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Don’t hate the vaccine tourists, hate the vaccine game

Vaccine tourism is a symptom of the larger struggle for equitable vaccine distribution and allocation.

People line up for a Covid-19 vaccine at a drive-through site at Hard Rock Stadium in Miami, Florida, on February 1, 2021.
Chandan Khanna/AFP via Getty Images
Jen Kirby is a senior foreign and national security reporter at Vox, where she covers global instability.

There was the TV personality from Argentina who posted a video of her mother getting vaccinated in Miami, Florida. And the TV journalist from Mexico who tweeted his Miami vaccination.

The rich and well-connected from California and New York hopping on private planes to Florida for their shots. The Canadian couple fined for flying to a remote, largely indigenous community in Yukon territory and allegedly posing as hotel workers to get their injections. The private club that’s reportedly flying wealthy Brits to Dubai for their jabs.

These are all glaring examples of what has come to be known as “vaccine tourism”: when people with means, resources, and connections seek out the Covid-19 vaccine wherever it might be, cutting in front of everyone else waiting in line for their turn to get the shot.

Exactly how many people are actually jet-setting around the world to get an injection is extremely difficult to quantify, but they are probably still outliers. At least within the United States, it’s more likely vaccine tourists are staying much closer to home, crossing state or county lines to try to get a shot they can’t get where they live, whether because of appointment availability or eligibility requirements.

There are teachers commuting to a different Tennessee county, or the immunocompromised Louisiana residents who travel to Mississippi for their injections. These are often stories of need. They’re the kind of loopholes that, if we’re being honest, many of us might consider using.

But all of this can make vaccine campaigns more chaotic, and potentially exacerbate inequities when it comes to Covid-19 vaccination allocation and distribution. States and counties receive a certain number of doses to try to meet the needs of their populations, and visitors and nonresidents may edge out others who qualify. And that might force others to have to seek a shot elsewhere, triggering a kind of domino effect of demand.

Vaccine tourism also has the potential to exacerbate the socioeconomic and racial inequalities that have persisted during the pandemic, enabling the rich and privileged to gain access to life-saving vaccines ahead of everyone else.

But efforts to curb vaccine tourism could also cause problems: Putting in restrictions like residency requirements may slow down the vaccine process, and stringent ID requirements may deter some from seeking out a vaccine.

Yet the privileged swooping in to get Covid-19 vaccines are also easy targets for the collective frustration over a slower-than-hoped-for vaccine rollout, replacing the spring breakers and anti-maskers as the punching bags in this stage of the Covid-19 pandemic.

“It’s plainly unethical, there’s no question about,” Harald Schmidt, assistant professor of medical ethics and health policy at the University of Pennsylvania, told me. But by focusing too much on the rule-breakers, we’re missing how the system itself might be failing — and how to fix it.

“We shouldn’t let this distract ourselves from what we really need to discuss,” Schmidt said. “And that’s equitable vaccine allocation. This might be a bit of a sideshow to that.”

How prevalent is vaccine tourism? It’s hard to say — and it depends a bit on how you define it.

In January, Florida officials introduced a residency requirement for people seeking out vaccines in response to news reports of tourists, including some from as far away as Argentina, jetting in solely to take advantage of the state’s more expansive eligibility requirements for receiving a Covid-19 vaccine.

“We can’t give them a priority over people who are here day in and day out,” Miami Mayor Francis Suarez told the local CBS affiliate in January, “because this is a health crisis and people are dying.”

More than 63,000 out-of-staters have received at least one dose of the Covid-19 vaccine in Florida as of February 11, according to the most recent state data available. (The only vaccines approved for emergency use in the US right now are from Moderna and Pfizer/BioNTech, both of which require two doses administered about three weeks apart.) That’s a small percentage of the more than 2.1 million people in the state who’ve received at least the first shot, but when vaccines are scarce and people are dying, every shot counts.

Cracking down on the vaccine tourists, however, still means having to accommodate seasonal and part-time residents — the “snowbirds” from places like Canada and New York who spend their winters in Florida. Officials and experts have said it makes sense to vaccinate even those temporary residents, as it still protects the rest of the community.

Other states with significant snowbird populations such as Arizona have said they need more vaccines because of the demand from snowbirds. “We’ve got a lot of people that come to Arizona, people migrate here from other cold-weather states,” Gov. Steve Ducey said earlier this month. “They need vaccinations as well.”

But most of those people do genuinely live in those states, albeit part time. That’s not quite the same thing as people who are coming in from elsewhere for no other reason than to get a vaccine before turning around and going right back to their home states or countries.

And just how many of the latter cases there are is hard to determine, especially since travel restrictions and a raging pandemic probably make these excursions hard.

Privileged people have exploited the system, though. As infuriating as that might be, they’re able to do so because of the United States’s uneven vaccine campaign.

Vaccine tourism is a symptom of the larger struggle for equitable vaccine distribution

The US pandemic response, including its vaccine rollout, has largely fallen under the purview of state and local governments, which determine everything from mask mandates to vaccination guidelines. The US Centers for Disease Control and Prevention (CDC) laid out broad vaccination recommendations, but it’s up to individual jurisdictions to make those final determinations.

“It was all helter-skelter, where every state, every county, and every city seem to have a different plan,” Noreen Hynes, director of the Geographic Medicine Center of the Division of Infectious Disease at Johns Hopkins University School of Medicine, told me.

The patchwork of requirements and regulations can be legitimately frustrating and confusing to people. Combine that with scarcity, and you get everyone scrambling to get a shot.

“The federal government has created this Hunger Games scenario where people are out there doing everything they can to get to the front of as many lines as they possibly can,” Francisco García, director of the Pima County Health Department in Tucson, Arizona, told the New York Times in February. “The limited vaccine supply provokes even more anxiety because people are trying to get their hands on a very rare commodity.”

People I’ve talked to were legitimately eligible to receive a vaccine because of age or other criteria but had to drive hours away to another county to finally get an appointment, or even consider signing up in another state.

And, as experts noted, it’s pretty hard to fault anyone for taking those sorts of steps.

“There is no easy fix that I see, and it is hard to blame those who are entitled to get a vaccine in their own state but can’t access it for trying elsewhere,” Marc Lipsitch, a professor of epidemiology at the Harvard T.H. Chan School of Public Health, wrote in an email.

At the same time, states and counties are planning their vaccine allotment plans around the population and needs of their jurisdictions, and a mad scramble for vaccines makes it more difficult for public health and government officials to manage a streamlined rollout. It can become something of an unintended loop: the more people who travel for a vaccine, the more people who have to travel for a vaccine.

Another problem is who’s actually doing the traveling, which might exacerbate longstanding health inequities. “One major concern with people crossing state lines or even traveling within states is that the individuals who can travel further are likely more advantaged,” Parag Pathak, an economics professor at MIT, told me in an email.

Having to wait in line for hours for a shot or driving hours to another part of the state may sound miserable, but it is also a luxury only available to people who can take time off or have flexible work schedules, a category that may not always include essential front-line workers or people with disabilities. So too with people who have reliable internet and phone access and who have language skills that can help them better navigate vaccine sites.

The current Covid-19 vaccines available do have a limited shelf life, so avoiding waste is important — better to get it in someone’s arm than to throw it out. But at the same time, it is vital that injections go to the people who are the most vulnerable to serious illness or death, or the most exposed because of their professions.

Black, Latino, and Native Americans are more likely to die of Covid-19 than white peers. So far, Black Americans are getting vaccinated at lower rates than white Americans. There is no simple answer to this; some of it is access, some of it is greater hesitancy among certain communities, rooted in legitimate fears and distrust.

Which is why experts said it’s often not good enough to just open a vaccine center in a neighborhood and hope the people who live there show up. Officials may need to do more outreach and education, or distribute vaccines in a different way — through community clinics or mobile units, or through partnerships with local churches and organizations that have high trust in neighborhoods and towns. When it comes to vaccines, it’s not so simple as building it and hoping people come.

Those efforts take resources, but experts cautioned against seemingly easy fixes like requiring people to provide proof of residency or other documentation. Those burdens, while they seem small, could also deter people who need the vaccine from getting it.

“What we don’t want is a real opportunity for perceived chilling effects such that undocumented populations, for example, are even more reluctant than they would already be to come in contact with health services,” Schmidt said, “because we all stand to gain from undocumented immigrants being vaccinated — those are the people who produce our food, who slaughter our pigs.”

Other experts agreed; making it simple to get vaccinated with few restrictions generally makes vaccinations more equitable, but it also makes it easier for people to take vaccines that might go to other residents, which can make the system less equitable. It’s a delicate balancing act.

Right now, demand for the vaccine outstrips the supply. This could change in months; former FDA Commissioner Scott Gottlieb has predicted that by April supply could exceed demand. That may diminish the scramble for shots, though it also means health officials and leaders will have to work harder to make sure they’re delivering shots to those who need them. But if you live in the United States, even if you have to wait, there will be a vaccine for you — and that’s something that isn’t yet true for much of the rest of the world.

The global challenge of equitable distribution

The United States has administered more than 46 million doses of the Covid-19 vaccines, according to CDC data, which means less than 15 percent of the population has had at least one injection.

The country is still a long way from getting out of the pandemic. But the United States has the capacity to buy up these doses, as do other wealthy countries. Together, the United States and other high-income (and some middle-income) countries have purchased nearly 3.8 billion vaccine doses, with options for another 5 billion, according to a study from Duke University.

That’s about enough to vaccinate everyone in the world, except those doses are in the hands of just a select few countries.

Indeed, the richest countries — with 14 percent of the world’s population — have bought up more than 53 percent of the vaccines most likely to be successful. This hoarding by rich countries means that people in the poorest countries will be waiting many, many months, and likely years, before they can get a Covid-19 vaccine dose.

Covax, a multilateral initiative, was set up to help develop, fund, and equitably distribute vaccines. Many lower-income countries are relying on the program, but it is short on funding and short on vaccines. Rich countries are backing this initiative, but so far, the majority have not yet dipped into their own stockpiles to contribute vaccines.

Vaccine tourism, in some ways, is a manifestation of these global inequalities. Middle- and lower-income countries may be struggling to provide mass vaccination campaigns because they lack adequate supplies. And so people with resources and connections in those countries are exploiting the cracks in the system, buying their way to the front of the line by seeking shots abroad. Here again, that only serves to further separate the haves from the have-nots.

As experts point out, a person who can fly to another country for a vaccine is also a person most likely able to withstand a few more months of quarantine. They’re likely not at risk of severe financial setbacks from job losses, they likely have access to superior medical care, they’re likely to be able to safely stay at home. They aren’t the people who desperately need the vaccine, even if we can sympathize with their desire to get one.

The more people vaccinated, the better. But with still-scarce resources and huge demand, getting the vaccines to the most vulnerable populations, from front-line workers to the elderly, whatever country they’re in, is the best strategy to curb the pandemic.

Not doing so will only prolong it, especially as new variants emerge. “We’re all going to suffer from this,” Hynes said, “and we are suffering from this.”