Virus Travel Bans Are Inevitable But Ineffective

When the World Health Organization (WHO) declared the coronavirus epidemic “a public health emergency of international concern” (PHEIC), more than 70 countries responded by imposing travel restrictions against China. Global health experts overwhelmingly decry travel and trade restrictions as bad policy and irresponsible violations of international law. Yet governments continue to implement them, even though scientific evidence—and economic self-interest—advises otherwise. If experts can’t reliably prevent such restrictions, they must take steps to mitigating their most harmful effects.

Travel and trade restrictions take various forms. With this coronavirus, governments are warning citizens not travel to China, and instructing those already there to leave; closing borders and banning flights; barring visitors who have recently been to China from entering the country; and implementing mandatory quarantines for returning residents. In past epidemics, governments have also imposed trade restrictions, such as bans on importing pork during the 2009 swine flu pandemic. Such restrictions are ineffective and economically costly for all sides. Initial estimates are that U.S. travel restrictions against China will cost the U.S. economy $10.3 billion. They also have more insidious downsides: incentivizing countries to conceal outbreaks, hindering response efforts, infringing on human rights, and fueling the spread of xenophobia.

In calmer times, governments recognize that trade and travel restrictions are highly problematic. In 2005, after the SARS epidemic, WHO member states adopted a revised International Health Regulations (IHR), the international legal framework that governs how countries prepare for and respond to outbreaks. A core purpose of the new framework is to “avoid unnecessary interference with international traffic and trade” by empowering WHO to make recommendations about whether restrictions are necessary. Countries committed not to impose “more restrictive” measures than WHO recommends (without providing scientific justification).

Since then, WHO has declared six PHEICs, each time advising that trade and travel restrictions were unwarranted. Yet in half those cases—H1N1 in 2009, Ebola in 2014, and the ongoing coronavirus outbreak—countries ignored WHO’s recommendations and imposed large-scale restrictions anyway. (There were fewer restrictions imposed in response to 2019 Ebola epidemic, which has remained largely confined to the Democratic Republic of the Congo; and none for Zika, which is transmitted by mosquitoes, or polio, which a vaccine can prevent.)

Unfortunately, governments’ behavior demonstrates that PHEIC declarations are more likely to provoke travel restrictions than to prevent them. (The restraint of the administration of then U.S. President Barack Obama during the 2014 Ebola epidemic stands out as a rare exception.) A principle of good leadership and public health practice is to meet people where they are. In this spirit, we need to recognize why policymakers keep opting for travel restrictions and why their reasoning might be difficult to overcome.

For one thing, the combination of common sense and fear generates strong public support for travel restrictions. Coronavirus travels in people, so in theory, anything that reduces the movement of people should help reduce the spread of the virus. In practice, travel restrictions prove ineffective because they are imposed too late or because people circumvent them. Perversely, the timing problem may simply drive policymakers to impose restrictions more quickly. And people frequently evade general immigration restrictions too, yet this does not persuade governments to dispense with visas or border checks.

Modeling studies show that travel restrictions might slow, but cannot prevent, an epidemic. However, policymakers may well decide that slowing it is better than not slowing it. (Even the authors of one such study demonstrating that the Hubei quarantine is unlikely to be effective are unwilling to give up on travel restrictions entirely. They conclude by advising that to “possibly succeed, substantial, even draconian measures that limit population mobility should be seriously and immediately considered.”)

Another reason policymakers gravitate towards travel restrictions is the lack of politically viable alternatives. In the face of a pandemic threat, governments are under substantial pressure. They must be seen to take proactive, robust steps to protect their citizens or else they pay a price. From a public-health standpoint, encouraging people to wash their hands and cough into their elbows is good policy. But politically, it’s insufficient to instill public confidence in health authorities; more dramatic action is needed. This kind of security theater can be dangerous—but the absence of security theater can be dangerous too. Apparent inaction (or insufficient action) erodes trust in public health authorities, which undermines response efforts. Pragmatically, policymakers may be damned if they do and damned if they don’t.

Efforts to prevent trade and travel restrictions often refer to governments’ obligation to comply with the IHR, a binding international treaty. But this argument misses key dynamics that strain the reach of the IHR. The first is the role of the private sector. During this coronavirus epidemic, the private sector has effectively imposed its own set of trade and travel restrictions. Numerous airlines have halted flights to China due to lack of demand or because pilots refuse to fly. Retailers such as Starbucks and Apple have closed their stores, while multinational firms have suspended employee travel. The repercussions of these measures will be every bit as severe—if not more so—as restrictions imposed by governments. Yet the private sector is not bound by the IHR. And as WHO Director-General Tedros Adhanom Ghebreyesus acknowledged, “it will be very difficult” for WHO to convince companies to act against their perceived business interests.

Second, the IHR focus on international travel and travel restrictions. But during this coronavirus epidemic, the most significant travel bans have been imposed within China, by the Chinese government. China has quarantined over 50 million people, suspended interprovincial buses, closed tourist destinations, and ordered travel agencies to halt tours abroad. Macau’s casinos are dark. Hong Kong has closed most border crossings and is quarantining visitors from the mainland. The fact that China is implementing travel restrictions on its own citizens—and WHO is not challenging those restrictions—makes it difficult to convince policymakers in other countries not follow suit.

China’s domestic response complicates arguments against travel restrictions on another level too. Numerous countries have evacuated their citizens from Wuhan, rather than leaving them stranded behind a cordon sanitaire indefinitely. Given the possibility of further quarantines, it’s reasonable for governments to warn against travel to China, lest additional evacuations become necessary. Steps that governments take to ensure the safety of citizens abroad are also beyond the scope of the IHR.

In short, travel restrictions are both harmful and difficult to prevent. Global health experts, led by WHO, should continue to discourage such measures. But once they are imposed, the critical question becomes: What can be done to mitigate their harms?

Travel restrictions inflict significant economic losses on affected countries, particularly low-income countries (which have a more difficult time rebounding). One approach might be to embrace the insurance principle of indemnification—making whole after a loss. Financing mechanisms such as the World Bank’s Pandemic Emergency Financing Facility and the WHO Contingency Fund for Emergencies already help countries respond to public health emergencies. Policymakers should explore whether these funds can be expanded, or other funds created, to directly indemnify countries for losses incurred as a result of travel restrictions imposed against WHO’s recommendation.

Fear of incurring trade and travel restrictions can also discourage governments from reporting potential PHEICs. There are two ways to mitigate this risk. WHO has broad but seldom-used latitude to act on information from sources other than governments. Making greater use of this authority can help discourage nonreporting by reducing the likelihood that governments will be able to hide an outbreak. Additionally, policymakers can give countries an economic incentive to report by expanding and fully financing the Contingency Fund for Emergencies. When WHO is notified about a possible PHEIC, it can immediately release funds to help affected governments assess and respond to the situation. Yet since its creation in 2015, the Contingency Fund for Emergencies has been consistently underfunded, which weakens its potential as a reliable incentive for reporting.

And finally, trade and travel restrictions interfere with international epidemic response efforts by making it more difficult to get medical supplies and health care workers into affected countries. One way of mitigating this harm is by creating a system of exceptions to the restrictions. Examples might include chartering special flights and shipments, less stringent quarantine measures for returning responders (e.g. self-monitored, home-based quarantines), or even exempting medical supplies from preexisting tariffs. WHO already sends teams of international experts to respond to PHEICs and coordinates efforts to ensure that affected countries have access to essential commodities. WHO’s members could expand its authority to coordinate those exceptions—and vitally needed spaces could be carved out to help keep people alive even as borders close.