Testing accuracy is the key to stopping the spread, says Cignpost Diagnostics chief medical officer Professor Denis Kinane
As the vaccine rollout accelerates across the world, many countries are thinking about how they can enable citizens to freely travel.
Under existing rules in the UK, the government will expect a multitude of tests to ensure passengers are able to travel.
This will mean that, from May 17, anyone travelling to and returning from an amber list destination will need to take four Covid-19 tests and isolate for 10 days, with the option of a fifth test to shorten their quarantine by a few days.
For those returning from green list destinations, multiple tests are required – both pre-departure and on arrival back in the UK.
This excessive testing procedure, on top of quarantine rules for red list destinations, means travel will remain impossible for large swathes of the population.
In contrast, the EU has announced plans for a digital vaccine certificate in time for the summer tourism season. These certificates will allow free movement without restriction within the EU, and avoid quarantine protocols like self-isolating for up to 14 days in a hotel.
Yet vaccine certification alone is not the magic key to reopen international travel.
Coronavirus vaccines, whilst an incredible tool in preventing serious illness, do not necessarily stop people catching or transmitting the virus.
The EU’s Digital Green Certificate proposal tackles this issue head on, comprising of vaccination certificates, negative test certificates (either a NAAT/RT-PCR test or a rapid antigen test) and medical certificates for people who have recovered from Covid-19 in the last 180 days.
This emphasis on testing also helps to tackle concerns raised over the privacy and discriminatory impact of a vaccine passport. With the potential to discriminate against the young, pregnant and those who cannot have the jab for medical reasons, there are strong legal and ethical complications around the idea.
If the UK were to follow a similar process, the testing aspect of this certificate would prove both anti-discriminatory and beneficial. About 21 million people under the age of 50 are not scheduled to receive their first vaccine until phase two of the rollout, so it is reassuring to know that testing will still be a requirement to obtain the certification.
Holidaymakers will need to treat testing as an essential part of the holiday planning process, alongside arranging insurance and changing their money.
In order to open borders both safely and sustainably, testing accuracy is the key facet in our fight against coronavirus.
This is why the gold standard PCR test, whilst costlier than lateral flow tests, is the way to go.
As the recent Cochrane Review reveals, Lateral Flow tests only pick up 42% of positive cases among asymptomatic individuals, so at current prevalence rates would result in around 72% of positive cases being wrong.
PCR tests are far more sensitive and can catch individuals with low levels of the virus before they are infectious, which will allow for preventative isolation.
It’s no surprise then, that the EU has specified a PCR test must be taken upon departure and arrival, and has also stated the Digital Green Certificate will be interoperable, allowing both those vaccinated against the virus and those who have not, to benefit from the scheme.
The UK needs to follow by tying both a PCR test and medical certificates into certificates, to allow those who can show they are not carrying the virus to travel freely.
Testing and vaccine passports will absolutely play a huge part in the return of international travel, but this regime needs to be guided by the science if it is to be implemented successfully.
What’s more, if the situation changes and we want to prevent new mutations coming to the UK, we can always increase testing requirements and strain assessment for those countries.
A smarter, evidence-led strategy like this can make the travel process as simple as possible for holidaymakers while ensuring travel returns at the first available opportunity.
Professor Denis Kinane is a professor in immunology and chief medical officer at government-approved test to release firm Cignpost Diagnostics.
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