As the global debate on the future of pandemic preparedness and response moves on, questions are still arising on the handling of the Omicron outbreak, namely with regard to travel restrictions. The B.1.1.529 variant of concern (renamed Omicron), was promptly reported by South Africa on 24 November 2021 (1). While the information was formally greeted with gratitude by global leaders, many State Parties decided to shut down their borders, sanctioning the same countries that flawlessly followed international rules. While travel bans have now been lifted, the case shed light on the failure of global cooperation.
Sikhulile Moyo, the scientist that headed the team that identified the Omicron variant, was incredibly deluded by the travel restrictions. “How do you reward the countries that alert you of a potentially dangerous pathogen with travel bans? My country was put on a red list, and I didn’t feel good about that.” (2) Also, it was not the first time that travel restrictions were imposed to South Africa, since the same happened with the Beta variant in October 2020.
The revised International Health Regulations (IHR) of 2005 prescribe, on Article 6, that State Parties must notify the World Health Organization (WHO) “of all events which may constitute a public health emergency of international concern within its territory in accordance with the decision instrument, as well as any health measure implemented in response to those events.” While South Africa complied with Article 6 of the IHR, 56 countries that put in place travel bans did not follow the procedure prescribed by Article 43 of the IHR (3), establishing that “Member states […] are supposed to inform the WHO of the travel measures and further provide the scientific and public health rationale when informing the WHO”. Article 43 also affirms (and this is the most crucial part) that “such measures shall not be more restrictive of international traffic and not more invasive or intrusive to persons than reasonably available alternatives that would achieve the appropriate level of health protection.”
Measures such as early detection, self-isolation, and household quarantine are supposed to have a bigger impact (4) than travel restrictions on the spreading of a COVID variant, while also being less restrictive of international traffic and less invasive and intrusive to persons. Besides, it is the WHO itself that recently stated that “the failure of travel restrictions introduced after the detection and reporting of the Omicron variant to limit the international spread of Omicron demonstrates the ineffectiveness of such measures over time.”
While travel restrictions alone have been proven to be insufficient to stop the spreading of a pathogen, there is evidence that such measures affect local economies (5), slow down genomic surveillance by cutting down supplies (6) (such as reagents for sequencing), and can discourage nations from alerting about new strains in the future. Back in November, South African President Ramaphosa declared that “the prohibition of travel is not informed by science.”, adding that “the only thing the prohibition on travel will do is to further damage the economies of the affected countries and undermine their ability to respond to, and recover from, the pandemic.”
Since the IHR’s entry into force in 2007, there has been another clear example of improper employment of travel restrictions. During the Ebola outbreak that took place in 2014 in West Africa, the governments of Guinea, Liberia, and Sierra Leone dealt with travel bans although the WHO had suggested not to proceed with such restrictions. The case of Ebola has not prevented Western countries from resorting to harsh travel bans to prevent the spreading of Omicron. Recent restrictions seem to consolidate, instead, the feeble model of compliance and accountability behind the IHR, especially with regard to Article 43.
It is important to remember that the system of the IHR, even if implemented, would not be enough to deliver an equitable balance between pathogen (and knowledge) sharing and benefit-sharing (vaccines, diagnostics, medicines, and technological know-how). The current model of global cooperation works in one direction only, pushing the Global South to share pathogens, while demanding no obligation to the Global North for the benefits.
Few international instruments are following a different approach: the Pandemic Influenza Preparedness (PIP) Framework, for example, is supposed to deliver a more efficient and equitable balance between these politically opposed interests: it is in fact designed to ensure fairness between the sharing of virus samples, and access to the resulting benefits (7). The PIP framework only applies to non-seasonal pandemic influenza, but its model could be useful to shape a more equitable approach around pathogen and knowledge-sharing obligations. The same applies to the Nagoya Protocol (NP) on access and benefit-sharing (8), a model of a certain interest but with limited reach. The PIP Framework was the outcome of years of negotiations and was massively influenced by Indonesia’s refusal to share viral samples of the H5N1 with the WHO’s influenza surveillance network (2006). Such an act highlighted that low-and-middle-income countries could always leverage pathogen and knowledge-sharing to obtain greater access to benefits at a later time. The PIP Framework is proof that the international community can come together and shape new instruments built on the fair balance between pathogen and benefit-sharing.
After more than two years through the COVID-19 pandemic, it is time to realize that an equitable model of global cooperation can’t be achieved without a climate of trust and reciprocity.
(1)World Health Organization. (2021). Classification of Omicron (B.1.1.529): SARS-CoV-2 Variant of Concern, WHO. https://www.who.int/news/item/26-11-2021-classification-of-omicron-(b.1.1.529)-sars-cov-2-variant-of-concern (retour au texte1)
(2) Schreiber, M. (2021, December 16). The scientist in Botswana who identified omicron was saddened by the world’s reaction. NPR. https://www.npr.org/sections/goatsandsoda/2021/12/16/1064856213/the-scientist-in-botswana-who-identified-omicron-was-saddened-by-the-worlds-reac (retour au texte2)
(3) Cullinan, K. (2021, December 1). Omicron Travel Bans Violate International Health Rules and Decimate Southern Africa’s Fragile Tourism Industry. Health Policy Watch https://healthpolicy-watch.news/omicron-travel-bans-violate-international-health-rules-and-decimate-southern-africas-fragile-tourism-industry/ (retour au texte3)
(4) Chinazzi M., Davis J. T., Ajelli M., Gioannini C., Litvinova M., Merler S., Pastore y Piontti A., Mu K., Rossi L., Sun K., Viboud C., Xiong X., Yu H., Halloran M. E., Longini I. M., & Vespignani A. (2020). The effect of travel restrictions on the spread of the 2019 novel coronavirus (COVID-19) outbreak. Science, 368(6489), 395–400 https://www.science.org/doi/10.1126/science.aba9757. A similar analysis was provided through the early stages of COVID-19 pandemic, as shown in Habibi, R., Burci, G. L., de Campos, T. C., Chirwa, D., Cinà, M., Dagron, S., Eccleston-Turner, M.,Forman, L., Gostin, L. O., Meier, B. M., Negri, S., Ooms, G., Sekalala, S., Taylor, A., Yamin, A. E., & Hoffman, S. J. (2020). Do not violate the International Health Regulations during the COVID-19 outbreak. Lancet (London, England), 395(10225), 664–666. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7133591/ (retour au texte4)
(5) Bill & Melinda Gates Foundation. (2021). Southern Africa: Last in line for vaccines, first in line for travel bans, BMGF. https://www.gatesfoundation.org/ideas/articles/omicron-covid-africa-travel (retour au text5)
(6) Mallapaty, S. (2021). Omicron-variant border bans ignore the evidence, say scientists. Nature, 600(7888), 199–199. https://www.nature.com/articles/d41586-021-03608-x#ref-CR4 (retour au texte6)
(7) The instrument was crafted to deliver a more equitable balance, but it would not necessarily be able to do so, as reported in Rourke, M. F. (2019). Access by Design, Benefits if Convenient: A Closer Look at the Pandemic Influenza Preparedness Framework’s Standard Material Transfer Agreements. The Milbank Quarterly, 97(1), 91–112. https://doi.org/10.1111/1468-0009.12364. Major changes could therefore be needed to enforce the pillar of benefit-sharing. (retour au texte7)
(8) The NP on access and benefit sharing could be a useful model but is more bilateral than “global”, and could hardly be extended to human pathogens and, therefore, public health, as observed in Nikogosian, H. (2021) “A guide to a pandemic treaty – Things you must know to help you make a decision on a pandemic treaty”, Global Health Centre – The Graduate Institute of International and Development Studies. https://www.graduateinstitute.ch/sites/internet/files/2021-09/guide-pandemic-treaty.pdf (retour au texte8)