A cataclysmic rise in COVID-19 cases on the Indian subcontinent was allowed to spread for too long before the Biden administration issued restrictions on travel, public health experts warn, a decision that could make thwarting potentially vaccine-resistant variants of the disease even more difficult just as America crosses a major milestone in vaccinations.
“Travel restrictions should have been imposed much earlier,” Lawrence Gostin, a professor of global health law and director of the O’Neill Institute for National and Global Health Law at Georgetown University, told The Daily Beast. “We have known for some time of the crisis in India—including worrying variants.”
The Biden administration announced on Friday that the United States would restrict travel from India “immediately” in order to stem the potential spread of “multiple variants circulating in India,” a White House official told The Daily Beast, noting that the directive came on the advice of the Centers for Disease Control and Prevention and would take effect at 12:01 a.m. on Tuesday.
But the call came weeks into an outbreak that has spun rapidly out of control in India, with hundreds of thousands of daily infections and an official death toll from the illness caused by the novel coronavirus that is estimated to be as little as one-tenth the actual number. At least two American consular employees have died in the outbreak, leading the State Department to authorize the voluntary departure of family members of embassy personnel last week.
But that decision, made “out of an abundance of caution,” according to department spokesperson Ned Price in a briefing on Thursday, came days before the U.S. government issued any guidance on protocol for travel into and out of India.
“Commercial travel continues, commercial flights continue to take off and land in India,” Price said Thursday. “When it comes to any travel restrictions, as you know, that is something that is determined in close coordination and under the advice of public health professionals at CDC and HHS.”
But neither the State Department nor the CDC released any information to travelers or American citizens abroad about possible quarantine rules for those returning from India, despite increasing concerns that the country’s high infection rate could give rise to variants that may be able to dodge vaccines that have returned a small sense of normalcy in the United States.
Asked ahead of the Biden administration’s announcement on Friday about the possibility of restrictions on travel or quarantines for those returning from India, the government departments and agencies tasked with doing so instead played a game of informational hot potato. The State Department deferred to the CDC, which in turn suggested speaking to the White House. The White House subsequently declined to speak on the record, citing its reliance on guidance from the CDC.
Restrictions on travel into the United States from India were eventually announced on Friday afternoon, with carve-outs for American citizens, lawful permanent residents, and “other exempted individuals,” according to an administration official. All international travelers into the U.S. from India, as from other countries, are required to test negative for the virus both before travel and upon arrival, and to quarantine if not vaccinated.
Included in those exempted individuals: humanitarian workers and public health officials, who have been deployed by the United Stated and non-governmental organizations to address the growing crisis. The United States will also continue to provide India with emergency supplies to fight the virus, including millions of unused doses of the AstraZeneca vaccine, much-needed oxygen, personal protective equipment, and therapeutics.
India, despite being one of the world’s largest manufacturers of vaccines, has fallen far behind in deploying doses of the vaccine to its billion-person population, due in part to vaccine hesitancy and in part to the exportation of millions of doses to the West before that hesitancy largely evaporated.
“It’s been clear for more than a month that India is the epicenter of the pandemic,” said Dr. Arnold Monto, a professor of epidemiology and global health at the University of Michigan. “These restrictions should have been in effect weeks ago.”
Gostin said the delay in issuing guidance, as well as the four-day break in between the announcement of the restrictions and their implementation, made him concerned that the government was falling behind in the race to keep India’s variants from gaining a foothold in the United States, where half of adults have gotten at least one dose of the coronavirus vaccine. The lack of clarity on potential quarantine for those following the guidance by returning home, too, is a source of frustration for public health experts.
“I do have concerns,” Gostin said. “Announcing the travel restrictions in advance will mean that many more passengers from India will arrive before then, some carrying dangerous variants into the U.S. Also, there are no clear rules for U.S. citizens who are just as likely to spread variants when they arrive home.”