Mathematical modeling of public health policy for international travelers (PHPIT): a case study of the COVID-19 pandemic in Thailand.

BACKGROUND

Following border closures implemented during the COVID-19 pandemic, Thailand subsequently reopened its international borders, employing public health policy for international travelers (PHPIT) to mitigate the importation of COVID-19 cases and minimize potential missed cases. These measures included departure country risk classification, vaccination certificate requirement, pre-departure and entry testing, and quarantine.

METHODS

To assess the effectiveness of these interventions, we developed a cross-border control model, which integrates cluster analysis and mathematical modeling to estimate reductions in missed cases in Thailand under various scenarios.

RESULTS

Our findings indicated that, as a single measure, when compared with implementing no interventions, quarantine for 1, 3, 5, 7, 10, and 14 days reduced missed cases by 45%, 58%, 72%, 80%, 88%, and 94%, respectively. Departure country risk classification reduced missed cases by up to 72% and vaccination certificate requirement by up to 24%. Testing once at 72, 48, 24, or 0 h pre-departure reduced missed cases by 5%, 7%, 10%, and 14% respectively. Entry testing (the "test-and-go" policy) reduced missed cases by 29%. Strategically combining quarantine with other PHPIT measures could achieve a 46-98% reduction in missed cases, with the maximum reduction in missed cases when implementing 14-day quarantine together with pre-departure testing.

CONCLUSIONS

Quarantine could serve as a standard measure to minimize missed cases and be optimized by a vaccination certificate requirement. Meanwhile, testing and departure country risk classification could be withdrawn due to their minimal effectiveness and potential for discrimination, respectively. The combinations and their optimization should be guided by domestic transmission dynamics, healthcare system capacities, societal perspectives, and economic adaptability. Future PHPIT implementation should incorporate pre-evaluation to balance intervention effectiveness, equity for international travelers, and public health and economic security.