Travel ban threatens information sharing, weakens global solidarity

In a hard-hitting editorial published in the authoritative medical journal, Lancet, on Saturday 4 December a group of eminent South African scientists have warned that the travel bans slapped on South Africa after reporting the Omicron variant was not only unwarranted but a threat to global solidarity and could have dire consequences for the sharing of information in future.

The editorial was written by Prof Marc Mendelson, Professor of Infectious Diseases and Head of the Division of Infectious Diseases & HIV Medicine at Groote Schuur Hospital, Prof Francois Venter, the head of Ezintsha at Wits University, Prof Mosa Moshabela from the University of KwaZulu-Natal, the President of the South African Medical Research Council, Prof Glenda Gray, Deputy Director of the National Institute for Communicable Diseases, Prof Lucille Blumberg, bioinformatician and director of the KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP) at the University of KwaZulu-Natal and Professor in Bioinformatics at Stellenbosch University's School for Data Science and Computational Thinking, Tulio de Oliveira and the head of the faculty of health sciences at Wits University Prof Shabir A Madhi.

The authors called the travel ban unwarranted adding their voices to the outrage expressed by both President Cyril Ramaphosa and the Minister of Health Dr Joe Phaahla who still had some angry words during his national Covid-19 briefing on Friday, as well as the World Health Organisation.

Apart from the United Kingdom, travel from South Africa has also been stopped by among others the United States, the European Union, Canada, Turkey, Sri Lanka, Oman, the United Arab Emirates, Australia, Japan, Thailand, Seychelles, Brazil, Rwanda, Mauritius and Guatemala.

“The folly of restricting travel to a handful of countries at best might only buy some time before the virus variant is eventually imported,” the authors said adding that this has been made worse by countries like the United Kingdom failing in their promises to donate 100 million doses of Covid-19 vaccines to the COVAX facility set up to distribute doses to low and middle-income countries.

“As of Dec 2, 2021, only 11·5% have been forthcoming,” the editorial reads.

“This situation puts countries such as South Africa in a difficult position, and potentially threatens future willingness to share information and weakens global solidarity. Once again, South Africa and other southern African countries have been stigmatised and will pay a heavy economic and societal price for sharing information. This experience is also likely to have a detrimental impact on the behaviour of other countries going forward. South Africa has been proactive in its contribution to the world’s COVID-19 response by sharing news of the new variant, but other countries have not fully supported an equitable COVID-19 response in low-income and middle-income countries. For example, of the promised 100 million COVID-19 vaccine doses to be donated to COVAX by the UK, as of Dec 2, 2021, only 11·5% have been forthcoming.

In their editorial, the scientists first describe how on 24 December 2020, the United Kingdom’s Prime Minister Boris Johnson announced an immediate travel ban on all flights to South Africa after the detection of the Beta variant by South African scientists.

This travel ban was only lifted 291 days later.

Almost eleven months later Johnson did it again after South African scientists reported the Omicron variant. 

Several other countries including Israel and the USA, swiftly followed suit with travel bans placed on flights from countries in sub-Saharan Africa, as a “precautionary measure.”

The authors pointed out that the only information available at the time was that Omicron has mutations that could make it less susceptible to neutralising antibody activity (meaning it can escape some of the body’s immune system defences) and was possibly as transmissible as or more transmissible than the Delta variant - but these had yet to be confirmed in laboratories and case studies by scientists.

They added that while the AstraZeneca vaccine, used in the UK, did not protect against mild and moderate Covid-19 caused by the Beta variant it still reduced the risk of severe Covid-19 by 80%.

Referring to the travel bans, the authors stressed that this was unwarranted and has generated intense anger and frustration. 

“Travel restrictions are unlikely to be able to stop the spread of coronaviruses unless countries are able to completely seal their borders to travellers from all nations. Predictably, soon after the UK travel ban announcement, cases of the omicron variant were reported in Europe, the UK, North America, and, as of 2 December, 25 countries in total. Paradoxically, the most concerning SARS-CoV-2 variants for a highly vaccinated population would likely arise in a high transmission environment where there are high levels of vaccine coverage, such as the UK, France, or Italy, to name but a few. New Zealand has comprehensively restricted COVID-19 numbers but only through its geographical location, totally sealing off of travel, and implementing aggressive hotspot management and strict lockdowns. Elsewhere, despite selective travel bans, successive SARS-CoV-2 variants of concern have spread widely. 

“Just 8 months after its discovery, the beta variant was present in 141 countries, including the UK. As of Dec 1, 2021, the delta variant dominates globally. By their nature, SARS-CoV-2 variants are several steps ahead of the international travel curve. Once community transmission of an airborne virus is occurring, travel restrictions have little effect. Before travel bans can be imposed a variant identified in country A has most likely already spread to country B and, thereafter, globally. 2 days after South Africa’s announcement, omicron was sequenced from an unvaccinated traveller returning to Belgium from Egypt via Turkey who became symptomatic 11 days later. She had no ties with or exposure to anyone from Southern Africa. Omicron has probably already spread globally. Countries with robust surveillance and genomics capability will be able to identify cases early; others will not. The folly of restricting travel to a handful of countries at best might only buy some time before the virus variant is eventually imported. 

“In 2002, the Chinese Government was criticised for withholding information on SARS. In November, 2021, South African scientists rapidly and transparently shared the findings of mutation and genomic sequences of the latest SARS-CoV-2 variant. Rather than applaud their generosity and openness, travel bans have had the opposite effect and could be damaging to the health response, economy, and freedom of movement. This situation puts countries such as South Africa in a difficult position, and potentially threatens future willingness to share information and weaken global solidarity.”

Highlighting the impact of the travel bans, the authors wrote: “We believe governments need to attend to their failings rather than penalise other countries unnecessarily. The latest travel ban has devastated family holiday plans and an industry. South Africa’s tourism industry contributes about R82 billion (£3·77 annually to the fiscus, by far the largest proportion coming from UK tourists). Tourism and allied industries account for an estimated 1.5 million jobs and livelihoods in South Africa. One day after the UK’s travel red-listing of South Africa occurred, the Federated Hospitality Association of Southern Africa and the Southern Africa Tourism Services Association did a survey of association members serving international markets. An average of 2,506 cancellations had occurred among 603 respondents from tourist bookings they held over the next four months, representing 1·5 million cancellations in the first 48 hours after the travel ban began, and 390 respondents reported R940 million of lost revenue, an average of R2.4 million each.

“We call on the UK and other governments to reverse their damaging travel bans and follow the advice of WHO and the International Health Regulations in keeping international borders open.

“Instituting public health measures to identify and manage cases of the omicron variant would be a far better investment. The UK in particular is damaging the economy of South Africa by its actions. Countless families in many countries have once again had their plans dashed by the decisions of politicians who want to be seen to be doing something rather than focusing on what they should be doing—meaningfully supporting global COVID-19 vaccination efforts.

Once again, South Africa and other southern African countries have been stigmatised and will pay a heavy economic and societal price for sharing information. This experience is also likely to have a detrimental impact on the behaviour of other countries going forward. South Africa has been proactive in its contribution to the world’s COVID-19 response by sharing news of the new variant, but other countries have not fully supported an equitable COVID-19 response in low-income and middle-income countries. For example, of the promised 100 million COVID-19 vaccine doses to be donated to COVAX by the UK, as of Dec 2, 2021, only 11·5% have been forthcoming.18 We believe governments need to attend to their failings rather than penalise other countries unnecessarily,” the editorial concluded. DM/MC