Policy challenges in the provision of COVID-19 border screening: evidence from eight countries

BACKGROUND: While border screening measures were widely adopted by countries during the COVID-19 pandemic, a lack of consensus on the utility of border screening created a gap in best practice for its implementation. As such, countries adopted a diversity of approaches, providing an opportunity to evaluate the configuration and evolution of border screening systems. The article addresses three questions: (i) how did countries configure their border screening systems for COVID-19? (ii) In what contexts did countries rely on public or private providers of these services? (iii) what do policies and narratives reveal about the perceived role of border screening in global public health? The article contributes to long-standing debates over the private sector's role in public health and the perceived value of border screening measures. METHODS: This article presents results from an international comparative study based on tracking the organisation of border screening in eight countries. Secondary data was collected between July 2021 - June 2022 from official government websites and policy publications, private sector sources where relevant, and trusted media sources in each study country. The countries included are Australia, Canada, Germany, Ireland, South Africa, South Korea, Spain, and the United Kingdom. RESULTS: All study countries used private provision for pre-departure diagnostic testing for international travellers. In contrast, screening of arriving travellers was more diverse. Countries that opted for private sector post-arrival screening saw governance challenges around accreditation and monitoring of providers, while public service provision saw challenges in capacity and high resource costs. Travel was often framed as a 'luxury,' allowing states to shift responsibility for obtaining tests onto individuals; especially in the context of individuals travelling from low income to high income countries. CONCLUSIONS: The different approaches countries followed for screening of departing and incoming travellers suggests wealthy countries were more oriented towards defending their populations against disease importation, rather protecting the international community from disease exportation. These findings provide an opportunity to reflect on the purpose and implementation of border screening. We emphasise a need for further discussion on the efficacy of border screening from both perspectives, given the tendency for countries to rely on these measures.