A few days after Tedros’s press conference, in response to mounting international pressure, the Biden administration pledged 20 million doses from its stash of Pfizer-BioNTech, Moderna, and Johnson & Johnson vaccines to COVAX. This represented a significant shift in policy: it was the first time the US was donating doses that could have been used domestically. (The administration has also committed to donate 60 million doses of AstraZeneca to COVAX but has yet to do so.)
Glenn Cohen, a law professor who directs Harvard Law School’s Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics, says that the pledge of 20 million doses is “a good first step” for a country that cannot get enough of its own people to use up its vaccine supply quickly enough.
But, he adds, it does not negate the ethical murkiness of having American cities and states offer, or consider offering, vaccines to visitors as official policy. Cohen, who has written a book on medical tourism, says vaccines were meant to go first to “those who are most in need” and not to “people who are able to travel, who have visas, who are able-bodied.”
To put it another way, he says: it’s as if “someone loans you their car to take your mother to the hospital, and then you decide to take that car and instead of giving it back to the person—or taking other people to the hospital—you run it as an Uber.”
Outsourcing ethical quandaries
Robert Amler, the dean of New York Medical College’s school of health science and practice, says that encouraging travelers to fly to the United States from places with low vaccination rates—and potentially higher levels of infection—may itself be bad for public health.
“Any risk of ‘importing’ covid infections will depend on the volume of incoming travelers and the percent of travelers arriving who already have covid infection,” says Amler, a former chief medical officer at the CDC. “We also can’t predict with certitude the city’s ability to manage their numbers if they become excessive.”
To combat this danger, some people who are traveling to get vaccinated are taking their own precautions to avoid becoming unwitting vectors for the virus—or causing other kinds of harm.
“Michael” (also a pseudonym) and his wife flew from Quito, Ecuador, to New Orleans for a five-day trip in mid-May, during which he received the J&J shot and she got her first dose of the Pfizer vaccine.
Michael’s family in Canada have yet to meet the couple’s twin boys, who were born in January 2020. By going to Louisiana for their shots, he estimates that they’ve sped up their vaccination status—and therefore their family reunion—by six to nine months.
Still, the couple wanted to make sure they were not taking vaccines that could have gone to someone else. “Our first thought was to go to a red state, because we knew supply outstripped demand,” he explains.
They took extra precautions before and during their trip, too. Having both contracted covid much earlier in the pandemic, they got antibody tests before flying. Then they kept to themselves to limit their exposure.
By taking the initiative, they may have dampened the potential negative impact from their trip, but this highlights another problem of vaccine tourism as policy—and of much of the world’s covid-19 response in general. Difficult ethical decisions that could have—or, some argue, should have—been matters of policy are instead being pushed onto individuals.
“The city is the one who sets the queue,” says Pamela Hieronymi, a philosopher at the University of California, Los Angeles. So if you have an issue with vaccine tourists in, say, New York, “it seems your complaint should be made to the city, not to the person using the line offered to them.”
Nicole Hassoun, a philosophy professor at Binghamton University and the head of its Global Health Impact Project, also argues that while vaccine tourists may grapple with their choice, the real ethical issue is not at the individual level. “I think the question is really about what states are doing with their resources and which countries are continuing to use them [vaccines] for their own advantage,” she says. “Globally, that’s really wrong.”
There may also be second-order effects like exacerbating local inequality, says Yadurshini Raveendran, a graduate of the Duke Global Health Institute, who points out that richer individuals in low-income countries—those who travel internationally and are thus more likely to take advantage of vaccine tourism—already have better access to health care than poorer people in those countries. Israel has the highest vaccination rates in the world, she notes, but Palestine has administered one dose to just 5% of the population.