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The UK yesterday became the first country to approve the Pfizer / BioNTech COVID-19 vaccine for wide use. Following a review by the country’s drug regulator, the UK government announced it would begin rolling out the vaccine next week.
Other countries are likely to follow suit soon, approving the Pfizer / BioNTech vaccine and possibly other leading candidates as well. The Australian Therapeutic Goods Administration says it will continue to evaluate the Pfizer / BioNTech data.
The world has been eagerly awaiting a COVID vaccine, which has been touted as our best hope for a return to “normalcy” since the pandemic began. A big part of that is the resumption of international travel.
An effective vaccine certainly brings that prospect much closer. However, a vaccine alone does not guarantee safe return to international travel. There are several other things that Australia and other countries need to consider.
International travel in the age of a COVID vaccine
When people are vaccinated before boarding a flight, we can be sure that the risk of COVID is significantly lower when traveling internationally. However, the data we have right now doesn’t tell us everything we need to know.
Take the Pfizer / BioNTech vaccine as an example. They reported that their mRNA vaccine was 95% effective in preventing symptomatic COVID-19 after testing it on about half of the 43,000 participants in their Phase 3 study (the other half received a placebo).
The vaccine appears to be safe and has only mild side effects in some participants. The study specifically included people aged 65 and over and people with health problems who were at higher risk for more serious illnesses.
However, the study did not officially report the vaccine’s effectiveness against infection rather than showing symptoms. While it is encouraging to know that a vaccine prevents people from getting sick, this point is important because if people can still be infected with SARS-CoV-2 (the virus that causes COVID-19), they can they may still be spreading it.
Ugur Şahin, co-founder and CEO of BioNTech, believes the vaccine could reduce transmission by 50%. This dampens vaccination as the key to safe resumption of international travel.
Also, at this point in time, we don’t know how long the immunity of those vaccinated with the Pfizer / BioNTech vaccine will last. However, as the process will take a few more months, some of this data should be available in 2021.
Not everyone is vaccinated right away, so we still need quarantine
It will take months – or more realistically years – to vaccinate everyone who wants to be vaccinated. It is not expected that every single person traveling internationally will be vaccinated.
There are several countries where Community transmission does not appear to have ever occurred. As of November, this included many Pacific island nations such as Tonga, Kiribati, Micronesia, Palau, Samoa and Tuvalu.
Then there are countries that have COVID-19 under control with little or no community transmission. Examples are Australia, New Zealand, Vietnam and Singapore.
People coming to Australia from these countries pose very little risk and shouldn’t require quarantine, whether or not they are vaccinated. For other countries, this would depend very much on their epidemic situation at the time.
Some organizations have already developed COVID risk assessments for different countries or jurisdictions. For example, the European Center for Disease Prevention and Control (ECDC) rates the COVID situation in each European country as “stable”, “of concern” or “of serious concern”.
These risk assessments are based on factors such as each country’s 14-day COVID case notification rate, the percentage of positive tests, and the death rate.
It is clear that people from risk areas or countries will still need to be quarantined upon arrival unless they have been vaccinated. It is likely that Australia will develop a similar scoring system as the ECDC to streamline these decisions.
In many countries, a negative COVID test certificate is required before entry. For example, Spain does not need a negative PCR test more than 72 hours prior to travel.
Similarly, some airlines such as Emirates and Etihad mandate COVID testing before travel.
It would also be useful to run quick antigen tests upon arrival at the airport or at border crossings. While these tests are not as accurate as PCR tests, they would provide a second check that a traveler did not incubate COVID-19 en route to their destination.
Even with vaccinations, tests are still important as vaccination does not guarantee that a passenger is not infected or infectious.
Certificates and passports
Once COVID-19 vaccines are available, countries and airlines may require visitors to provide a certificate of vaccination.
Alan Joyce, Qantas CEO, has suggested that all Qantas international passengers will require a COVID vaccination certificate from next year.
There are also many groups around the world working on immunity passports and technologies to track travelers’ virus status.
For example, the International Air Transport Association is developing a digital health passport that bears test and vaccination status.
It is likely that international travel will be allowed worldwide in the second half of next year once vaccination has gotten off to a good start.
It will be wonderful to be able to travel internationally again, but wherever we go – even with a vaccine – it will be some time before the trip looks like it did before the pandemic.
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