Article Text

An analysis of WHO’s Temporary Recommendations on international travel and trade measures during Public Health Emergencies of International Concern
  1. Catherine Z Worsnop1,
  2. Samuel Nass1,
  3. Karen Ann Grépin2,
  4. Kelley Lee3
  1. 1School of Public Policy, University of Maryland, College Park, Maryland, USA
  2. 2School of Public Health, University of Hong Kong Li Ka Shing Faculty of Medicine, Hong Kong, Hong Kong
  3. 3Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
  1. Correspondence to Dr Catherine Z Worsnop; cworsnop{at}


During Public Health Emergencies of International Concern (PHEICs), The International Health Regulations (IHR) require the WHO to issue Temporary Recommendations on the use of international travel and trade measures. During the COVID-19 pandemic, WHO’s initial recommendation against ‘any travel or trade restriction’ has been questioned, and virtually all countries subsequently used international travel measures. WHO’s Recommendations to States Parties also changed over the course of the pandemic. There is a need to understand how WHO’s treatment of this issue compared with other PHEICs and why States Parties’ actions diverged from WHO’s initial Recommendations. This first analysis of WHO’s Temporary Recommendations on international travel and trade measures during all seven PHEICs compares the guidance for clarity and consistency in several areas of substance and process. We find that lack of clarity and inconsistency in WHO guidance makes it difficult to interpret and relate back to IHR obligations. Based on this analysis, we offer recommendations to increase consistency and clarity of WHO’s guidance on this issue during global health emergencies.

  • COVID-19
  • Health policy
  • Control strategies

Data availability statement

All data relevant to the study are included in the article or uploaded as online supplemental information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as online supplemental information.

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  • Handling editor Seye Abimbola

  • Twitter @CatWorsnop, @KarenGrepin, @profplum8

  • Contributors CZW conceptualised the study, developed the methodology, led data analysis and drafted the manuscript. SN collected data, conducted data analysis and contributed to manuscript drafting. KAG and KL contributed to study conceptualisation and provided input into the manuscript. All authors have approved and are accountable for the final version of this submission.

  • Funding This study was funded by New Frontiers in Research Fund (operating grant awarded under the Canadian Institutes of Health Research Rapid Research Funding Opportunity) (NFRFR-2019-00009).

  • Competing interests CZW was a member of a WHO guideline development group and technical consultation in 2019. KL was a member of two donor-funded reviews of WHO in 1995 and 1997. She was previously a codirector of the WHO Collaborating Centre on Global Change and Health, and has received WHO funding for research on globalisation and infectious diseases, global health governance, tobacco control and COVID-19. She is currently a member of an expert group and editorial board supporting the WHO Programme of Work on the Economic and Commercial Determinants of Health.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.