https://orcid.org/0000-0001-8685-7758
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ABSTRACT
Travel restrictions have become a common disease control measure during the 2019 Coronavirus disease pandemic (COVID-19). Measures have ranged from quarantines when entering a country to outright travel bans. Yet more widespread travel restrictions in the form of country vaccine entry requirements have been in place for a long time for another disease – yellow fever. We track the historical underpinnings and policy developments that have led to stringent vaccine entry requirements today. We also discuss the political issues raised by health measures imposed on borders and discuss the reasons behind some clear regional differences. Almost no European countries currently have vaccine entry requirements, while at the other end of the spectrum, the majority of countries in the African region do, making vaccine entry requirements a global south phenomenon. We argue that vaccine entry requirements should be reassessed in the future as an underused public health tool, likely to become increasingly common. Vaccine entry requirements have proved effective in controlling the international spread of yellow fever but more can be done to ensure better use of this measure. Caution is needed due to the close links between public health and politics, evident since the first travel restriction in quarantines.
Acknowledgements
We would like to thank to thank the participants at the 2020 Vienna Workshop on Global Health & Diplomacy organised by Katharina T. Paul and Anna Pichelstorfer, who provided us with very useful early feedback. We also consulted a number of experts in international institutions and would like to thank Tonia Thomas from the Oxford Vaccine Group and Brian Martin from the University of Wollongong in particular for their suggestions.
Disclosure statement
No potential conflict of interest was reported by the author(s).
Notes
1 We follow the WHO terms employed here in referring to vaccine entry requirements as applied to ‘countries’ even though these policies may be introduced more specifically by governments or health departments.
2 ‘Vaccination might also be considered for a small subset of travellers to these areas who are at increased risk of exposure to mosquitoes or are unable to avoid mosquito bites’ (WHO, Citation2019a).
3 ‘vaccination is generally not recommended in areas where there is low potential for yellow fever virus exposure (no human cases of yellow fever ever reported and evidence to suggest only low levels of yellow fever virus transmission in the past)’ (WHO, Citation2019a).
4 ‘vaccination is recommended for all travellers ≥ 9 months of age in areas where there is evidence of persistent or periodic yellow fever virus transmission’ (WHO, Citation2019a).
5 At the third international sanitary conference around 1865, the British government felt that ‘(quarantine) appears to serve no better purpose than the enriching of a set of incompetent and corrupt officials’ but it was difficult to depart from prevailing opinions and avoid coordinated retaliation from country ports trying as reducing sanitary measures tended to face resistance by both their citizens and trading partners (Harrison, Citation2012).
6 Inoculation refers to methods of artificially induced immunity that includes vaccination but also older practices such as variolation.
7 The IHR were later modified in 1973, 1981, and 2005.
8 Samoa, for example, requires proof whilst American Samoa, does not. In the Caribbean, Saint Kitts and Nevis, require a yellow fever and polio vaccine for people from risk areas whilst Antigua and Barbuda only have a yellow fever vaccine entry requirements for people from risk countries. Anguilla has no entry requirements. Some islands on the East Coast of Southern Africa also diverge from the pattern of yellow fever vaccine entry requirements for travellers from risk countries with no entry requirements (Comoros, Mauritius and Reunion). In contrast, Mayotte, another island in that area, has the same requirement as the rest of Southern Africa.
9 Afghanistan, Bhutan, Djibouti, Kiribati, Mauritius, Nauru, Reunion and Timor-Leste.
10 Dominican Republic, Papua New Guinea, and the United Arab Emirates.
11 Lebanon and the Philippines
12 According to Monath and Vasconcelos (Citation2015) yellow fever is transmitted mainly by blood-feeding mosquitoes mainly belonging to the genera Haemagogus and Aedes (Stegomyia) in South America and Africa respectively. Other mosquito species are also capable of transmitting yellow fever, hence the risk of spillover into Asia.
13 For Kenya the WHO recommends the yellow fever vaccination but specifies that it is generally not recommended for travellers going to certain parts.
14 Eritrea, Rwanda, Sao Tome and Principe, Somalia, Tanzania and Zambia.
15 Something (such as a symptom or condition) that makes a particular treatment or procedure inadvisable (CitationMerriam Webster Dictionary).
16 The Scientific and Technical Advisory Group on Geographical Yellow Fever Risk Mapping was established in 2015 to maintain up-to-date yellow fever risk mapping and to provide guidance on yellow fever vaccination for travellers. The annually updating list of vaccine entry requirements and recommendations is produced after consultation with State Parties and includes input from WHO technical units in Headquarters from WHO Regional Offices. In addition, states are consulted yearly to confirm or update their country’s requirements (WHO, Citation2019b).
17 The countries are the USA, UK, Canada, Switzerland, Germany, Singapore and Nigeria. In the acknowledgements, the authorities of a number of low-and-middle-income countries are thanked, yet almost all the contributors are from high-income countries.