A global analysis of quarantine and isolation policies governing outbreak responses

IntroductionCountries across the world implemented diverse quarantine and isolation policies throughout the COVID-19 pandemic with varying levels of effectiveness. Their widespread use invites new considerations regarding the effectiveness of domestic quarantine and isolation policies, the ways they are enforced, and the jurisdictions responsible for ordering these measures. MethodsWe systematically analyzed legally-enforceable policies in current standing in each United Nations (UN) member state, assessing the authorities to quarantine and isolate individuals within national borders. We captured the text of each policy and categorized the responsible jurisdictional authority and enforcement mechanisms. ResultsOf UN member states, 91.67% (176/192) had legally-enforceable policies that addressed both quarantine and isolation. Two countries only had quarantine policies, seven only had isolation policies, and seven countries had neither. Jurisdictional quarantine authority was primarily vested in the national level (74.16%; 132/178), with the remainder mixed (22.47%; 40/178) and subnational only (3.37%; 6/178). Isolation authority was also primarily at the national level (69.40%; 127/183) but with a greater proportion mixed (27.87%; 51/183) and subnational only (2.73%; 5/183). Quarantine enforcement mechanisms were codified in a majority of countries (80.91%; 144/178) with nearly all (94.44%; 136/144) enforcing quarantine through monetary fines or incarceration penalties for non-compliant individuals. Isolation enforcement mechanisms were codified in an even greater number of countries (86.89%; 159/183), with 95.51% (149/156) having penalties for non-compliant individuals. ConclusionWe created a novel repository for quarantine and isolation policies to assist in future outbreak responses. We identify specific country-level policy gaps, which can be addressed through epidemic and pandemic preparedness efforts. Finally, the repository provides the necessary evidence base for future research analyzing the impact of quarantine and isolation policies upon disease outbreak response outcomes. Key Messages1. What is already known on this topic - summarize the state of scientific knowledge on this subject before you did your study and why this study needed to be done Non-pharmaceutical interventions, including quarantine and isolation, are critical to controlling the spread of infectious diseases. Legally-enforceable policies often authorize jurisdictional authorities to implement and enforce non-pharmaceutical intervention strategies. During the COVID-19 pandemic, there was widespread and diverse implementation of domestic quarantine and isolation policies. However, there have been no global efforts to collect and analyze the legal frameworks for quarantine and isolation governance and enforcement authorities. 2. What this study adds - summarize what we now know as a result of this study that we did not know before We comprehensively map the current regulatory environment for legally-enforceable quarantine and isolation policies in each UN Member State. We use representative policy examples to demonstrate the diversity in jurisdictional authority to order quarantine and isolation, as well analyze the current penalty schemes employed by nations to enforce non-pharmaceutical interventions. We find that financial enforcement mechanisms that reflect economic fluctuations may remain a more durable deterrent overtime than set penalty ranges, yet few countries utilize such flexible penalization schemes. 3. How this study might affect research, practice or policy - summarize the implications of this study Our novel repository of global quarantine and isolation policies can be used to assist future outbreak responses and identify country-level policy gaps to be addressed through preparedness efforts and updating legal frameworks. Analysis of the impact of different quarantine and isolation policies and enforcement mechanisms upon disease outbreak outcomes using this repository are warranted.