pass it onto Kelley and to Alexandre. But in my view, countries will do what they feel is best for their own populations. Political leaders have been elected to – or put in place to protect their people. So, they will do what they want to do. Hopefully, though, they will follow some of the information that’s coming out, especially from studies in the UK, in Israel, in other places, about the effectiveness of vaccines, and also, about the effectiveness of protection after one has had natural infection. All of these things will become available, but again, remember, countries are sovereign, and they will make their own decisions. I know that many countries and many groupings of countries are working on prototype immunity passports. Whether or not they will be used, I’m sure depends on when the evidence comes in that makes them sure they can use them appropriately, at least I would hope that’s the case. Kelley?
Professor Kelley Lee
Yeah, that’s absolutely right, David. I think that throughout this pandemic what we’ve seen is governments adopting policies that aren’t evidence-based or evidence-informed, so I don’t see any difference here. I think there are really powerful economic interests to get people moving again and you know, regardless of whether we have all the studies in or not, which it’s going to take a while, so there may be some impatience there, but I think these policies are going to be moving forward, which does concern me, because we could be put back to square one, if we move too quickly. So – but yeah, this has been this story of this pandemic throughout, unfortunately.
Emma Ross
Oh dear. Okay, so, we’re getting closer to our end and I know we have a hard stop, so I’m going to give Alexandre the last question, and this is the most upvoted at the moment, from Mahesh Kotecha, hopefully I’ve pronounced that okay. “Are there any clear reasons why countries are unwilling to adopt a common set of rules? Is it different perceptions of risk, concerns about information sharing, differences and opinions of what is safe, complexity or lack of authority or all of the above? Alexandre, do you have any
17 Sustaining the Response: Pandemics, Border Controls and International Travel
sense as to, you know, why countries might not be willing to move along with these commonly adopted standards?
Alexandre de Juniac
What I can say in affirming, from the beginning, countries have acted in a complete unco-ordinated way. That – so it has been a nightmare for us, but that’s the way it is. There are two or three reasons. First of all, they were addressing an unknown issue or a difficult issue, a new issue. Secondly, it’s a sovereign decision to close or to open borders or to impose restrictions and it’s also a sovereign decision, you know, to impose a health policy. Fourth, there was no organisation, international organisation, that took the lead to impose or to suggest a minimum co-ordination, including WHO, by the way. So, as a result, we have seen a complete disorganised patchwork of measures, of policies implemented. That’s a pity, but that’s the way the world works. We have tried our best to co-ordinate, to make people collaborate, to make people discuss, but it has been pretty unsuccessful. It is progressing, but even in areas such as the EU, in which you could have thought that there is a common framework, it has been – it has not been the case. So, slight improvement, but the road is still very long in front of us.
Emma Ross
Okay, well, on that note, that – I think we’ve got quite a bit of clarity of what travel might look like, at least airline travel, going forward. It’s not going to be too far off. It doesn’t seem that dramatic, but still a lot of issues to sort out, and whether travel will wait for those to be sorted out seems a bit doubtful. But I want to thank you both for joining David and I for a really, really fascinating – it seems like we could – I could go on three, four times as long as this and still be picking at the questions. But thank you so much for joining us on this, it was a great conversation and…
Alexandre de Juniac
Thank you very much.
Emma Ross
Yeah, and everyone else, thank you. Sorry we couldn’t get to all the questions. We will be back in two weeks on the 10th of March with some of the members of the international team that recently went to Wuhan to study the origins of the virus. So, if that’s something you’re interested in, we look forward to seeing you then. Otherwise, again, to Kelley and Alexandre, thank you so much.
Alexandre de Juniac
Thank you very much, bye, bye.
Professor Kelley Lee
Thank you very much.
Professor David Heymann CBE
Thank you.
18 Sustaining the Response: Pandemics, Border Controls and International Travel
Emma Ross
Okay, bye.
Professor David Heymann CBE
Bye.
Professor Kelley Lee
Bye for now.