The UK has now experienced nearly a year of lockdowns and social restrictions, but there are areas of the world where life is approaching normality.
Good governance and strict border policies mean residents in Australia, New Zealand, Hong Kong, Taiwan and Vietnam are enjoying relaxed restrictions and little to no community transmission of the SARS-CoV-2Â virus that causes covid-19.
But as vaccine roll-outs progress and plans are made for international travel to resume, how will such countries with zero or very few covid-19 cases safely reopen their borders?
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In the short-term, it is unlikely that countries pursuing an elimination approach to the virus would be willing to settle for anything less, says Michael Baker at the University of Otago in New Zealand, who devised New Zealand’s elimination strategy.
This makes reopening borders a tricky proposition. Vietnam, which has a two-week quarantine system in place and has seen only 35 covid-19 deaths throughout the pandemic, is unlikely to open its borders any time soon, says Guy Thwaites at the University of Oxford’s Clinical Research Unit in Ho Chi Minh City, Vietnam.
“The government has zero tolerance for the infection at the moment, and they’ve shown that they can maintain that position,” says Thwaites.
The Vietnamese public is largely supportive of the border closures, despite the heavy blow to the country’s tourism industry, he says. “They look at other countries’ experiences and are not envious of what is happening elsewhere in the world.”
“Countries that have eliminated covid-19 will not be able to safely reopen their borders until they have achieved herd immunity through vaccination,” says Zoe Hyde at the University of Western Australia.
In Australia, vaccination was expected to be completed by October, but vaccine roll-out has been slower than expected.
A lack of vaccine clinical trial data in children is a hurdle, says Raina MacIntyre at the University of New South Wales in Sydney, because the inability to vaccinate children is an obstacle to achieving herd immunity. More certainty is also needed about how effective the vaccines are at preventing or reducing transmission of the virus.
“If we can find we’re not detecting anyone who is incubating covid-19 who has been vaccinated, then we’ll certainly get to a point where there is a green lane for vaccinated people [entering New Zealand],” says Baker. “I think we’ll get to a point where we have greatly reduced quarantine requirements for people coming from an expanding group of countries that have little to no covid-19 transmission.”
New Zealand has already implemented quarantine-free travel bubbles with Australia and certain Pacific islands.
Longer-term, researchers agree that herd immunity may lead to covid-19 elimination in some countries or regions, while the virus becomes endemic in others.
Ben Cowling at the University of Hong Kong believes China may continue with an elimination strategy and strict border control until it has vaccinated at least 1 billion people.
In some countries, there may have to be a transition away from a position of zero tolerance for any covid-19 cases, says Thwaites. There will need to be “an acceptance that the disease will transmit, but because of vaccination, it won’t cause unnecessary mortality, morbidity and pressures on the health system”, he says.
If enough Australians are vaccinated to create herd immunity and there is good surveillance, any covid-19 that is brought into the country through travel shouldn’t cause an epidemic, says MacIntyre.
Fully doing away with travel restrictions and the need for quarantine or contact tracing isn’t beyond the realms of possibility. “This strategy is dependent on reaching a high vaccine coverage, otherwise a resurgence in cases would overwhelm the healthcare system and undo all the elimination efforts of the past year,” says Cowling.
