On Dec 24, 2020, the UK's Prime Minister Boris Johnson announced an immediate travel ban on all flights to South Africa after the detection of SARS-CoV-2 beta variant by South African scientists. The resulting travel restriction was lifted 291 days later. On Nov 25, 2021, South African scientists reported a new SARS-CoV-2 variant, B.1.1.529, that was subsequently designated omicron. Although the omicron variant has mutations that could make it less susceptible to neutralising antibody activity and possibly as transmissible as or more transmissible than the delta variant, such concerns have yet to be determined by in-vitro and in-vivo evidence. Furthermore, it is also relevant to consider that although antibody activity induced by the ChAdOx1 nCoV-19 vaccine (AZD1222) had nominal neutralising activity against the beta variant and failed to protect against mild to moderate COVID-19 due to the beta variant, the vaccine still reduced risk of severe COVID-19 due to beta or gamma variants by 80%.
2 Days after the identification of omicron, the UK Government promptly reapplied a travel ban on travel from South Africa and some other African countries. Several other countries, such as Israel and the USA, swiftly followed suit with travel bans from countries in sub-Saharan Africa, citing this action as a precautionary measure. This unwarranted action 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 Dec 2, 2021, 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 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. 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 tourist industry contributes about ZAR82 billion (£3·77 billion) 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. 1 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 2506 cancellations had occurred among 603 respondents from tourist bookings they held over the next 4 months, representing 1·5 million cancellations in the first 48 h after the travel ban began, and 390 respondents reported ZAR940 million of lost revenue, an average of ZAR2·4 million each (Rosa N, Southern Africa Tourism Services Association, personal communication).
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.
FV reports grants from USAID, Unitaid, the Bill & Melinda Gates Foundation, the South African Medical Research Council (SAMRC), the US National Institutes of Health, ViiV, and Merck; non-financial support from Merck, ViiV, and Gilead; personal fees from Virology Education, Gilead, ViiV, Mylan, Merck, Adcock-Ingram, Aspen, Abbott, Roche, J&J, and Cipla all unrelated to the topic of this Comment. SAM reports grants and personal fees from the Bill & Melinda Gates Foundation and grants from SAMRC, Novavax, Pfizer, and Minervax unrelated to the topic of this Comment. MMo reports consultancy fees from Kreditanstalt für Wiederaufbau (KfW) unrelated to the topic of this Comment. MMe, GG, LB, and TdO declare no competing interests.
Authors: Marc Mendelson; Francois Venter; Mosa Moshabela; Glenda Gray; Lucille Blumberg; Tulio de Oliveira;et al.
View the original article on The Lancet Website