A global analysis of quarantine and isolation policies governing outbreak responses.

INTRODUCTION: Countries across the world implemented diverse quarantine and isolation policies throughout the COVID-19 pandemic with varying levels of efficacy. 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. METHODS: We systematically analysed 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 categorised the responsible jurisdictional authority and enforcement mechanisms. RESULTS: Of 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 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. CONCLUSIONS: We 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 analysing the impact of quarantine and isolation policies on disease outbreak response outcomes.