The current volume, speed, and reach of travel in the world today is unprecedented. So too is the potential for infectious diseases to spread globally. Migration of humans has been the pathway for disseminating infectious diseases throughout recorded history and will continue to shape the emergence, frequency, and spread of infections in geographic areas and populations.
With a growth rate of 6.8 percent (2018–2019), India is one of the fastest-growing economies in the world. This growth has increased international trade and traffic into and out of the country, thus giving rise to the need for strengthening the existing points of entry (POE) and, in some cases, the building of new ones. Building a robust POE mechanism needs to be aimed at better management of passengers and goods in the wake of the evolving COVID-19 pandemic and related challenges. However, an increase in global exchange also means that various communicable (infectious) diseases including COVID-19 may spread even more widely and rapidly than before.
India shares international borders with at least nine sovereign countries through land, maritime, as well as both land and maritime.
- Only land borders — China, Bhutan, Nepal, Pakistan, Bangladesh, and Myanmar
- Both land and maritime borders — Bangladesh and Pakistan
- Only maritime borders — Sri Lanka
- Special maritime borders — Thailand, Myanmar, and Indonesia (through Andaman and Nicobar Islands.
The International Health Regulations (IHR) requires World Health Organization (WHO) Member States to have specific core capacities at all international POE. As a member country of the WHO and a signatory to the IHR (2005), India is required to ensure that all designated airports, ports, and ground crossings abide by the IHR regulations.
At all times, these POEs must:
- Provide access to appropriate medical services (including diagnostic facilities) for ill travelers
- Provide equipment and personnel for the transport of ill travelers to an appropriate medical facility
- Ensure a safe environment for travelers in POE facilities by providing potable water supplies, eating establishments, public washrooms, and proper solid and liquid waste disposal services.
In times of a public health emergency of international concern, all POEs must:
- Have the capability to establish and maintain a public health emergency contingency plan
- Provide assessment and care for affected travelers
- Ensure availability of appropriate spaces for the interviewing and quarantine of suspect travelers away from other travelers, and
- Apply recommended measures for disinfection and decontamination, among other capabilities.
India and the COVID-19 Pandemic
Though COVID-19 brought the discussion about strong and well controlled POEs into public view, the concept of management of POE is not new. Several aspects of POE management including capacity building of all POE staff, establishment of health units and deploying medical staff (including public health experts, surveillance teams for infectious diseases, emergency management teams, etc.), and infrastructure strengthening (like of isolation and quarantine centers) were already being implemented as per the public health emergency contingency plan (PHECP) in line with the International Health Regulations (2005). The PHECP includes a multilayer and multi-agency coordination plan to prevent the introduction, transmission, or spread of communicable disease at POE. The PHECP has been adopted and applied to the occurrence of several forms of natural and man-made disasters, including public health threats such as the Zika, Ebola, and COVID-19 disease (SARS-CoV-2 virus) outbreaks.
It is imperative to update the PHECP plans from time to time to keep pace with evolving trends such as increased traffic across borders and the ever-changing nature of new and emerging public health threats. One of the many lessons learned from the ongoing COVID-19 pandemic emphasizes the need to strengthen health systems to make them more resilient in times of crisis and high-demand. This includes ensuring strong and comprehensive systems to detect and control spread of infectious diseases across borders and at POE.
During the entire period of COVID-19 pandemic mitigation, the emergency response at India’s POEs has taken the form of rigorous POE surveillance efforts such as scanning of passengers, looking for classic symptoms, mandatory usage of the contact tracing, mobile application ‘Aarogya Setu,’ testing by establishment of laboratory testing facilities in collaboration with public and private sectors, implementation of standard operating procedures (SOPs), and updating guidelines for POE personnel and travelers as needed. Strategic surveillance is also conducted at other interstate transit sites and borders to monitor the course of the pandemic. In addition, the regulations for international travel are continuously being revised based on the emergence of new variants of concern like the delta and omicron variants of SARS-CoV-2. As travel restrictions are being relaxed for the greater ease of the public, mandatory testing for COVID-19 and full vaccination prior to travel will continue to be instrumental in preventing its spread.
India has received global applause for the exemplary steps taken to mitigate the spread of COVID-19, especially the country’s effective and timely interventions at the POE. For example, in February 2021, the prime minister of India announced the ‘Prime Minister Aatma Nirbhar Swasth Bharat Yojna’ (PM ASBY) scheme— a six-year intervention focused on developing the capacities of health systems and institutions across the country. Among other things, this intervention will include the “operationalization of 17 new public health units and strengthening of 33 existing public health units at POE, that is at 32 airports, 11 seaports and 7 land crossings” by capacity building of the staff, installing new technologies, digitalization, upgrading surveillance methods and proper coordination with the countries to get information related to PHEIC in advance.
Always Be Prepared
Despite these improvements, the increasing amount of traffic and trade at POEs around the world will continue to increase the likelihood of public health emergencies spreading across international borders. Therefore, it is imperative to meticulously plan and prepare for such emergency situations by strengthening the existing system and upgrading it with innovative science and technology. This will require international cooperation wherein the countries sharing borders must come forward to work together based on the lessons learned from the recent pandemic and develop collective best practices to mitigate PHEIC and to ease travelers experience at their common borders. Strong collaboration with various stakeholders and key players will also be needed between the health, security, and immigration sectors, as well as border communities of POEs. While the COVID-19 pandemic may end someday, the need for effective management and surveillance of POEs is an everlasting concept that will always be required to prevent, detect, and respond to any international public health emergencies.