Abstract
Background/ObjectiveInternational travel measures to contain the coronavirus disease of 2019 (COVID-19) pandemic represent a relatively intrusive form of non-pharmaceutical intervention. To inform decision-making on the (re)implementation, adaptation, relaxation or suspension of such measures, it is essential to not only assess their effectiveness but also their unintended effects.MethodsThis scoping review maps existing empirical studies on the unintended consequences, both predicted and unforeseen, and beneficial or harmful, of international travel measures. We searched multiple health, non-health and COVID-19-specific databases. The evidence was charted in a map in relation to the study design, intervention and outcome categories identified and discussed narratively.ResultsTwenty-three studies met our inclusion criteria—nine quasi-experimental, two observational, two mathematical modelling, six qualitative and four mixed-methods studies. Studies addressed different population groups across various countries worldwide. Seven studies provided information on unintended consequences of the closure of national borders, six looked at international travel restrictions and three investigated mandatory quarantine of international travellers. No studies looked at entry and/or exit screening at national borders exclusively, however six studies considered this intervention in combination with other international travel measures. In total, 11 studies assessed various combinations of the aforementioned interventions. The outcomes were mostly referred to by the authors as harmful. Fifteen studies identified a variety of economic consequences, six reported on aspects related to quality of life, well-being, and mental health and five on social consequences. One study each provided information on equity, equality, and the fair distribution of benefits and burdens, environmental consequences and health system consequences.ConclusionThis scoping review represents the first step towards a systematic assessment of the unintended benefits and harms of international travel measures during COVID-19. The key research gaps identified might be filled with targeted primary research, as well as the additional consideration of gray literature and non-empirical studies.
Highlights
IntroductionThe novel coronavirus SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), which causes coronavirus disease of 2019 (COVID-19), has spread to every country of the world since its identification in Wuhan in December 2019 and the declaration by the World Health Organization (WHO) of a global pandemic in March 2020.1 Non-pharmaceutical interventions (NPIs) have constituted the primary response to the virus by national governments over the first year of the pandemic,[2] with highly variable success across the globe.[3,4,5] NPIs comprise measures that can be implemented at the individual and population level (e.g. physical distancing, face masks, school closures and hand hygiene) to contain the spread of a disease.[6] Among these, measures affecting human travel across national borders, designed to contain the COVID-19 pandemic (hereinafter referred to as ‘international travel measures’) have been implemented in various combinations since the early stages of the pandemic
The novel coronavirus SARS-CoV-2, which causes coronavirus disease of 2019 (COVID-19), has spread to every country of the world since its identification in Wuhan in December 2019 and the declaration by the World Health Organization (WHO) of a global pandemic in March 2020.1 Non-pharmaceutical interventions (NPIs) have constituted the primary response to the virus by national governments over the first year of the pandemic,[2] with highly variable success across the globe.[3,4,5] NPIs comprise measures that can be implemented at the individual and population level to contain the spread of a disease.[6]
No studies looked at entry and/or exit screening at national borders exclusively, six studies considered this intervention in combination with other international travel measures
Summary
The novel coronavirus SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), which causes coronavirus disease of 2019 (COVID-19), has spread to every country of the world since its identification in Wuhan in December 2019 and the declaration by the World Health Organization (WHO) of a global pandemic in March 2020.1 Non-pharmaceutical interventions (NPIs) have constituted the primary response to the virus by national governments over the first year of the pandemic,[2] with highly variable success across the globe.[3,4,5] NPIs comprise measures that can be implemented at the individual and population level (e.g. physical distancing, face masks, school closures and hand hygiene) to contain the spread of a disease.[6] Among these, measures affecting human travel across national borders, designed to contain the COVID-19 pandemic (hereinafter referred to as ‘international travel measures’) have been implemented in various combinations since the early stages of the pandemic These range from the relatively non-intrusive, such as entry and exit screening at national borders, to the more severe, such as travel bans and the complete closure of national borders.[7] A Cochrane rapid review assessed the effectiveness of international travel measures in the context of the COVID-19 pandemic,[8] finding an expansive and heterogeneous evidence base suggesting (albeit with low to very low certainty) that some of these measures have a positive impact on infectious disease-related outcomes. None of the included studies reported on adverse effects or unintended consequences, a gap that is likely, in part, an artefact of the review’s reliance on biomedical databases, its exclusion of qualitative evidence and the failure or inability of most studies of disease transmission (notably modelling studies) to examine broader societal outcomes
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