Latest revisions to the International Health Regulations will fail to prevent future travel chaos.

The poor management of public health risks associated with travel by most countries proved among the most contentious issue areas during the COVID-19 pandemic. Evidence from previous outbreaks suggested travel restrictions were largely unnecessary and counterproductive to timely reporting. This led to initial WHO recommendations against the use of travel restrictions. Substantial evidence of the role of human travel in spreading SARS-CoV-2 worldwide throughout the evolving pandemic supported new thinking about the use of different types of travel measures (ie, screening, restrictions, quarantine, immunity documentation) to limit the introduction of SARS-CoV-2 into jurisdictions with low incidence and onward transmission. However, governments failed to work together, undermining public health goals. In addition, profound secondary impacts were caused by uncoordinated, frequently changing and poorly evidenced use of travel measures. Alongside the need to better understand what, when and how travel measures should be used during public health emergencies of international concern, improved global governance is required. Recently adopted revisions to the International Health Regulations (IHR), notably Article 43, failed to change current rules and commitments. Travel measures are also not being addressed in the negotiation of a pandemic agreement. Evolving evidence from COVID-19 supports a risk-based approach but global consensus on a standardised methodology remains needed. Setting aside further IHR revision, this methodology and guidelines could be advanced through a WHO technical working group. A risk-based decision instrument that incorporates pathogen and jurisdictional characteristics, and public health and social, political and economic risk analysis could then be developed as a new IHR annex.