Global trends in air travel: implications for connectivity and resilience to infectious disease threats
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Abstract
Background
Increased connectivity via air travel can facilitate the geographic spread of infectious diseases. The number of travellers alone does not explain risk; passenger origin and destination will also influence risk of disease introduction and spread. We described trends in international air passenger numbers and connectivity between countries with different capacities to detect and respond to infectious disease threats.
Methods
We used the Fragile States Index (FSI) as an annual measure of country-level resilience and capacity to respond to infectious disease events. Countries are categorized as: Sustainable, Stable, Warning or Alert, in order of increasing fragility. We included data for 177 sovereign states for the years 2010 to 2019. Annual inbound and outbound international air passengers for each country were obtained for the same time period. We examined trends in FSI score, trends in worldwide air travel and the association between a state’s FSI score and air travel.
Results
Among countries included in the FSI rankings, the total number of outbound passengers increased from 0.865 billion to 1.58 billion between 2010 and 2019. Increasing fragility was associated with a decrease in travel volumes, with a 2.5% (95% CI: 2.0–3.1%) reduction in passengers per 1-unit increase in FSI score. Overall, travel between countries of different FSI categories either increased or remained stable.
Conclusions
The world’s connectivity via air travel has increased dramatically over the past decade. There has been notable growth in travel from Warning and Stable countries, which comprise more than three-quarters of international air travel passengers. These countries may have suboptimal capacity to detect and respond to infectious disease threats that emerge within their borders.
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SciScore for 10.1101/2020.03.29.20046904: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
NIH rigor criteria are not applicable to paper type.Table 2: Resources
Software and Algorithms Sentences Resources 1 (SAS Institute, Cary NC) and R.15 SAS Institutesuggested: (Statistical Analysis System, RRID:SCR_008567)Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:The use of the FSI does come with limitations. The data are also not available for all countries, limiting the scope of the analyses. The classification of countries into 4 categories based on numeric scores, while …
SciScore for 10.1101/2020.03.29.20046904: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
NIH rigor criteria are not applicable to paper type.Table 2: Resources
Software and Algorithms Sentences Resources 1 (SAS Institute, Cary NC) and R.15 SAS Institutesuggested: (Statistical Analysis System, RRID:SCR_008567)Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:The use of the FSI does come with limitations. The data are also not available for all countries, limiting the scope of the analyses. The classification of countries into 4 categories based on numeric scores, while useful for communicating and understanding the risk levels, may reduce power to detect trends in the data. To address this, we used the continuous FSI score when possible. The data are only available at the country level, which does not allow for analyses at a finer geographic scale. A key assumption in this analysis is that passenger volumes are a measure of importation pressure, with humans acting as the ‘vectors’ of disease.23 This does not account for important differences in population vulnerability, such as vaccination status, pre-existing health conditions, specific locations where tourists may be likely to visit, and reasons for traveling. In summary, there is an association between changes in the coping capacity of a country to manage outbreaks, and changes in outgoing passenger volumes. Air travel will likely continue to increase, outpacing the improvements in our ability to prevent, detect and control epidemics, especially in resource limited settings. While air travel remains a safe and rapid means of connecting people across the world, the impact of even one exported case can be catastrophic, emphasizing the importance of strengthening global health capacity and security.
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
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