Selam Gebrekidan et al., New York Times, September 30, 2020
They came from across the world to ski in the most famous resorts of the Austrian alps.
They knew in late February and early March that the coronavirus was spreading in nearby northern Italy, and across the other border in Germany, but no one was alarmed. Austrian officials downplayed concerns as tourists crowded into cable cars by day, and après-ski bars at night.
Then they all went home, unwittingly taking the virus with them. Infected in Ischgl (pronounced “ISH-gul”) or in surrounding villages, thousands of skiers carried the coronavirus to more than 40 countries on five continents. Many of Iceland’s first known cases were traced to Ischgl. In March, nearly half the cases in Norway were linked to Austrian ski holidays.
Nine months into an outbreak that has killed a million people worldwide, Ischgl is where the era of global tourism, made possible by cheap airfares and open borders, collided with a pandemic. For decades, as trade and travel drew the world closer, public health policy, enshrined by treaty, encouraged global mass tourism by calling for open borders, even during outbreaks.
When the coronavirus emerged in China in January, the World Health Organization didn’t flinch in its advice: Do not restrict travel.
But what is now clear is that the policy was about politics and economics more than public health.
Public health records, scores of scientific studies and interviews with more than two dozen experts show the policy of unobstructed travel was never based on hard science. It was a political decision, recast as health advice, which emerged after a plague outbreak in India in the 1990s. By the time Covid-19 surfaced, it had become an article of faith.
“It’s part of the religion of global health: Travel and trade restrictions are bad,” said Lawrence O. Gostin, a professor of global health law at Georgetown University who helped write the global rules known as the International Health Regulations. “I’m one of the congregants.”
Covid-19 has shattered that faith. Before the pandemic, a few studies had demonstrated that travel restrictions delayed, but did not stop, the spread of SARS, pandemic flu and Ebola. Most, however, were based on mathematical models. No one had collected real-world data. The effect of travel restrictions on the spread of the latest coronavirus is still not understood.
Not knowing is especially vexing as the world seeks a way back to normalcy. For months, national leaders have invoked travel restrictions that vary in strictness and are often contradictory. Some shut their borders and simultaneously imposed domestic lockdowns, others required tests and quarantines. Many regularly revised their lists of risky destinations, sometimes responding tit for tat when their citizens were denied entry.
The restrictions have humbled powerful nations like the United States, whose citizens are no longer welcome across most of the world. Even so, President Trump has called his travel restrictions “the biggest decision we made so far” and attacked the W.H.O.’s early advice on borders as “disastrous.”
Still, it is too soon to know, based on data and hard science, how much travel restrictions help, and if they do, which restrictions help most. Experts who had defended open borders at the start of the pandemic now say countries should use judicious travel measures. The W.H.O. now calls for a gradual reopening in which each country weighs its own risks.
What is vividly clear is that global public health policies are inadequate, especially regarding travel. Low-cost airlines have created a surge in global travel. The number of people taking at least one overseas trip a year has grown by 80 percent since the regulations were formulated in 2005.
The ease and expansion of global travel is why “super spreader” events helped accelerate the pandemic: Just as skiers in Ischgl carried the virus around the world, congregants at a French megachurch took the disease to Africa, Latin America and across Europe.
Growing up in Hamburg, Annette Garten was 16 when her family first visited the sleepy resort of Ischgl in the late 1980s. It catered to avid skiers, mostly Germans. Cow manure sometimes littered the streets.
The village became a resort in the 1960s, after an enterprising resident went door to door collecting money for a cable car. When Ms. Garten visited, it was hardly on the global tourism map.
That began to change in the 1990s, when Ms. Garten started spotting Britons on the slopes and Russians in big furry hats. New hotels rose along the narrow streets. Stars like Elton John and Bob Dylan headlined concerts.
The same forces of globalization reshaping Ischgl were transforming the world. Multinational companies embraced outsourcing and international supply chains. Global trade made countries interdependent, which also came with risks.
In the fall of 1994, a plague outbreak struck the Indian port city of Surat. Hysteria erupted, and countries quickly banned travel to India. Tourists abandoned their vacations. Airlines canceled flights. The United Arab Emirates banned Indian cargo, while Russia demanded quarantines on shipments.
Plague is not uncommon, with small outbreaks every year, even in the United States, and Surat’s outbreak turned out to be relatively mild, with just over 50 deaths. But the global panic devastated the city and cost India’s economy an estimated $3 billion.
The reaction to the outbreak alarmed David Heymann, an American epidemiologist who was then a senior W.H.O. official involved in the agency’s response to Surat. Indian officials had properly reported the outbreak and quickly brought it under control. Yet India was punished, a response he considered “irrational.”
At the time, the International Health Regulations were designed to prevent trade interruptions. But they only applied to three diseases — plague, cholera and yellow fever. Enforcement was impossible, and countries often implemented arbitrary travel bans for other diseases.
Surat exposed the most glaring blind spot. The world’s pandemic alert system depended on political leaders to sound the alarm. If financial ruin was the cost, no country would report an outbreak.
The W.H.O. soon undertook a broad reassessment of the rules but the revisions ground slowly until the SARS epidemic hit in 2003. Fearing a pandemic, the W.H.O. advised against travel to affected countries, the most stringent recommendations in its 55-year history.
Most of the affected countries were in Asia, but it was Canada that felt most aggrieved, after the W.H.O. advised against travel to Toronto. Then, member states of the W.H.O. gathered during the SARS epidemic and told the agency to complete the revisions.
This time, the process was swift. In 2005, diplomats struck a compromise intended to balance public health needs with the economic consequences of “unnecessary interference” with travel and trade. While the new rules did not explicitly prohibit countries from closing borders or restricting trade, they made it clear that doing so should be a last resort.
But the rules were never based on a scientific body of evidence. There were reasonable assumptions — closed borders could slow the arrival of medicine and aid workers, for example. Yet, no one studied whether restricting travel might slow a fast-spreading disease, partly because there was no tradition of collecting data on such interventions.
The new rules took effect in 2007 even as the world was rapidly making them obsolete. Focused heavily on trade, they failed to account for “a tourism industry that grows out of bounds,” said Prof. Ilona Kickbusch, at the Graduate Institute of International and Development Studies in Geneva.
Dr. Heymann, who helped shape the last revision, acknowledges that the current regulations “are not fit for purpose on travel and trade.”
“More and more,” Dr. Heymann said, “we’re understanding that there are some times when travel and trade might need to be restricted.”