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Objective: To describe the adoption of international travel measures during the first year of the COVID-19 pandemic., Methods: To comprehensively analyze the measures adopted, we constructed a dataset based on the WHO's Public Health and Social Measures (PHSM) database, which covered 252 countries, territories, or other areas (CTAs), including all 194 WHO Member States, from December 31, 2019, to December 31, 2020. We examined the adoption of measures by type, over time, and by the implementing and targeted CTA, including their levels of income., Findings: We identified 11,431 international travel measures implemented during the first year of the pandemic. The adoption of measures was rapid and widespread: over 60% of Member States had adopted a travel measure before the WHO declared COVID-19 a Public Health Emergency of International Concern on January 30, 2020. Initially, health screening and travel restrictions were the most adopted measures; however, quarantine and testing became more widely adopted over time. Although only a small portion of the total measures adopted constituted full border closure, approximately half of all Member States implemented this measure. Many travel measures targeted all CTAs but were unlikely to have been adopted universally enough to provide public health benefits. Low-income countries relied more on more universal measures, including full border closure, and were slower in scaling up testing compared to higher-income countries., Conclusion: The adoption of international travel measures during the first year of the COVID-19 pandemic varied across jurisdictions and over time. Lower-income countries used a different mix and scaled-up measures slower than higher-income countries. Understanding what measures were used is crucial for assessing their effectiveness in controlling the spread of COVID-19, reviewing the usefulness of the International Health Regulations, and informing future pandemic preparedness and response activities., (© 2024. The Author(s).)

Background: Assessment of the effective use of international travel measures during the COVID-19 pandemic has focused on public health goals, namely limiting virus introduction and onward transmission. However, risk-based approaches includes the weighing of public health goals against potential social, economic and other secondary impacts. Advancing risk-based approaches thus requires fuller understanding of available evidence on such impacts., Methods: We conducted a scoping review of existing studies of the social impacts of international travel measures during the COVID-19 pandemic. Applying a standardized typology of travel measures, and five categories of social impact, we searched 9 databases across multiple disciplines spanning public health and the social sciences. We identified 26 studies for inclusion and reviewed their scope, methods, type of travel measure, and social impacts analysed., Results: The studies cover a diverse range of national settings with a strong focus on high-income countries. A broad range of populations are studied, hindered in their outbound or inbound travel. Most studies focus on 2020 when travel restrictions were widely introduced, but limited attention is given to the broader effects of their prolonged use. Studies primarily used qualitative or mixed methods, with adaptations to comply with public health measures. Most studies focused on travel restrictions, as one type of travel measure, often combined with domestic public health measures, making it difficult to determine their specific social impacts. All five categories of social impacts were observed although there was a strong emphasis on negative social impacts including family separation, decreased work opportunities, reduced quality of life, and inability to meet cultural needs. A small number of countries identified positive social impacts such as restored work-life balance and an increase in perceptions of safety and security., Conclusions: While international travel measures were among the most controversial interventions applied during the COVID-19 pandemic, given their prolonged use and widespread impacts on individuals and populations, there remains limited study of their secondary impacts. If risk-based approaches are to be advanced, involving informed choices between public health and other policy goals, there is a need to better understand such impacts, including their differential impacts across diverse populations and settings., (© 2024. The Author(s).)

Introduction: Assessment of the use of travel measures during COVID-19 has focused on their effectiveness in achieving public health objectives. However, the prolonged use of highly varied and frequently changing measures by governments, and their unintended consequences caused, has been controversial. This has led to a call for coordinated decision-making focused on risk-based approaches, which requires better understanding of the broader impacts of international travel measures (ITMs) on individuals and societies., Methods: Our scoping review investigates the literature on the economic impact of COVID-19 ITMs. We searched health, social science and COVID-19-specific databases for empirical studies preprinted or published between 1 January 2020 and 31 October 2023. Evidence was charted using a narrative approach and included jurisdiction of study, ITMs studied, study design, outcome categories, and main findings., Results: Twenty-six studies met the inclusion criteria and were included for data extraction. Twelve of them focused on the international travel restrictions implemented in early 2020. Limited attention was given to measures such as entry/exit screening and vaccination requirements. Eight studies focused on high-income countries, 6 on low-income and middle-income countries and 10 studies were comparative although did not select countries by income. Economic outcomes assessed included financial markets (n=13), economic growth (n=4), economic activities (n=1), performance of industries central to international travel (n=9), household-level economic status (n=3) and consumer behaviour (n=1). Empirical methods employed included linear regression (n=17), mathematical modelling (n=3) and mixed strategies (n=6)., Conclusion: Existing studies have begun to provide evidence of the wide-ranging economic impacts resulting from ITMs. However, the small body of research combined with difficulties in isolating the effects of such measures and limitations in available data mean that it is challenging to draw general and robust conclusions. Future research using rigorous empirical methods and high-quality data is needed on this topic., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

During Public Health Emergencies of International Concern (PHEICs), The International Health Regulations (IHR) require the WHO to issue Temporary Recommendations on the use of international travel and trade measures. During the COVID-19 pandemic, WHO's initial recommendation against 'any travel or trade restriction' has been questioned, and virtually all countries subsequently used international travel measures. WHO's Recommendations to States Parties also changed over the course of the pandemic. There is a need to understand how WHO's treatment of this issue compared with other PHEICs and why States Parties' actions diverged from WHO's initial Recommendations. This first analysis of WHO's Temporary Recommendations on international travel and trade measures during all seven PHEICs compares the guidance for clarity and consistency in several areas of substance and process. We find that lack of clarity and inconsistency in WHO guidance makes it difficult to interpret and relate back to IHR obligations. Based on this analysis, we offer recommendations to increase consistency and clarity of WHO's guidance on this issue during global health emergencies., Competing Interests: Competing interests: CZW was a member of a WHO guideline development group and technical consultation in 2019. KL was a member of two donor-funded reviews of WHO in 1995 and 1997. She was previously a codirector of the WHO Collaborating Centre on Global Change and Health, and has received WHO funding for research on globalisation and infectious diseases, global health governance, tobacco control and COVID-19. She is currently a member of an expert group and editorial board supporting the WHO Programme of Work on the Economic and Commercial Determinants of Health., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Why do some international agreements fail to achieve their goals? Rather than states' engaging in cheap talk, evasion, or shallow commitments, the World Health Organization's (WHO) International Health Regulations (IHR)-the agreement governing states' and WHO's response to global health emergencies-point to the unintended consequences of information provision. The IHR have a dual goal of providing public health protection from health threats while minimizing unnecessary interference in international traffic. As such, during major outbreaks WHO provides information about spread and severity, as well as guidance about how states should respond, primarily regarding border policies. During COVID-19, border restrictions such as entry restrictions, flight suspensions, and border closures have been commonplace even though WHO recommended against such policies when it declared the outbreak a public health emergency in January 2020. Building on findings from the 2014 Ebola outbreak, we argue that without raising the cost of disregarding (or the benefits of following) recommendations against border restrictions, information from WHO about outbreak spread and severity leads states to impose border restrictions inconsistent with WHO's guidance. Using new data from COVID-19, we show that WHO's public health emergency declaration and pandemic announcement are associated with increases in the number of states imposing border restrictions., (© The Author(s) (2022). Published by Oxford University Press on behalf of the International Studies Association.)

Objective: To review the effectiveness of travel measures implemented during the early stages of the COVID-19 pandemic to inform changes on how evidence is incorporated in the International Health Regulations (2005) (IHR)., Design: We used an abbreviated Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols to identify studies that investigated the effectiveness of travel-related measures preprinted or published by 1 June 2020., Results: We identified 29 studies, of which 26 were modelled. Thirteen studies investigated international measures, while 17 investigated domestic measures (one investigated both). There was a high level of agreement that the adoption of travel measures led to important changes in the dynamics of the early phases of the COVID-19 pandemic: the Wuhan measures reduced the number of cases exported internationally by 70%-80% and led to important reductions in transmission within Mainland China. Additional travel measures, including flight restrictions to and from China, may have led to additional reductions in the number of exported cases. Few studies investigated the effectiveness of measures implemented in other contexts. Early implementation was identified as a determinant of effectiveness. Most studies of international travel measures did not account for domestic travel measures thus likely leading to biased estimates., Conclusion: Travel measures played an important role in shaping the early transmission dynamics of the COVID-19 pandemic. There is an urgent need to address important evidence gaps and also a need to review how evidence is incorporated in the IHR in the early phases of a novel infectious disease outbreak., Competing Interests: Competing interests: KL was a member of two donor-funded reviews of WHO in 1995 and 1997. She has previously received funding from WHO to conduct research on global health governance and global tobacco control and review evidence on the impacts of globalisation and infectious diseases. CZW was a member of a WHO guideline development group and technical consultation in 2019., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Slow outbreak reporting by states is a key challenge to effectively responding to global health emergencies like Zika, Ebola, and H1N1. Current policy focuses on improving domestic outbreak surveillance capacity globally in order to reduce reporting lags. However, governments also face economic and political incentives to conceal outbreaks, and these incentives largely are ignored in policy discussions. In spite of the policy implications for outbreak response, the "capacity" and "will" explanations have not been systematically examined. Analysis of a dataset coding the timeliness of outbreak reporting from 1996-2014 finds evidence that states' unwillingness to report-rather than just their inability-leads to delayed reporting. The findings suggest that though building surveillance capacity is critical, doing so may not be sufficient to reduce reporting lags. Policy aimed at encouraging rapid reporting must also mitigate the associated economic and political costs., (© The Author(s) (2019). Published by Oxford University Press on behalf of the International Studies Association.)

This article examines the connection between disease outbreaks and human trafficking. A central challenge in combating trafficking is poor data on its nature and scope. One way to deal with these gaps in knowledge and still target resources effectively is to identify key "push and pull" factors that increase the likelihood of trafficking from origin countries and to destination countries. One under-examined push factor is the outbreak of disease. Outbreaks are associated with several well-documented trafficking risk factors, from the breakdown of rule of law and increase in criminal activity to competition for resources and diminished economic opportunity. Disease outbreaks can also disrupt family ties. For example, the 2014 Ebola outbreak in West Africa left thousands of orphans at increased risk of exploitation. The article outlines possible mechanisms through which outbreaks could increase trafficking risk and, using data on disease outbreaks and trafficking across states over the past 2 decades, provides evidence that countries that have recently experienced a disease outbreak are more likely to have trafficking outflows. The findings point to the importance of integrating trafficking prevention into outbreak response and call for a research agenda more fully examining the connection between trafficking and outbreaks (and potentially other types of natural disasters as well).

During the 2009 H1N1 pandemic, the World Health Organization (WHO), acting under the authority of the International Health Regulations (IHR), recommended against the imposition of trade or travel restrictions because, according to WHO, these barriers would not prevent disease spread. Why did 47 states impose barriers anyway? This article argues that states use barriers as political cover to prevent a loss of domestic political support. This logic suggests that governments anticipating high domestic political benefits for imposing barriers during an outbreak will be likely to do so. Logistic regression and duration analysis of an original dataset coding state behavior during H1N1 provide support for this argument: democracies with weak health infrastructure-those that stand to gain the most from imposing barriers during an outbreak because they are particularly vulnerable to a negative public reaction-are more likely than others to impose barriers and to do so quickly., (© Springer Science+Business Media New York 2016.)