Tony Concil speaks to Dr David Heymann, an infectious disease epidemiologist and public health expert, about the impact of the coronavirus pandemic on travel and the possible future outcomes.

Will we see the end of COVID-19?

Most scientists believe it will become endemic, like tuberculosis and HIV – two endemic human infections that have come from the animal kingdom. We need to learn to live with it. And, as that realization grows, governments will be motivated to find ways of getting people back to normal in all aspects of their lives, including travel. That means individuals learning to do their own risk assessments and protecting the vulnerable, as they do for other infectious diseases.

We have many tools at our disposal—diagnostic tests, vaccines and therapeutic drugs. A challenge, of course, is making sure that access to these is universal.

I think that ultimately vaccines are the road back to normal, with the biggest issue being access. Diagnostic tests used for screening will likely help us to function in the interim period and will be necessary for continuing to diagnose infections as the disease becomes endemic.

The unknown in this is long COVID. Some people who have been infected struggle with fatigue, shortness of breath and other symptoms for extended periods of time. The public health implications of that are still being determined.


When can people begin to travel again?

Airlines have done well in implementing measures to stop transmission at the airport and on the plane. That is important for travelers. But it is not enough to open borders widely to travel.

As international travel increases, governments will need to assess countries for risk. The key is concluding that there is an equal and small risk of COVID transmission if borders are opened. And countries must have the confidence that they are able to detect and control any outbreak of infection.

Right now, governments are relying on testing and quarantine measures. Once the most vulnerable are protected by vaccination they will be able to look more aggressively at other strategies that will certainly include vaccination, as a means of enabling normal trade and travel.

But there are still unknowns about the vaccines. We need to understand clearly whether vaccines prevent infection and nasal carriage of the virus, or whether they modify the infection to make it less severe. Data should tell us that soon. We also need a better understanding of the length of immunity and how that immunity will work against new variants.


What will be the impact of new variants? Will they stop travel?

The variants from South Africa and Europe do not appear to be escaping the protection given by vaccines. There is a question as to whether the Brazil variant may escape natural immunity. But at the moment, all vaccines seem to be protecting against serious illness. That’s good news.

Of course, we do not know when or where the next variant will appear. That means we need to continue to respond rapidly to outbreaks with test and trace. And we have the potential to modify the vaccines quickly. With current technology vaccine manufacturers believe they can produce modified vaccines in a matter of months.


Does the private sector have a role to play?

Yes. The private sector will play a major role in moving people out of pandemic controls. Organizations like multinationals and airlines are already studying how they can contribute. That includes the monitoring and evaluation necessary to show that the measures they propose are effective.

The burden is on the private sector to make sure they are speaking with government, and together develop a way out of the lockdowns that have occurred. That dialog will ensure everybody can work in harmony. Convincing governments that their activities are not a risk to people with the scientific evidence will kick-start the return to normal.


What can international organizations do to restart travel?

International organizations have an important role in setting norms and standards.

The World Health Organization (WHO) efforts in the current pandemic have been hampered as governments tended to work in isolation or regionally. That should help us see even more clearly the need for collaboration and agreement on what health standards might be useful for travel and how they can be evaluated and implemented properly.

IATA’s work with international organisations, including WHO and the International Civil Aviation Organization, and governments to help these efforts is essential.


Governmental health and transport departments are not necessarily on the same page in this crisis. What’s the remedy?

Governments need to instil a “whole of government” approach. We’ve seen that work effectively in some Asian countries where COVID-19 has been effectively managed. The virus involves every sector, including health and the economy. One of the major lessons learned during the pandemic is that the response must be a full cross-government response to get back to work rapidly.


Does a ramp up in travel necessarily mean a rise in coronavirus transmission?

That primarily depends on people not being in the incubation period when they get on an aircraft. That is a real challenge because they could be in the incubation period and not know it.

There is modelling which suggests that pre-departure testing can significantly reduce the risk of cross-border transmission. We now need to build experience. As airlines and others develop ways to make sure passenger travel will not be spreading infection, we must have evaluation systems in place—capturing data to prove the point.


Are quarantines necessary with testing and vaccination?

Once populations are vaccinated there will be more relaxed approaches at borders. Testing will likely be necessary for some time. The blunt tool of quarantine will hopefully not be necessary.

Opening borders without quarantine could be helped if international organizations are able to establish a framework of options that governments could select from. It is a very difficult issue at the moment because many countries are attempting shut the virus out 100% at their borders, accepting no risk. And the more realistic approach is calculating acceptable risk and being ready to contain outbreaks quickly when they happen.   


What is the best solution for testing at airports given that PCR tests are costly and slow?

The gold standard is PCR. But governments will need to weigh up the risks involved with a small number of potential false negatives that rapid antigen tests produce.

Governments will need to set a threshold they will accept for false negatives. Once it has been established, they can begin to use those tests. But governments will need the confidence that the number of false negatives is low and that they can effectively manage that risk.


Can vaccine passports work without vaccine equity?

A vaccination passport is very attractive to many groups. And there is a precedent in yellow fever vaccination and the international vaccination certificate. But ethical questions arise because of the inequality in vaccine availability, and there is work to do before governments could ethically apply vaccination certificates for COVID.

The Covax facility and other mechanisms are trying to increase vaccine access in developing countries and countries that cannot afford vaccines. But even in the best-case scenario that will take time. Vaccine production is the current bottleneck in availability of vaccines through Covax.

We also need to know more about vaccines. Do they protect from transmission or only serious illness? How long will immunity last? There are many unanswered questions that are inhibiting a full engagement in the vaccine passports at present.


What role does contact tracing play?

Countries that decrease transmission to a low level must ramp up their contact tracing. Asian countries have shown that test and trace is effective.

If countries can stop clusters of infection from spreading into the community, they can be more comfortable with letting people enter because they can stop outbreaks immediately.


It could take years for everyone to be vaccinated. But what happens if we find out that the vaccine is only effective for a short period of time?

This is an emerging virus. A year and a half ago nobody had immunity to it. Now people are developing immunity either through infection or vaccines. So that will modify the way infection occurs, even if there are variants.

The more experience we have with the virus the expectation is that we will have fewer cases of serious illness. We’ll see if that is true in due course. In the meantime, the way that we manage influenza could give us clues to what will be needed.


What have we learned so far?

There has been difficult dialogue between public health and political leaders in some countries. And we have seen geopolitical tension on issues, including on vaccine and PPE distribution.

Even so, the world has worked together extremely well technically. There are new vaccines, there are diagnostic tests. And we understand a lot about this virus. That’s because WHO has been able to convene the technical groups that have been willing to work together, and the stimulus initiatives in the private sector to develop vaccines, diagnostics tests and therapeutics. We have learned a lot about the virus and its potential and I hope this collaborative spirit in sharing understanding will get the world back to normal soon.


Are you looking forward to traveling again?

Everybody is looking forward to traveling again! But I would be surprised if travel will return fully to the extent it has pre-pandemic because of online technologies like Zoom. But these technologies can’t replace the quality of a face-to-face meeting, replicate the joy of travel or substitute for a hug with a family member. The quantity of travel may reduce, but the need will not disappear. Managing the risks of COVID-19 through testing, vaccination, contact tracing and measures in the travel process should get us back in the skies again.


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