GOVERNMENTS will go to default “shut borders” mode in absence of “scientific, calibrated approach”, argues president-elect of International Society of Infectious Diseases
The travel industry needs to take a more proactive approach to managing future pandemics because even if WHO declares an end to the Covid-19 pandemic by or towards the end of the third quarter, the next one is just around the corner and the industry cannot afford for the default response from governments to be “let’s shut down borders”.
Singapore-based infectious disease expert Dr Paul Tambyah said that unless the industry works with the medical fraternity to come up with a scientific, calibrated approach to give confidence to governments, that will become the default mode, given the success seen in countries like New Zealand and Australia that implemented sharp lockdowns over isolated cases.
In Episode 35 of the WiT Podcast, National University of Singapore professor, Dr Tambyah, who is president-elect of the International Society of Infectious Diseases (ISID), covers a wide range of topics including the possibility that WHO may declare the end to the pandemic by or towards the end of the third quarter given the rapid acceleration of vaccine rollouts but a recurring theme was how travel and medicine needed to work closer together to prevent a Covid-like devastation of the travel industry from happening again.
He said, “The travel industry has been relatively passive right now … they’re just taking what comes from the scientists, from the WHO, from the US CDC and various other agencies. But I think it’s reached the point where the travel industry has been hit so bad by this…
“The WHO, to this day on its website, says we do not recommend any travel restrictions. And nobody believes that …”
He said international agencies need to communicate with each other, suggesting that IATA gets together with WHO, which controls the yellow fever vaccination certificate, and work out a safe, digital version of the yellow book which has been around a long time and has been proven to work.
In March, he and several colleagues published an article urging for the use of the WHO International Certificate of Vaccination in the International Journal of Infectious Diseases.
“Vaccination requirements have been in place for a long time in many countries and regions, and the most notable of those is the yellow fever vaccination requirement. It’s mandatory under the International Health Regulations for travel from parts of Africa and Latin America to have a yellow fever vaccination certificate before they can leave those countries.”
Singapore in particular is vulnerable “and the reason is that the mosquito that spreads yellow fever is the same mosquito that spreads dengue. And dengue is widespread across South-east Asia. So if yellow fever were to be introduced in South-east Asia … it could be devastating.
“The death rate from yellow fever is really high, but that hasn’t happened. People thought it would happen 50 years ago, but with a good vaccine, and a good screening regime, we haven’t had that problem. So there is a precedent. We just need to look at the existing structures and the mechanisms that are already in place, and try and strengthen them, rather than try and present this as something new and something oppressive and whatnot.”
He said IATA and WHO could agree to look at all the different apps out there and say, “let’s have an internationally recognized app, and let’s get it monitored in in Beijing and in Washington or Seattle, or wherever it is, then it’s something that the whole world can trust, because people who don’t trust China will trust the US and people who don’t trust the US will trust China.
“It’s something that the international agencies need to get together on. And they need to take the lead – the trouble is that now everybody goes private and private is just a bit of a cowboy kind of world out there. It is a situation where you have to have an internationally recognized regulator step in.”
He said it was time for the travel industry to step up and fund its own research. “The industry has to really come up with its own set of questions that they need answered by the scientific community and obviously fund targeted research, and provide good solid data, which will allow governments to make decisions with confidence.
“… the travel industry depends on people moving from place A to place B, and if this cannot be done safely, and if the knee jerk response of governments and international agencies is just to shut the borders, then then you’re going to be held hostage to what’s going to happen.”
Unfortunately, “the way it’s been portrayed in the media is, if something new comes up, that’s potentially deadly, then you have to shut down … And because we don’t have that kind of calibrated or scientific approach which I think can happen, but it’s not going to happen yet because we haven’t got our act together as a scientific community integrated with the travel community …”
Other key takeaways from the interview:
• The role of vaccinations in opening borders: All eyes on the US
“What it needs is somebody needs to take the first step. The good news is the United States is slowly becoming the world thought leader again. And the US CDC just last week announced that if you are fully vaccinated, you don’t need to quarantine, if you’re returning from overseas, and you come back to the United States. And for domestic travel, you don’t need to quarantine either.
“So the rest of the world is going to watch and see what happens in the United States …”
• What happens when governments recognise only specific vaccines
In a follow-up question after the podcast, I asked Dr Tambyah about governments recognising only travellers with their recognised vaccines – for example, Vietnam has announced it will exempt vaccinated foreigners from quarantine from September but only if they use the same vaccines as Vietnam, AstraZeneca and Sputnik V?
His response: “If only one or two vaccines are authorised in a country, it is hard for that country to accept vaccination using a different vaccine for entry into that country. That would be the equivalent of saying that the country believes that a vaccine which they have NOT authorised is safe and effective which raises a lot of legal questions.
“I think that ultimately, if there is a global regime sanctioned by WHO under the IHR, vaccines which are WHO prequalified (see List of Prequalified Vaccines) will be the ones which will enable WHO certification in the yellow book or its digital equivalent.”
• The prerequisites for opening borders: A suggested safe template
Vaccinate enough of the local population – percentage depends on how porous borders are (in Singapore’s case, it could be 80%-90%), allow vaccinate travellers in, have good surveillance so if there are any infections, apply “ring vaccination” – give booster shots to people within the ring. It’s been known to have worked with smallpox as well as currently, with mumps in US college campuses.
• The possibility that WHO could declare an end to the pandemic by or towards end of the third quarter
“There’s a reasonable chance, because the rate of vaccination is just going up like crazy. The USA is vaccinating a million people a day. And many wealthy countries have actually got more than enough vaccine for the whole population. So once they vaccinated everyone who wants to get vaccinated, then they can start giving it away. And when they start giving it away, there are mechanisms in place.
“There’s a polio vaccination programme, which is very successful. Polio is now only seen in two countries, Wild Type Polio, in Afghanistan, in Pakistan, in these mountainous regions, which are really inaccessible. In villages all across Africa, there’s no more polio. There. It’s been eliminated for several years. The infrastructure is in place. It’s just getting access to the vaccines. And I think once the rich countries have vaccinated everyone, there’ll be plenty of vaccines to go around.”
• Do you have to get vaccinated before you can travel?
“Yes, that’s the sad reality. Governments will respond to this … right now, the vaccine is free in Singapore, and in many other countries. So it’s not a matter of whether you can afford it or not, it’s a matter of whether you get access to the queue. And it’s the same for example, with the pilgrimage in Saudi … everybody who goes there has to get meningitis vaccine and influenza vaccine. What countries do is that they organize mass vaccinations or campaigns and bulk purchase and discount so they try and mitigate the inequality or the discrepancy that will naturally arise when you put in a vaccine requirement.”
• How about families with kids – where the parents are vaccinated and the kids are not?
“This going to be a huge problem. Both Pfizer and Madonna are pushing very aggressively to get the vaccines licensed for children. And until then It’s going to be really hard for families with children to travel because I don’t see how the authorities are going to make exceptions. The best hope, though, is that if the vaccination really gets rolled out, and if the numbers drop across the world, then the WHO can declare the pandemic over in the third quarter, maybe, and towards the end of the third quarter. And if that happens, it’s going to be very hard to put in very stringent restrictions on children.”
• Should travel companies have medical staff onboard the way they have government relations experts?
“One of the most interesting conferences I attended in 2019 … was organised by a private group, which provides travel-related medical services to major multinational companies, US and other government agencies and international organizations.
“They know, if you get into a traffic accident in the middle of the jungle, they can tell you 100 miles away is a hospital where this surgeon can fix your fracture, or you’re better off calling for an airplane to fly you back to London or New York. That kind of intelligence already exists. And what was interesting was at that meeting, I met the medical advisors of the oil majors. They have in house experts, but the in house experts recognize the limitations of what they can do. And they tap on to some of these international medical professional travel experts and so the infrastructure is already there.”
(Note: Delta Airlines recently named Dr Henry Ting, Chief Health Officer, previously from Mayo Clinic)
• Are we more prepared for the next pandemic?
“I think we are … the capacity has improved, the ability to produce vaccines. We’re using new technologies. We have got much better technology, which is easier to use, which can scale up very quickly. So in terms of vaccines, and in terms of diagnostics, we are better prepared, it’s just a question of how we can implement it.”